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To report a case of a 20-year-old woman who developed massive and progressive corneal remodeling in both eyes after bilateral PRK with mitomycin and CXL as an elective refractive procedure for mild keratoconus. The patient had 6 years of follow up, initially presenting with focal steepening of up to 20 diopters on both eyes one-and-a-half- years postoperatively that spontaneously reversed over the next five years while the high order aberrations worsened. At the present time, the patient depends on bilateral scleral contact lenses for her day-to-day activities. The use of combined elective PRK with mitomycin and prophylactic CXL could lead to progressive corneal deformation. Additional reports would help to establish the role of this combination procedure among the armamentarium to visually rehabilitate patients with keratoconus.

Keratoconus (KC) is a complex disease whose pathophysiology is only partially understood. The priority in management is to halt the progression of corneal deformation as soon as possible in the course of KC disease. Corneal cross-linking (CXL) is at present the only dedicated treatment for this purpose. Its biochemical mechanism of action leads to changes in the viscoelastic properties of the cornea induced by matrix bonding and renewal of keratocytes. The effect of CXL is difficult to quantify when measured in in-vivo conditions because of a lack of consistent tools adapted for clinical practice. Nevertheless, a large amount of evidence has been collected so far confirming the positive action of CXL on corneal structural reinforcement, and numerous studies have demonstrated significant efficacy in halting progression of KC with long-term follow-up. Published studies, however, are of relatively low scientific power given the great heterogeneity of the disease and the numerous associated biases in evaluation. The purpose of this paper is to summarize the consistent evidence of efficacy of CXL and to justify its role in our therapeutic armamentarium for management of progressive KC.

The elasticity of cornea was investigated with and without dextran content in the 0.1% Riboflavin solutions including salt and glucose, respectively. These five different solutions were studied for keratoconus treatment alternatively. The elasticity of the treated and untreated cornea was characterized by using compressive technique. The cornea can be modeled by the mass–spring–damping system. It is understood that the compressive elastic modulus of the cornea changes before and after treatment by the alternative solutions. The mechanical behavior of cornea likes composite anisotropic material due to the structure of cornea which consists of collagen fibrils. The sheep cornea was used as a pilot study before the application of treatment to human cornea. In the cornea, the nonlinear pressure deformation was observed as the behavior of elastomer materials. We found a significant increase in biomechanical rigidity after the cross-linking processes. The observed elasticity properties are consistent with the suggested values in the literature. This study is one of the alternative solutions studies for the treatment of corneal deformation illness after our spectroscopic and mechanical investigations.

BackgroundThe "air-puff" tonometers, include the Corvis, are a type of device for measuring intraocular pressure and biomechanics parameters. The paper attempts to analyse this response and its relationship with other parameters measured in the Corvis tonometer. MethodsA number of 13,400 2D images were acquired from the Corvis device and analysed (32 healthy and 16 ill people). A new method has been proposed for the analysis of responses of the eyeball based on morphological transformations and contextual operations. ResultsThe proposed algorithm enables to determine responses of the eyeball to an air puff coming from the Corvis tonometer. Additionally, responses of the eyeball have been linked to some selected features of corneal deformation. The results include, among others: (1) distinguishability between the left and right eye with an error of 7%; (2) the correlation between the area under the curve in corneal deformation and the response of the eyeball -0.26; (3) the correlation between the highest concavity time and the maximum deformation amplitude of 0.4. All these features are obtained fully automatically and repetitively at a time of 3.8s per patient (Core i7 10GB RAM). DiscussionIt is possible to measure additional parameters of the eye deformation which are not available in the original software of the Corvis tonometer. The use of the proposed methods of image analysis and processing provides results directly from the eye response measurement when measuring intraocular pressure. The proposed algorithm enables to determine responses of the eyeball to an air puff.Responses of the eyeball can be linked to some features of corneal deformation.Using profiled algorithm enables to measure additional parameters from the Corvis.

Purpose To examine the role of elevated corneal temperature in the development of rubbing/massage-related corneal deformation and the possibility that warm compresses in the management of meibomian gland dysfunction or chalazion could contribute to such adverse responses. Methods With reference to reports of corneal deformation associated with meibomian gland dysfunction, chalazion, dacryocystoceles and post-trabeculectomy, the mechanisms for increased corneal temperature due to ocular massage, especially when combined with warm compresses are examined. Results Several mechanisms for rubbing/massage to elevate corneal temperature have been described, apart from the application of warm compresses or other forms of heat. Conclusions Raised corneal temperature helps to explain corneal deformation which develops in association with rubbing or massage in conditions such as keratoconus, chalazion, post-trabeculectomy, post-laser assisted in situ keratomileusis, post-graft and dacryocystoceles. When combined with warm compresses or other methods of heat delivery to the eye, the elevation of corneal temperature appears to explain how meibomian gland dysfunction treatment involving warm compresses and massage could induce rubbing-related deformation. Patients whose management involves iatrogenic ocular massage appear to require screening for risk of corneal deformation. Risk may be increased for patients with a concurrent habit of rubbing their eyes abnormally in response to allergic itch for example. It appears to be possible to modify ocular massage techniques to reduce the risk of corneal deformation. Careful tutoring and follow-up using corneal topography appears to be required when massage is prescribed, especially when used in conjunction with heat application.

Purpose To evaluate corneal air-puff deformation responses and ocular geometry as predictors of Marfan syndrome. Design Prospective observational clinical study. Methods Sixteen investigator-derived, 4 standard Ocular Response Analyzer (ORA), and geometric variables from corneal tomography and optical biometry using Oculus Pentacam and IOL Master were assessed for discriminative value in Marfan syndrome, measuring right eyes of 24 control and 13 Marfan syndrome subjects. Area under the receiver operating characteristic (AUROC) curve was assessed in univariate and multivariate analyses. Results Six investigator-derived ORA variables successfully discriminated Marfan syndrome. The best lone disease predictor was Concavity Min (Marfan syndrome 47.5 ± 20, control 69 ± 14, P = .003; AUROC = 0.80). Corneal hysteresis (CH) and corneal resistance factor (CRF) were decreased (Marfan syndrome CH 9.45 ± 1.62, control CH 11.24 ± 1.21, P = .01; Marfan syndrome CRF 9.77 ± 1.65, control CRF 11.03 ± 1.72, P = .01) and corneas were flatter in Marfan syndrome (Marfan syndrome K mean 41.25 ± 2.09 diopter, control K mean 42.70 ± 1.81 diopter, P = .046). No significant differences were observed in central corneal thickness, axial eye length, or intraocular pressure. A multivariate regression model incorporating corneal curvature and hysteresis loop area (HLA) provided the best predictive value for Marfan syndrome (AUROC = 0.85). Conclusions This study describes novel biodynamic features of corneal deformation responses in Marfan syndrome, including increased deformation, decreased bending resistance, and decreased energy dissipation capacity. A predictive model incorporating HLA and corneal curvature shows greatest potential for noninvasive clinical diagnosis of Marfan syndrome.

EDITOR: WE AGREE WITH BRANDT AND ASSOCIATES 1 THAT GOLDmann applanation tonometry (GAT) yields systematic errors in measurement of intraocular pressure (IOP) attributable significantly to variations in central corneal thickness (CCT). We further agree that “true” IOP is far more complex than can be modeled by a simple linear arithmetic correction. However, there are a few issues related to the study that may be worth further discussion. We would like to point out that two plywoods placed together can bear four times as much weight as one. GAT is based on corneal deformation to external pressure. The relationship between the degree of corneal deformation to external pressure and the corneal thickness is not linear, but exponential. Exponential IOP correction formulas 2,3 are available, and they should give a better estimate of “true” IOP than a simple linear formula. Using the exponential IOP correction formula we developed, we calculated the “true” IOP from the data presented in Table 3 of

An analytical model has been developed for the localized corneal deformation produced in the region of the head of a pterygia. Astigmatism results when this localized deformation enters the central region or optical zone of the cornea. The amount and direction of the pterygia-induced astigmatism may be predicted from the values of the corneal curvature within the optical zone. The analytical solution of Lur'e based on the Papkovich-Neuber theory was applied to the anatomical and mechanical conditions affecting the cornea and conjunctiva. The force exerted by the head of a pterygia was measured experimentally for the first time. This force is of the order of that produced by the extraocular muscles in primary gaze. Using this model it is possible to predict that 2.35 diopters of the pterygia-induced astigmatism would result from a pterygia exerting 5 g of force along a meridian passing through the center of the cornea, and whose head is located 2.38 millimeters from the optical center of the cornea of an eye having a 4 mm pupillary diameter.