| 1. |
- Artzen, Ditte, et al.
(författare)
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Visual acuity and intraocular pressure after surgical management of late in-the-bag dislocation of intraocular lenses. A single-centre prospective study
- 2019
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Ingår i: Eye (Basingstoke). - : Springer Science and Business Media LLC. - 0950-222X .- 1476-5454.
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To describe logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) and intraocular pressure (IOP) after surgical management of late in-the-bag dislocation of the intraocular lens. Subjects/methods: In a single-centre prospective study, 165 consecutive cases having surgical correction for late in-the-bag-dislocation of intraocular lenses were analysed. One-year follow-up data of BCVA, IOP and a specially created composite variable designated “IOP issue” which considered IOP ≥ 23 mmHg, ongoing pressure reducing treatment and previous pressure reducing surgery were compared with baseline values. Logistic regression was used to investigate factors with a possible influence on the results. Results: The vast majority, 80% of patients, were operated with an anterior approach with repositioning of the present IOL. Remaining patients were managed with lens exchange via a posterior approach combined with a pars plana vitrectomy (PPV). Baseline BCVA values improved from 0.65 ± 0.48 to 0.32 ± 0.41 (p < 0.001), IOP decreased from 20.12 ± 8.4 to 18.44 ± 5.96 mmHg (p = 0.02) whereas the proportion of cases with a pressure issue remained unchanged, 47.3%, at the 1-year follow-up. Determinants for having a pressure issue at the 1-year follow-up were present a pressure issue at baseline and IOL repositioning with the anterior approach. Conclusions: Both surgical methods provided similar visual rehabilitation to other techniques described in the literature. However, subjects whose IOL was exchanged in combination with a PPV were at lower risk for an IOP issue at the follow-up.
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| 2. |
- Claesson, Margareta, et al.
(författare)
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Validation of Catquest-9SF-A Visual Disability Instrument to Evaluate Patient Function after Corneal Transplantation
- 2017
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Ingår i: Cornea. - 0277-3740 .- 1536-4798. ; 36:9, s. 1083-1088
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Catquest-9SF is a 9-item visual disability questionnaire developed for evaluating patient-reported outcome measures after cataract surgery. The aim of this study was to use Rasch analysis to determine the responsiveness of Catquest-9SF for corneal transplant patients. Methods: Patients who underwent corneal transplantation primarily to improve vision were included. One group (n = 199) completed the Catquest-9SF questionnaire before corneal transplantation and a second independent group (n = 199) completed the questionnaire 2 years after surgery. All patients were recorded in the Swedish Cornea Registry, which provided clinical and demographic data for the study. Winsteps software v.3.91.0 (Winsteps.com, Beaverton, OR) was used to assess the fit of the Catquest-9SF data to the Rasch model. Results: Rasch analysis showed that Catquest-9SF applied to corneal transplant patients was unidimensional (infit range, 0.73-1.32; outfit range, 0.81-1.35), and therefore, measured a single underlying construct (visual disability). The Rasch model explained 68.5% of raw variance. The response categories of the 9-item questionnaire were ordered, and the category thresholds were well defined. Item difficulty matched the level of patients' ability (0.36 logit difference between the means). Precision in terms of person separation (3.09) and person reliability (0.91) was good. Differential item functioning was notable for only 1 item (satisfaction with vision), which had a differential item functioning contrast of 1.08 logit. Conclusions: Rasch analysis showed that Catquest-9SF is a valid instrument for measuring visual disability in patients who have undergone corneal transplantation primarily to improve vision.
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| 3. |
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| 4. |
- Kilarski, Witold W., et al.
(författare)
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Biomechanical regulation of blood vessel growth during tissue vascularization
- 2009
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Ingår i: Nature Medicine. - : Springer Science and Business Media LLC. - 1078-8956 .- 1546-170X. ; 15:6, s. 657-664
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Tidskriftsartikel (refereegranskat)abstract
- Formation of new vessels in granulation tissue during wound healing has been assumed to occur solely through sprouting angiogenesis. In contrast, we show here that neovascularization can be accomplished by nonangiogenic expansion of preexisting vessels. Using neovascularization models based on the chick chorioallantoic membrane and the healing mouse cornea, we found that tissue tension generated by activated fibroblasts or myofibroblasts during wound contraction mediated and directed translocation of the vasculature. These mechanical forces pulled vessels from the preexisting vascular bed as vascular loops with functional circulation that expanded as an integral part of the growing granulation tissue through vessel enlargement and elongation. Blockade of vascular endothelial growth factor receptor-2 confirmed that biomechanical forces were sufficient to mediate the initial vascular growth independently of endothelial sprouting or proliferation. The neovascular network was further remodeled by splitting, sprouting and regression of individual vessels. This model explains the rapid appearance of large functional vessels in granulation tissue during wound healing.
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| 5. |
- Potapenko, Ivan O., et al.
(författare)
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Donor Endothelial Cell Count Does Not Correlate With Descemet Stripping Automated Endothelial Keratoplasty Transplant Survival After 2 Years of Follow-up
- 2017
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Ingår i: Cornea. - : Lippincott Williams & Wilkins. - 0277-3740 .- 1536-4798. ; 36:6, s. 649-654
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To analyze the influence of low endothelial cell density (ECD) of donor cornea tissue, donor age, and sex on the transplant survival rate after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: Graft ECD, age, and sex of donors used for DSAEK (n = 1789) during 7 years (2007-2014) in 4 Scandinavian hospitals were assessed for potential association with transplant survival at 2 years of follow-up using a Cox regression model correcting for confounding factors. The data were obtained from The Swedish Cornea Transplant Registry. Results: Transplant failure occurred in 196 patients, with 69 early failures during the first 3 postoperative months, and 127 late secondary failures. Twenty-five of the late secondary failures were due to rejection. Reversible rejections occurred in 67 patients. There was no significant impact of donor age [hazard ratio (HR) 1.0, 95% confidence interval (CI), 0.99-1.02, P = 0.32] or endothelial cell count (HR 1.00, 95% CI, 0.99-1.01, P = 0.3) on the survival rate of DSAEK transplants at 2 years of follow-up. The use of donor grafts with low ECD (, 2300 cells/mm(2)) did not influence the survival rate (HR 1.3, 95% CI, 0.76-2.35, P = 0.31). Male donor sex was associated with lower 2-year graft survival (HR 1.5, 95% CI, 1.042.28, P = 0.03), but not with rejection events (P = 0.26). Conclusions: Based on data from The Swedish Cornea Transplant Registry, low donor ECD was not detrimental to graft survival, whereas donor sex seemed to influence the outcome at the end of the 2-year follow-up.
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| 6. |
- Samolov, Branka
(författare)
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Experimental studies of corneal neovascularisation
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The cornea contains no vessels, which is a prerequisite for the maintenance of its transparency. Vessel ingrowth leads to opacification resulting in visual impairment, sometimes complete blindness. This important clinical problem affects patients of all ages and may be due to chronic inflammation, hypoxia, chemical injury, stem cell deficiency, infection, dry eyes, a loss of sensation or transplant rejection. Corneal neovascularisation (NV) may be inhibited by anti-inflammatory treatment but not completely reversed or prevented. Although angiogenic research has translated into the development of new promising drugs, a deeper knowledge of angiogesis is needed to define optimal treatment options and save vision. The present studies aimed to broaden the understanding of corneal angiogenesis on a molecular, cellular and tissue level. All three studies were based on an experimental mouse model were a transcorneal silk suture causes inflammation and NV. Genetically modified mice lacking functional genes (knockout mice) for matrix metalloproteinase-2 (MMP-2) or interleukin-10 (IL-10) were used in the first two studies. In the third study the cornea model was an in vivo-part of an experiment cluster including the chick chorioallantoic membrane model (CAM), cell cultures, in-vitro gel-contraction and peptide-inhibitor experiments. The vessel visualization was performed with dye/ink perfusions and immunohystochemical stainings. NV was studied and quantified with a digital microscope with image analysis software, assessing spatiotemporal aspects. Studies of the inflammatory reaction were performed with immunohistochemistry for cellular markers while in-situ hybridization and real time-Polymerase Chain Reaction (rt-PCR) were used for identification of mRNA for relevant target molecules. MMP-2, a member of an enzyme family essential for degradation of extracellular matrix (ECM) and the vascular basement membrane, acted as an angiogenic regulator in this model. NV correlated with increased expression of MMP-2 mRNA and protein, both mainly found in activated keratocytes. In the second study, the anti-inflammatory and angio-regulatory cytokine IL-10 was found to act pro-angiogenically which could be explained neither by its anti-inflammatory effects nor by an apparent cross-talk with other potent angiogenic and immuno-modulatory factors. The third study revealed that tissue tension generated by activated myofibroblasts during wound contraction was able to mediate and direct the initial vascular invasion of the cornea and CAM-matrix gels through mainly vessel enlargement and elongation, independently of endothelial sprouting or proliferation. Neutralizing antibodies to vascular endothelial growth factor receptor-2 (VEGFR-2) could not prevent vessel ingrowth, while inhibition of gel contractibility did so. The results from this study may contribute to the already established theories on angiogenesis and this novel explanation model has been tentatively named looping angiogenesis. Taken together, these studies show that corneal neovascularisation is dependent on both chemical signals and mechanical factors. Further investigations of the interaction between these mechanisms will hopefully broaden the understanding of the complex and vital biological process that angiongesis represents.
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| 7. |
- Viberg, Andreas, et al.
(författare)
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Corneal transplantation in aniridia-related keratopathy with a two-year follow-up period, an uncommon disease with precarious course
- 2023
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Ingår i: Acta Ophthalmologica. - : John Wiley & Sons. - 1755-375X .- 1755-3768. ; 101:2, s. 222-228
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this study is to study the frequency, surgical transplantation technique and outcome in patients with aniridia-related keratopathy (ARK) with two-year follow-up period. Methods: A retrospective registry-study including all ARK cases performed in Sweden and Denmark between 2001 and 2016 and registered in the Swedish Cornea Transplant Registry. Results: A total of 36 eyes of 26 patients were subjected to corneal transplantation due to ARK during 2001 to 2016. Penetrating keratoplasty (PK) was the procedure of choice in 58.3% (n = 21) of the eyes, followed by a combination of PK and limbal stem cell transplantation in 13.9% (n = 5) and keratolimbal allograft in 13.9% (n = 5). Boston keratoprosthesis was used in 8.3% (n = 3), and anterior lamellar keratoplasty in 5.6% (n = 2). Thirteen of the procedures (36.1%) were retransplantations. Two years after surgery 26 cases were available to follow-up of which 16 of the grafts were functioning (61.5%). The median visual acuity showed a trend of improvement from hand motion to counting fingers. Conclusions: A majority of the ARK cases (61.5%) had a graft providing useful vision for the patient 2 years after corneal transplantation, but the visual gain was modest at best. Longer follow-up time is required to evaluate functional graft outcomes. Despite the introduction of limbal stem cell transplantation as a suitable treatment, PK was the most common surgical method in the present study.
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| 8. |
- Viberg, Andreas, et al.
(författare)
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Descemet stripping automated endothelial keratoplasty versus descemet membrane endothelial keratoplasty for fuchs endothelial corneal dystrophy : a national registry-based comparison
- 2023
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Ingår i: Ophthalmology. - : Elsevier. - 0161-6420 .- 1549-4713. ; 130:12, s. 1248-1257
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To compare the outcome between posterior lamellar corneal transplant procedures for Fuchs endothelial corneal dystrophy, taking preoperative patient characteristics in consideration. Surgical methods compared were Descemet membrane endothelial keratoplasty (DMEK), Descemet stripping automated endothelial keratoplasty (DSAEK), and DSAEK with concomitant cataract surgery (phacoemulsification plus DSAEK).Design: Registry-based study with propensity score matching. Participants: One thousand six hundred seventy-seven patients from all Swedish corneal transplantation units treated from 2012 through 2019.Methods: All patients undergoing endothelial keratoplasty performed from 2012 through 2019 with completed 2-year follow-up data reported to The Swedish Corneal Transplant Register were included, totaling 1677 patients. Three comparable groups (DMEK, DSAEK, and phacoemulsification plus DSAEK) with 216 patients in each group were generated with propensity score matching based on preoperative visual acuity, age, sex, year of surgery, and preoperative risk factors such as inflammation, vascularization, and glaucoma.Main Outcome Measures: Best-corrected visual acuity (BCVA) at the 2-year follow-up, frequency of graft dislocation, graft rejection episodes, and graft failure within 2 years including primary graft failure.Results: The preoperative corneal status was affected more severely in the DSAEK group before matching. In the matched groups, the median BCVA 2 years after surgery was 0.1 logarithm of the minimum angle of resolution (logMAR) in both the DMEK and the phacoemulsification plus DSAEK groups and 0.15 logMAR in the DSAEK group (P = 0.001). The frequency of graft dislocation was higher among the patients undergoing phacoemulsification plus DSAEK, but the frequency of graft failure and primary graft failure was higher in the DMEK group.Conclusions: Visual acuity improved in most patients (90%) with all 3 surgical methods. However, DMEK and phacoemulsification plus DSAEK reached higher levels of visual acuity 2 years after surgery, and phacoemulsification plus DSAEK was superior considering graft survival rate. All 3 surgical procedures showed both strengths and weaknesses, suggesting that the choice of surgical method should be individualized, taking into consideration not only the cornea, but each patient's complete medical status as well as the entire course of postoperative medical care.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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| 9. |
- Viberg, Andreas, et al.
(författare)
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Incidence of corneal transplantation after phacoemulsification in patients with corneal guttata : a registry-based cohort study
- 2020
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Ingår i: Journal of cataract and refractive surgery. - : Lippincott Williams & Wilkins. - 0886-3350 .- 1873-4502. ; 46:7, s. 961-966
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To investigate the risk for corneal transplantation after phacoemulsification related to corneal guttata.Setting: Forty-nine Swedish cataract surgical units and 7 Swedish cornea transplantation units.Design: Registry-based cohort study.Methods: Patient data from the Swedish National Cataract Registry between 2010 and 2012 were linked with data from the Swedish Cornea Transplant Registry between 2010 and September 2017. Data from cataract patients were linked with data from patients who underwent corneal transplantation because of endothelial failure. Triple procedures and other surgical methods for cataract extraction other than phacoemulsification were excluded. If both eyes had surgery, 1 eye was randomly selected from the registry to obtain unrelated samples. The incidence was calculated per 10 000 person years, and Poisson regression analysis was used to investigate the risk for corneal transplantation because of endothelial failure after phacoemulsification.Results: Altogether, data from 276 362 cataract patients were linked with data from 2091 patients who underwent corneal transplantation. The incidence rate of corneal transplantation after phacoemulsification among patients with corneal guttata was 88 per 10 000 person years (95% CI, 74.5-103.1). The annual incidence rate was highest within the first year and diminished thereafter. The incidence rate of corneal transplantation among patients without corneal guttata was 1.4 per 10 000 person years (95% CI, 1.2-1.6). Phacoemulsification in patients with corneal guttata was associated with corneal transplantation with an adjusted relative risk of 68.2 (95% CI, 54.0-86.2).Conclusions: The relative risk for corneal transplantation after phacoemulsification was 68.2 times higher for patients with corneal guttata than that for those without. Still, most of the patients with corneal guttata did not undergo corneal transplantation during the study period.
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| 10. |
- Viberg, Andreas, et al.
(författare)
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Risk of corneal transplantation after phacoemulsification in patients with cornea guttata
- 2019
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Ingår i: Acta Ophthalmologica. - : John Wiley & Sons. - 1755-375X .- 1755-3768. ; 97:S263
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Purpose: To investigate the risk of corneal transplantation after phacoemulsification related to cornea guttata.Methods: In this retrospective registry‐based cohort study, patient data from the Swedish National Cataract Register for years 2010‐2012 were linked with data from the Swedish Cornea Transplant Register for years 2010‐2017. Altogether, data from 276,354 cataract patients was linked with data from 2,091 patients with primary and secondary endothelial failure as indication for corneal transplantation. Other surgical methods for cataract extraction than phacoemulsification were excluded. If both eyes had surgery, one eye was randomly selected to obtain unrelated samples. A Kaplan‐Meier curve and Cox regression analysis were used to investigate the risk for corneal transplantation due to endothelial failure after phacoemulsification.Results: Out of the 3,346 phacoemulsification patients with cornea guttata, 153 underwent corneal transplantation within 6.2 years in median. The cumulative transplantation rate, 6 years after the phacoemulsification was 4.8% in the group with cornea guttata and 0.08% in the group without. The annual transplantation rate among the cornea guttata patients during the first year was 1.64% and diminished the following 5 years to 0.55% in average. The annual transplantation rate among the patients without cornea guttata was 0.01% in average after phacoemulsification during the same period of time. The transplantation hazard ratio for cornea guttata present at the phacoemulsification was 67.6 (95% CI: 53.6.0‐85.3, p < 0.001), when adjusting for potential confounders.Conclusions: The hazard of corneal transplantation after phacoemulsification was 67.6 times higher with cornea guttata than without. Still, the great majority of the patients with cornea guttata did not undergo corneal transplantation during the study period.
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