The keratoconus enigma: A review with emphasis on pathogenesis

Ferrari, Giulio; Rama, Paolo

doi:10.1016/j.jtos.2020.03.006

Cited by 113 publications

(118 citation statements)

References 160 publications

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“…By changing the orientation of the fibres from parallel to the surface to ectatic, we saw that the conical shape is recreated without altering the anterior layers of the cornea. This result differs from the current theory regarding the pathogenesis of keratoconus stating the involvement of epithelial cells and degradation of anterior layers in the disease process (Fernandes et al 2008;Meek and Boote 2009;Ferrari and Rama 2020).…”

Section: Discussioncontrasting

confidence: 99%

“…Added to this, histological studies showed that anterior parts of the cornea are also particularly degraded in late stage of the disease (Fernandes et al 2008;Ferrari and Rama 2020), meaning that degradative processes occur as well in anterior layers and participate to the disease progression.…”

Section: Resultsmentioning

confidence: 99%

“…The keratoconus disease is described as a progressive and non-inflammatory corneal ectasia caused by decrease in the biomechanical strength of the tissue. As the cornea becomes thinner and softer, it cannot support the inner eye pressure anymore and assumes a conical shape which leads to increasingly blurred vision (Ferrari and Rama 2020).…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical analysis of corneal keratoconic disease

Patoor

Cleymand

Perone

2020

Computer Methods in Biomechanics and Biomedical Engineering

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Section: Discussioncontrasting

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Biomechanical analysis of corneal keratoconic disease

Patoor

Cleymand

Perone

2020

Computer Methods in Biomechanics and Biomedical Engineering

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“…Using a Spectralis OCT our group have previously described a thicker macular choroid in KC eyes compared to healthy age-matched control, with KC patients showing a 67.55 µm thicker subfoveal choroid (CI 95% 36.61-98.49) 23 . The more recent theories about the pathophysiology of KC hint to a possible inflammatory component, which might explain the increase in their CT profile compared to a healthy population 6,7,23,24 . In fact, a large number of studies provided evidence of increased levels of pro-inflammatory cells, cytokines and other inflammatory mediators in tears of KC patients, whereas inflammatory suppressants seem to be reduced 6,13 .…”

Section: Discussionmentioning

confidence: 99%

“…pathophysiology of KC hint to a possible inflammatory component, which might explain the increase in their CT profile compared to a healthy population 6,7,23,24 . An important clue is raised by Gutierrez-Bonet et al as they observed that the increase in CT is only verified until age 45 24 , and is well known that KC typically progresses over a period of 15-20 years from its diagnosis, usually during early adult life 1,21 .…”

mentioning

confidence: 99%

Increased choroidal thickness is not a disease progression marker in keratoconus

Pinheiro-Costa

Correia

Pinto

et al. 2020

Sci Rep

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The recent findings of increased Choroidal Thickness (CT) in Keratoconus (KC) patients raised the question of whether CT could be an indicator of progressive KC. To test this hypothesis, we evaluated and compared the choroidal profile in progressive and non-progressive KC. We ran a cross-sectional observational study in 76 patients diagnosed with KC, age 14–30, to assess KC progression. Progression was defined as when at least two of the studied variables confirmed progression (Kmax, Km, PachyMin, D-Index, Astig, K2, 3 mm PCR). Included patients performed a Spectralis Optical Coherence Tomography (OCT) with enhanced depth image (EDI) technology to evaluate choroidal profile. Choroidal measurements were taken subfoveally and at 500 µm intervals from the fovea, in 7 different locations, and compared between groups. Multivariate linear regression analyses were also performed to assess the influence of CT in KC progression. Thirty-six eyes (47.4%) were classified as KC progressors. The mean subfoveal CT observed in the total sample was 382.0 (± 97.0) μm. The comparison between groups (progressive and non-progressive KC) showed no differences in the locations evaluated (mean subfoveal CT difference between groups was 2.4 μm, p = 0.915). In the multivariate analysis CT seems not be influenced by KC progression (B = 6.72 μm, 95% CI − 40.09 to 53.53, p = 0.775). Assessment of choroidal profile does not appear to be a useful tool to differentiate progressive and non-progressive KC. Further research is needed in order to better understand the role of choroid in KC.

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Two‐photon collagen crosslinking in ex vivo human corneal lenticules induced by near‐infrared femtosecond laser

Cheng

Zhang

Chang

et al. 2022

Journal of Biophotonics

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Myopia and keratoconus have become common corneal diseases that threaten the quality of human vision, and keratoconus is one of the most common indications for corneal transplantation worldwide. Collagen crosslinking (CXL) using riboflavin and ultraviolet A (UVA) light is an effective approach for treating ophthalmic disorders and has been shown clinically not only to arrest further progression of keratoconus but also to improve refractive power for cornea. However, CXL surgery irradiated by UVA has various potential risks such as surface damage and endothelial cell damage. Here, near‐infrared femtosecond laser‐based two‐photon CXL was first applied to ex vivo human corneal stroma, operating at low photon energy with high precision and stability. After two‐photon CXL, the corneal stiffness can be enhanced by 300% without significantly reducing corneal transparency. These findings illustrate the optimized direction that depositing high pulses energy in corneal focal volume (not exceeding damage threshold), and pave the way to 3D CXL of in vivo human cornea with higher safety, precision, and efficacy.

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The keratoconus enigma: A review with emphasis on pathogenesis

Cited by 113 publications

References 160 publications

Biomechanical analysis of corneal keratoconic disease

Biomechanical analysis of corneal keratoconic disease

Increased choroidal thickness is not a disease progression marker in keratoconus

Two‐photon collagen crosslinking in ex vivo human corneal lenticules induced by near‐infrared femtosecond laser

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