| 1. |
- Beckman Rehnman, Jeannette, 1969-
(författare)
-
New methods to evaluate the effect of conventional and modified crosslinking treatment for keratoconus
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Today corneal crosslinking with ultraviolet-A photoactivation of riboflavin is an established method to halt the progression of keratoconus. In some cases, when the refractive errors are large and the visual acuity is low, conventional corneal crosslinking may not be sufficient. In these cases it would be desirable with a treatment that both halts the progression and also reduces the refractive errors and improves the quality of vision.Aims: The aims of this thesis were to determine whether mechanical compression of the cornea during corneal crosslinking for keratoconus using a sutured rigid contact lens could improve the optical and visual outcomes of the treatment, and also to find methods to evaluate the effect of different corneal crosslinking treatment regimens.Methods: In a prospective, open, randomized case-control study, 60 eyes of 43 patients with progressive keratoconus, aged 18-28 years, planned for routine corneal crosslinking, and a corresponding age- and sex-matched control group was included. The patients were randomized to conventional corneal crosslinking (CXL; n=30) or corneal crosslinking with mechanical compression of the cornea during the treatment (CRXL; n=30).Biomicroscopy, autorefractometry, best spectacle corrected visual acuity, axial length measurement, Pentacam® HR Scheimpflug photography, pachymetry, intraocular pressure measurements and corneal biomechanical assessments were performed before treatment (baseline) and at 1 month and 6 months after the treatment.One of the articles evaluated and compared the optical and visual outcomes between CXL and CRXL, while the other three articles focused on methods to evaluate treatment effects. In Paper I, the corneal light scattering was manually quantified from Scheimpflug images throughout the corneal thickness at 8 measurements points, 0.0 to 3.0 mm from the corneal centre, in patients treated with CXL. In Paper IV the corneal densitometry (light scattering) was measured with the Pentacam® HR software, in 4 circular zones around the corneal apex and at 3 different depths of the corneal stroma, in both CXL and CRXL treated corneas. Paper III quantified the biomechanical effects of CXL in vivo.Results: Corneal light scattering after CXL showed distinctive spatial and temporal profiles and Applanation Resonance Tonometry (ART) -technology demonstrated an increased corneal hysteresis 1 and 6 months after CXL. When comparing the refractive and structural results after CXL and CRXL, CRXL failed to flatten the cornea, and the treatment did not show any benefits to conventional CXL treatment, some variables even indicated an inferior effect. Accordingly, the increase in corneal densitometry was also less pronounced after CRXL.Conclusions: Analysis of corneal light scattering/densitometry shows tissue changes at the expected treatment location, and may be a relevant variable in evaluating the crosslinking effect. ART -technology is an in vivo method with the potential to assess the increased corneal hysteresis after CXL treatment. By refining the method, ARTmay become a useful tool in the future. Unfortunately, CRXL does not improve the optical and visual outcomes after corneal crosslinking. Possibly, stronger crosslinking would be necessary to stabilize the cornea in a flattened position.
|
|
| 2. |
- Dunker, Suryan L., et al.
(författare)
-
Outcomes of corneal transplantation in Europe : report by the European Cornea and Cell Transplantation Registry
- 2021
-
Ingår i: Journal of Cataract and Refractive Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1873-4502 .- 0886-3350. ; 47:6, s. 780-785
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To analyze real-world graft survival and visual acuity outcomes of corneal transplantation in Europe. SETTING: Corneal clinics in 10 European Union member states, the United Kingdom, and Switzerland. DESIGN: Multinational registry study. METHODS: All corneal transplant procedures registered in the European Cornea and Cell Transplantation Registry (ECCTR) were identified. Graft survival of primary corneal transplants were analyzed using Kaplan-Meier survival curves with log-rank test and Cox regression. Corrected distance visual acuities (CDVAs) are reported at baseline and 2 years postoperatively using the Lundström distribution matrix. RESULTS: A total of 12 913 corneal transplants were identified. Overall, 32-year graft survival of corneal transplants was high (89%) but differed between indications, ranging from 98% in keratoconus and 80% for trauma. Overall, CDVA improved postoperatively, but the risk for losing vision ranged from 7% (baseline vision ≤0.1 Snellen) to 58% (baseline vision ≥1.0 Snellen). CONCLUSIONS: This report provides a comprehensive overview of graft survival and visual outcomes of corneal transplantation in Europe. In addition, it provides real-world estimates of outcomes for a variety of indications and surgical techniques to support benchmarking and demonstrates the relationship between baseline and postoperative vision.
|
|
| 3. |
- Dunker, Suryan L., et al.
(författare)
-
Practice patterns of corneal transplantation in Europe : first report by the European Cornea and Cell Transplantation Registry
- 2021
-
Ingår i: Journal of Cataract and Refractive Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1873-4502 .- 0886-3350. ; 47:7, s. 865-869
-
Forskningsöversikt (refereegranskat)abstract
- PURPOSE: To report practice patterns of corneal transplantation in Europe. SETTING: Corneal clinics in 10 European member states (MS), the United Kingdom, and Switzerland. DESIGN: Multinational registry study. METHODS: Corneal transplant procedures registered in the European Cornea and Cell Transplantation Registry were identified. Preoperative donor and recipient characteristics, indication and reason for transplantation, and surgical techniques were analyzed. RESULTS: A total of 12 913 corneal transplants were identified from 10 European Union MS, the United Kingdom, and Switzerland. Most countries were self-sufficient with regard to donor tissue. Fuchs endothelial corneal dystrophy was the most common indication (41%, n = 5325), followed by regraft (16%, n = 2108), pseudophakic bullous keratopathy (12%, n = 1594), and keratoconus (12%, n = 1506). Descemet stripping automated endothelial keratoplasty (DSAEK, 46%, n = 5918) was the most commonly performed technique, followed by penetrating keratoplasty (30%, n = 3886) and Descemet membrane endothelial keratoplasty (9%, n = 1838). Vision improvement was the main reason for corneal transplantation (90%, n = 11 591). Surgical technique and reason for transplantation differed between indications. CONCLUSIONS: This report provides the most comprehensive overview of corneal transplantation practice patterns in Europe to date. Fuchs endothelial dystrophy is the most common indication, vision improvement the leading reason, and DSAEK the predominant technique for corneal transplantation.
|
|
| 4. |
- Germundsson, Johan
(författare)
-
Surgical outcomes of phototherapeutic keratectomy on Epithelial basement membrane dystrophy, and the characterisation of Bowman´s Layer
- 2014
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background. Epithelial basement membrane dystrophy (EBMD) is a common disease of the anterior cornea that can lead to problems with vision and/or painful recurrent erosions of the corneal epithelium. Several treatment options have been used, but recurrence of EBMD after treatment is a problem. Excimer laser phototherapeutic keratectomy (PTK) has become an increasingly popular surgical option in recent years due to its accuracy, reproducibility, and good clinical outcomes. When treating EBMD with PTK, the anterior corneal structures including the epithelium, Bowman´s layer (BL), and subbasal nerves are disrupted or removed completely. Little is known about how BL, nerves, and the stroma recover after PTK treatment, or how they could influence recurrence of EBMD symptoms. Additionally, very little is known about the properties and actual thickness of BL in-vivo.Aims. To improve the understanding and management of EBMD by investigating the clinical diagnosis and treatment of EBMD and its relationship to Bowman´s layer.Method. An excimer laser was used to treat EBMD patients at the Department of Ophthalmology during the period 2001-2010. IVCM was used to perform pre- and postoperative examinations. In particular, images of anterior corneal structures, cells, and nerves in high-resolution were obtained. Additionally, a group of over 100 healthy volunteers underwent a full ophthalmic examination including IVCM. Other subjects examined in this work included a group of 17 patients who underwent full-thickness transplantation of the cornea.Results and conclusions. Clinical follow-up revealed that PTK is an effective method of alleviating the clinical symptoms of EBMD, but the dystrophy can recur with time. Recurrence can be divided into clinical and morphologic types, and may depend upon treatment parameters including the type and depth of ablation. IVCM was found to be a useful screening tool pre- and postoperatively, and could prevent patients with symptoms, but no visible signs of EBMD on slit lamp examination, to go undiagnosed and untreated. BL was found to play a role in regenerative wound healing after PTK, and was also found to be important regarding the treatment and recurrence of EBMD. BL may present a physical barrier that protects the subepithelial nerve plexus thereby facilitating sensory recovery, and BL may also serve as a barrier that prevents direct traumatic contact with the corneal stroma, avoiding a stromal wound healing response. To aid in accurate assessment of BL in patients, an in vivo method for determining BL thickness was developed. This method could be an important tool to aid in clinical assessment and planned treatments of the anterior cornea. Using this tool, a large inter-individual variability in BL thickness and a strong negative correlation of BL thickness with age were found in a healthy population. Using IVCM, it was also found that subbasal nerves are pathologically reduced in EBMD compared to a healthy population, and that this nerve deficit does not improve in the long term after PTK treatment.
|
|
| 5. |
- Gustafsson, Ingemar, et al.
(författare)
-
An inter-day assessment of the ABC parameters in the evaluation of progressive keratoconus
- 2021
-
Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 11:1
-
Tidskriftsartikel (refereegranskat)abstract
- The progression of keratoconus is commonly determined by comparing the results of corneal tomographic measurements on different occasions. However, investigations on the repeatability of measurements are commonly performed within the same day, thus not taking the inter-day variation into account. The effect of keratoconus disease severity on the measurement error is also seldom considered. In this post hoc investigation, the parameters A, B and C in the Belin ABCD Progression Display were evaluated in relation to disease severity in intra-day and inter-day measurements. Four consecutive measurements were performed on 61 patients with keratoconus on the same day (intra-day). In another cohort, four consecutive measurements were obtained and then repeated 3 days later in 25 patients with keratoconus and 25 healthy controls (inter-day). The results suggest that the diagnosis of disease progression would benefit from inter-day measurements, and the stratification of the parameters A and C according to disease severity. It is also recommended that tomographic systems such as the Pentacam HR be modified to allow the comparison of both single measurements and the mean of replicate measurements of the parameters used in the assessment of progression of keratoconus.
|
|
| 6. |
- Gustafsson, Ingemar, et al.
(författare)
-
Association between keratoconus disease severity and repeatability in measurements of parameters for the assessment of progressive disease
- 2020
-
Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:2
-
Tidskriftsartikel (refereegranskat)abstract
- Background Progressive keratoconus can lead to severely impaired vision, but there is currently no consensus on the definition of progressive disease. Errors in the measurement of the parameters commonly used to establish progressive disease were evaluated in an attempt to determine the limits at which a true change in the values can be detected. The possible association between measurement error and disease severity was also investigated to evaluate the need for limits based on disease severity. Methods Sixty-one eyes were studied in 61 patients with keratoconus. Four replicate measurements were made in each patient using a Scheimpflug-based tomographic system (denoted the PC) and an auto-keratometer (denoted the AK). The repeatability coefficient, i.e., the level below which differences between two measurements are found in 95% of paired observations, was calculated. Patients were further divided into three groups based on disease severity (parameter magnitude). Results Increasing magnitude of all the keratometric parameters investigated was significantly associated with increasing measurement errors, and thus worse repeatability. The maximum keratometry value (Kmax) was the least repeatable parameter (1.23 D, 95% CI 1.11–1.35 D) and showed the strongest association between parameter magnitude and measurement error. The repeatability coefficient ranged between 0.32 and 1.62 D, depending on disease severity. The most repeatable parameter was the flattest central keratometry value (K1), measured with the PC (0.51 D, 95% CI 0.46–0.56 D) and the AK (0.54 D, 95% CI 0.48–0.59 D). K1 showed the weakest association between parameter magnitude and measurement error. The repeatability coefficient for K1 ranged between 0.40 and 0.54 D when using the PC, and between 0.34 and 0.70 D when using the AK in the three groups. Conclusions The association between the magnitude of the keratometric parameters and their measurement errors suggests that limits should be based on disease severity to ensure reliable detection of progressive keratoconus. Further studies are, however, required.
|
|
| 7. |
- Gustafsson, Ingemar, et al.
(författare)
-
Current clinical practice in corneal crosslinking for treatment of progressive keratoconus in four Nordic countries
- 2023
-
Ingår i: Acta Ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 101:1, s. 109-116
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To evaluate clinical practice in the diagnosis and treatment of progressive keratoconus with corneal crosslinking (CXL) in four Nordic countries.METHODS: A questionnaire was sent to all centres at which keratoconus patients are evaluated and CXL is performed in Sweden, Denmark, Norway and Iceland. Nineteen of 20 centres participated.RESULTS: CXL is performed approximately 1300 times per year in these four Nordic countries with a population of around 21.7 million (2019). In most cases, progression is evaluated using the Pentacam HR, and the maximum keratometry reading (Kmax ) is considered the most important parameter. The most frequently used treatment protocol in Scandinavia is the 9 mW/cm2 epi-off protocol, using hydroxylpropyl methylcellulose riboflavin (HPMC-riboflavin). The participants deemed the following areas to be in most need of improvement: adaptation of the CXL protocol to individual patients (5/19), the development of effective epi-on treatment protocols (4/19), optimal performance of CXL in thin corneas (4/19), improvement of the definition of progression (2/19), and diagnosis of the need for re-treatment (2/19).CONCLUSIONS: We concluded that the diagnosis of progressive keratoconus and the diagnostic equipment used are similar. Treatment strategies are also similar but are suitably different to provide an interesting basis for the comparison of treatment outcomes. The high degree of participation in this survey indicates the possibility of future scientific collaboration on CXL focusing on the areas deemed to need improvement. It would also be of interest to evaluate the possibility of creating a Nordic CXL Registry. The high number of CXL treatments performed ensures sufficient statistical power to solve many questions. Such a registry could be an important contribution to evidence-based care and would allow for longitudinal evaluation.
|
|
| 8. |
- Gustafsson, Ingemar, et al.
(författare)
-
Early findings in a prospective randomised study on three cross-linking treatment protocols : Interruption of the iontophoresis treatment protocol
- 2023
-
Ingår i: BMJ Open Ophthalmology. - 2397-3269. ; 8:1
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose To present the outcome of the interrupted iontophoresis-assisted treatment arm in an ongoing randomised clinical trial (NCT04427956). Methods A randomised clinical study of corneal cross-linking (CXL) using continuous UV-A irradiation at a rate of 9 mW/cm 2 and three different types of riboflavin and riboflavin delivery mode: (1) iso-osmolar dextran-based riboflavin (epithelium-off), (2) hypo-osmolar dextran-free riboflavin (epithelium-off) and (3) iontophoresis-assisted delivery of riboflavin (epithelium-on) for the treatment of progressive keratoconus. Inclusion criteria were an increase in the maximum keratometry value (Kmax) of 1.0 dioptre over 12 months or 0.5 dioptre over 6 months. The primary outcome in evaluating treatment efficacy was Kmax. Recently presented stratified detection limits were used post hoc to confirm the enrolment of patients with truly progressive keratoconus and in the assessment of the need for re-CXL. Results Thirteen patients had been randomised to iontophoresis-assisted CXL when the treatment arm was interrupted; two patients dropped out. Of the remaining 11 patients, 7 were deemed as having truly progressive disease according to the more recent stratified detection limits. The disease continued to progress in three patients according to the original definition (increase in Kmax≥1 D), necessitating re-CXL with epithelium-off CXL. This progression was confirmed by post hoc analysis using the stratified detection limits for progression. Conclusions The iontophoresis-assisted CXL protocol failed to halt further disease progression in 27% of the patients. The failure rate increased to 38% when considering only the patients deemed to have truly progressive disease using the stratified detection limits.
|
|
| 9. |
- Gustafsson, Ingemar, et al.
(författare)
-
Early findings in a randomised controlled trial on crosslinking protocols using isoosmolar and hypoosmolar riboflavin for the treatment of progressive keratoconus
-
Ingår i: Acta Ophthalmologica. - 1755-3768. ; , s. 1-10
-
Tidskriftsartikel (refereegranskat)abstract
- PurposeTo present baseline characteristics and to present the perioperative corneal thickness during corneal crosslinking (CXL) treatment for progressive keratoconus and to describe how the addition of sterile water (SW) efficaciously can maintain the corneal thickness. The treatment efficacy will be evaluated when the 1-year follow-up is complete.MethodsA randomised clinical study using epithelium-off CXL with continuous UVA irradiation (9 mW/cm2) and two kinds of riboflavin solutions: (i) isoosmolar dextran-based riboflavin (n = 27) and (ii) hypoosmolar dextran-free riboflavin (n = 27). Inclusion criteria: progressive keratoconus with an increase in maximum keratometry value (Kmax) of 1.0 dioptre (12 months) or 0.5 dioptres (6 months). Corneae thinner than 400 μm were also included. Outcome parameters: Perioperative corneal thickness and the effect of adding SW.ResultsSeventy-four per cent of the patients in the isoosmolar group and 15% in the hypoosmolar group required the addition of SW, which effectively maintained a corneal thickness of 400 μm in all cases during CXL. The addition of SW was primarily needed during the irradiation procedure and not the preoperative soaking period.ConclusionsEspecially during the CXL irradiation phase, isoosmolar riboflavin causes a significant dehydrating effect leading to corneal thinning during CXL. The customised addition of SW is efficacious in maintaining the corneal thickness during CXL and could increase the safety of the procedure.
|
|
| 10. |
- Gustafsson, Ingemar, et al.
(författare)
-
Introducing a new tool for the assessment of progressive keratoconus: the Scandinavian Keratoconus Progression Application
- 2022
-
Ingår i: Journal of EuCornea. - : EuCornea. - 2452-4034. ; 11:3, s. 1-9
-
Tidskriftsartikel (refereegranskat)abstract
- PurposeTo develop an application for the Pentacam HR for the purpose of optimising the accuracy of the diagnosis of progressive keratoconus.MethodsMeasurements were performed on one randomised eye in twenty-five subjects with keratoconus Stage 1-2 according to the Amsler-Krumeich classification on two occasions, three days apart. Four replicate measurements were made by a single examiner on each occasion. The inter-day repeatability and detection limits for the diagnosis of progressive keratoconus were calculated for the following parameters: K2 and Kmax, and the parameters A, B and C from the Belin ABCD Progression Display. The measurements used as input are automatically extracted from the Pentacam HR database as comma-separated values. The application, developed in the R programming environment, provides a web browser-based user interface that presents these parameters both numerically and graphically.ResultsThe application includes detection limits for the diagnosis of progressive keratoconus obtained from two previous studies on the inter-day repeatability of measurements in subjects with keratoconus. The detection limits are based on inter-day repeatability, stratified according to disease severity, allowing the comparison of single measurements or a mean of four replicates.ConclusionsThis is the first application to provide an assessment of progressive keratoconus using detection limits based on inter-day repeatability. We believe this application will contribute to the more accurate diagnosis of progressive keratoconus. It also facilitates diagnosis and improves the clinical workflow as all the relevant information is presented numerically, graphically, and colour-coded in one interface.
|
|
| 11. |
- Gustafsson, Ingemar, et al.
(författare)
-
Patient experience and repeatability of measurements made with the Pentacam HR in patients with keratoconus
- 2023
-
Ingår i: BMC Ophthalmology. - 1471-2415. ; 23:1, s. 201-201
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To investigate whether the repeatability of measurements with the Pentacam HR in patients with keratoconus is improved by patients gaining more experience of the measurement situation. Such an improvement could enhance the accuracy with which progressive keratoconus can be detected. METHODS: Four replicate measurements were performed on Day 0 and on Day 3. Parameters commonly used in the diagnosis of progressive keratoconus were included in the analysis, namely the flattest central keratometry value (K1), the steepest central keratometry value (K2), the maximum keratometry value (Kmax), and the parameters A, B and C from the Belin ABCD Progression Display. In addition, quality parameters used by the Pentacam HR to assess the quality of the measurements were included, namely the analysed area (front + back), 3D (front + back), XY, Z, and eye movements. RESULTS: Neither the diagnostic parameters nor the quality parameters showed any statistically significant improvement on Day 3 compared to Day 0. The quality parameter "eye movements" deteriorated significantly with increasing Kmax. CONCLUSION: Gaining experience of the measurement situation did not increase the accuracy of the measurements. Further investigations should be performed to determine whether the increasing number of eye movements with increasing disease severity has a negative effect on the repeatability of the measurements.
|
|
| 12. |
|
|
| 13. |
- Gustafsson, Ingemar, et al.
(författare)
-
The Interday Repeatability of Parameters for the Assessment of Progressive Disease in Subjects With Less Advanced Keratoconus
- 2021
-
Ingår i: American Journal of Ophthalmology. - : Elsevier BV. - 0002-9394. ; 225, s. 38-46
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: To evaluate the interday repeatability in the measurement of parameters used for the detection of progression of keratoconus by prediction limits (PL) for single measurements, and the repeatability coefficient (RC) for the mean of replicate measurements. Design: Prospective reliability analysis for cases and control eyes. Methods: Twenty-five eyes in 25 subjects with KC and 25 eyes in 25 healthy controls were included. Four consecutive measurements were made, 3 days apart, with a Pentacam HR tomographic instrument (denoted the Pentacam) and a Nidek ARK 560-A auto-keratometer (denoted the keratometer). Main outcome measures were the intra- and interday RC of parameters used in the detection of progression of keratoconus. Results: The most repeatable parameter obtained with the Pentacam was the curvature power of the central flat meridian (K1, 0.44 D [RC], -0.55 to 0.60 diopter [D] [PL]), followed by the central steep meridian (K2, 0.72 D [RC], -0.90 to 0.94 D [PL]). The interday repeatability of K1 and K2 was similar when using the keratometer (K1, 0.32 D [RC], -0.66 to 0.57 D [PL], K2, 0.93 D [RC], -1.36 to 1.08 D [PL]). The interday repeatability of the curvature power of the steepest point (Kmax, 0.84 D [RC], -0.90 to 1.11 D [PL]) would benefit from being stratified: RC = 0.44 D and PL = -0.49 to 0.67 D for Kmax < 49.0 D, and RC = 1.08 D and PL = -1.19 to 1.42 D for Kmax ≥ 49.0 D. Conclusions: The interday repeatability of measurements, single or replicate, in subjects with keratoconus should be considered when diagnosing progressive disease. K1 exhibited the best intraday repeatability. Kmax benefits from being stratified according to disease severity.
|
|
| 14. |
- Gustafsson, Ingemar, et al.
(författare)
-
The intra- and inter-day repeatability of corneal densitometry measurements in subjects with keratoconus and in healthy controls
- 2023
-
Ingår i: Scientific Reports. - 2045-2322. ; 13
-
Tidskriftsartikel (refereegranskat)abstract
- The healthy cornea is transparent, however, disease can affect its structure, rendering it more or less opaque. The ability to assess the clarity of the cornea objectively could thus be of considerable interest for keratoconus patients. It has previously been suggested that densitometry can be used to diagnose early keratoconus, and that the values of densitometry variables increase with increasing disease severity, indicating that densitometry could also be used to assess progressive keratoconus. Previous studies have only assessed the repeatability of corneal densitometry measurements on the same day, which does not reflect the clinical setting in which changes are evaluated over time. We have therefore evaluated the inter-day repeatability of densitometry measurements in both patients with keratoconus and healthy controls. Measurements in the middle layer of the 2-6 mm zone of the cornea showed the best repeatability. Although an objective measure of the corneal transparency could be interesting, the generally poor repeatability of densitometry measurements limits their use. The repeatability of corneal clarity measurements could be improved by using other approaches such as optical coherence tomography, but this remains to be investigated. Such improvements would allow the more widespread use of corneal densitometry in clinical practice.
|
|
| 15. |
- Heijl, Anders, et al.
(författare)
-
Nordic research in ophthalmology.
- 2005
-
Ingår i: Acta ophthalmologica Scandinavica. - : Wiley. - 1395-3907 .- 1600-0420. ; 83:3, s. 278-88
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Nordic ophthalmologists and vision scientists are active in many fields of eye research. This is most evident at the biannual Nordic Congress of Ophthalmology, most recently held in Malmö in June 2004. The authors here review some of the research in vision and ophthalmology presented at this meeting or published recently by Nordic scientists. This paper does not represent a comprehensive review of all Nordic research in the field, but attempts to give an overview of some of the activities underway in eye research in this part of the world.
|
|
| 16. |
|
|
| 17. |
- Nielsen, Esben, et al.
(författare)
-
Validation of Catquest-9SF in Danish : developing a revised form of the Catquest-9SF – the Danish Catquest-7SF
- 2019
-
Ingår i: Acta Ophthalmologica. - : Wiley. - 1755-375X .- 1755-3768. ; 97:2, s. 173-177
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: The primary goal was to validate a Danish translated version of the Catquest-9SF by Rasch analysis. The secondary goal was to investigate whether preoperative Catquest-9SF scores, best-corrected visual acuity, comorbidity, gender, age or corneal astigmatism could predict improvements in subjective outcome. Methods: In a prospective trial, 250 patients eligible for cataract surgery were included. Patients filled out the translated Catquest-9SF questionnaire before surgery and again 3 months after surgery. Both preoperative and postoperative questionnaires were included in the Rasch analysis. A multiple reverse stepwise regression model was used to investigate the correlation between preoperative measurements and subjective improvement. Results: The preliminary Rasch analysis showed misfit of items 4 and 6. These items were removed, and the remaining seven items demonstrated a measurement precision of 2.78, a person reliability coefficient of 0.89, ordered response categories, infit of 0.69–1.22, outfit of 0.73–1.14, observed raw variance explained by measures of 70.4% and an eigenvalue of 1.7. Item 7 showed a mild DIF for gender (0.54 logits), and person mean Rasch score targeting was −1.69 logits. Preoperative Catquest score was the only parameter with a significant correlation to a gain in subjective outcome (p < 0.001). A preoperative Catquest-9SF score of 0.5 carried a 95% likelihood of an increase in subjective outcome. Conclusion: The Danish version of the Catquest-9SF fit the Rasch model. Only preoperative Catquest-9SF score was correlated to subjective improvement, and a cut-off value of 0.5 predicted an improvement in subjective outcome with 95% probability.
|
|
| 18. |
- Potapenko, Ivan O., et al.
(författare)
-
Donor Endothelial Cell Count Does Not Correlate With Descemet Stripping Automated Endothelial Keratoplasty Transplant Survival After 2 Years of Follow-up
- 2017
-
Ingår i: Cornea. - : Lippincott Williams & Wilkins. - 0277-3740 .- 1536-4798. ; 36:6, s. 649-654
-
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.
|
|
| 19. |
- Ruutila, Minna, et al.
(författare)
-
Diagnostic Criteria for Terrien Marginal Degeneration : Nordic Terrien Degeneration Study
- 2021
-
Ingår i: Cornea. - : LIPPINCOTT WILLIAMS & WILKINS. - 0277-3740 .- 1536-4798. ; 40:2, s. 133-141
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: To refine the diagnostic criteria for Terrien marginal degeneration (TMD) based on experience in 3 Nordic countries. Methods: This is a retrospective, multicenter, hospital-based cross-sectional study of 49 eyes of 29 white patients in tertiary referral centers in Finland, Sweden, and Denmark from 1998 to January 2018. The median follow-up was 3 years. Symptoms, best corrected visual acuity, astigmatism, corneal thickness, curvature and cavities, stage, and progression were analyzed. Results: TMD was diagnosed equally likely between 15 and 86 years of age (median, 47 years). Twenty patients (69%) had bilateral disease, and 62% were men. Seventeen patients (59%) had symptoms including blurred vision and ocular surface disease symptoms without inflammatory signs. Eight patients (28%) had slightly reduced corneal sensitivity. Median best corrected visual acuity was 20/25 (range, 20/16-20/200) and astigmatism was 2.6 diopters (D) (range, 0-10) with a mean progression of 0.41 D per year (range, 0-5.4). Age and astigmatism were not correlated. All eyes had peripheral vascularization, lipid deposits, and hyperreflectivity throughout thinned peripheral stroma and its anterior edge. The thinning progressed in 15 patients (52%). Of 26 patients, 8 (31%) had single or confluent paralimbal intrastromal cavities, most commonly superiorly. By Suveges classification, the stage was 2 (92%) or 3 (8%). Minimum corneal thickness and corneal curvature were loosely associated, leading to different stages in Wang classification in 34 eyes (69%). Conclusions: TMD is defined by peripheral corneal thinning, superficial neovascularization, lipid deposition at the leading edge, absence of ulceration and inflammation, and frequently cavitation. The most sensitive way to follow its progression is anterior segment optical coherence tomography.
|
|
| 20. |
- Sagerfors, Susanna, 1977-
(författare)
-
Infectious keratitis : causative microorganisms and how to detect them
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- First, to describe the microbial spectrum in infectious keratitis by both a culture and a targeted sequencing approach; second, to describe the clinical and genetic characteristics of Corynebacterium macginleyi; and third, to study different aspects of the corneal culture process by comparing two instruments used for sampling and two sampling and inoculation strategies. The five studies in this thesis made use of two retrospective study populations and one prospective study population.In the retrospective population the microbial spectrum by corneal culture was explored, Gram-positive bacteria, mainly coagulase-negative staphylococci, Staphylococcus aureus, and Corynebacterium spp. were commonly isolated. In the prospective study population, culture detected 13 different bacterial genera, while targeted sequencing identified a total of 168 different bacterial genera, with individual samples having a median of 13 (7–28) genera. Culture and sequencing showed an 82% agreement on the bacterial genera detected by culture. Genome sequencing and analysis of C. macginleyi revealed two different clades of which the minor clade (n=7), not previously described, exhibited a more complicated disease course. Cotton tipped applicators generated a significantly higher rate (44%) of positive corneal cultures on solid media than knife blades (31%). Direct transferal of multiple corneal samples to culture media generated a significantly higher rate of positive corneal cultures (61%) than indirect transferal through a single transport medium (44%).In conclusion, the microbial spectrum in a Swedish population is similar to previously described in Europe, and C. macginleyi may be considered a corneal pathogen. Targeted sequencing may gain clinical application if further developed. The findings of this thesis indicate that a cotton tipped applicator may be sufficient for corneal sampling for direct inoculation, and the corneal culture procedure can be simplified from seven samplings on four different media to three samplings on two media.
|
|
| 21. |
- Sorensen, Karina Meden, et al.
(författare)
-
Screening of Congenital Heart Disease Patients Using Multiplex Ligation-Dependent Probe Amplification: Early Diagnosis of Syndromic Patients
- 2012
-
Ingår i: American Journal of Medical Genetics. Part A. - : Wiley. - 1552-4825. ; 158A:4, s. 720-725
-
Tidskriftsartikel (refereegranskat)abstract
- Recurrent copy number variants (CNVs) are found in a significant proportion of patients with congenital heart disease (CHD) and some of these CNVs are associated with other developmental defects. In some syndromic patients, CHD may be the first presenting symptom, thus screening of patients with CHD for CNVs in specific genomic regions may lead to early diagnosis and awareness of extracardiac symptoms. We designed a multiplex ligation-dependent probe amplification (MLPA) assay specifically for screening of CHD patients. The MLPA assay allows for simultaneous analysis of CNVs in 25 genomic regions previously associated with CHD. We screened blood samples from 402 CHD patients and identified 14 rare CNVs in 13 (3.2%) patients. Five CNVs were de novo and six where inherited from a healthy parent. The MLPA screen led to early syndrome diagnosis in two of these patients. We conclude that the MLPA assay detects clinically relevant CNVs and suggest that it could be used within pediatric cardiology as a first tier screen to detect clinically relevant CNVs and identify syndromic patients at an early stage. (C) 2012 Wiley Periodicals, Inc.
|
|
| 22. |
- Viberg, Andreas, et al.
(författare)
-
Corneal transplantation in aniridia-related keratopathy with a two-year follow-up period, an uncommon disease with precarious course
- 2023
-
Ingår i: Acta Ophthalmologica. - : John Wiley & Sons. - 1755-375X .- 1755-3768. ; 101:2, s. 222-228
-
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.
|
|
