Efficacy of Intrastromal Corneal Ring Segments Combined With Flash Collagen Cross-Linking in Keratoconus.

PURPOSE: To evaluate outcomes, efficacy, and safety of intrastromal corneal ring segment implantation for treatment of keratoconus combined with collagen cross-linking (CXL) with 1-year follow-up. METHODS: One hundred nineteen eyes of 82 patients with keratoconus (37 females) underwent femtosecond (Intralase FS; Abbott Medical Optics, Inc) laser-assisted intrastromal corneal ring segment implantation (INTRASEG; Gamma Vision) with flash CXL (18 mW/cm for 5 minutes). The outcome measures were uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (CDVA), subjective refractive error, keratometry values, and corneal thickness. RESULTS: Mean age of patients at implantation was 31 years (range 12-63, SD 9.5). According to the Amsler-Krumeich scale of keratoconus severity, 62 eyes were type 1 (52%), 43 eyes, type 2 (36%), and 14 eyes, type 3 (11.8%). Statistically significant improvement of UDVA/CDVA and reduction in the mean cylinder and mean keratometry at 1 year were observed. Mean UDVA (logMAR) was 1.11 ± 0.61 (SD) preoperatively and 0.54 ± 0.58 (SD) postoperatively (P < 0.001). Mean CDVA was 0.52 ± 0.18 (SD) preoperatively and was 0.14 ± 0.17 (P < 0.0001) postoperatively. Preoperative Kmax was 48.75 diopters (D) (range 41.0-55.0 D), and postoperative Kmax was 46.18 D (P < 0.0006); preoperative Kmin was 44.69 D (SD) 3.59 and postoperative Kmin was 43.00 D (SD) 2.53. The mean cylinder was -5.19 D preoperatively (range -0.80 to -8.80 D) and -2.6 D (range -1.00 to -7.25) postoperatively. Mean corneal pachymetry was 486.6 µm (range 391-591). No intraoperative complications occurred. No patient lost any lines of UDVA or CDVA. CONCLUSIONS: Implantation of the INTRASEG with the Intralase combined with flash CXL was apparently safe and effective in treatment of keratoconus. The variety of options in thickness and arc length of the segments enables more precise correction of keratoconus and refractive errors.

Proteomic analysis of human aqueous humor using multidimensional protein identification technology.

Aqueous humor (AH) supports avascular tissues in the anterior segment of the eye, maintains intraocular pressure, and potentially influences the pathogenesis of ocular diseases. Nevertheless, the AH proteome is still poorly defined despite several previous efforts, which were hindered by interfering high abundance proteins, inadequate animal models, and limited proteomic technologies. To facilitate future investigations into AH function, the AH proteome was extensively characterized using an advanced proteomic approach. Samples from patients undergoing cataract surgery were pooled and depleted of interfering abundant proteins and thereby divided into two fractions: albumin-bound and albumin-depleted. Multidimensional Protein Identification Technology (MudPIT) was utilized for each fraction; this incorporates strong cation exchange chromatography to reduce sample complexity before reversed-phase liquid chromatography and tandem mass spectrometric analysis. Twelve proteins had multi-peptide, high confidence identifications in the albumin-bound fraction and 50 proteins had multi-peptide, high confidence identifications in the albumin-depleted fraction. Gene ontological analyses were performed to determine which cellular components and functions were enriched. Many proteins were previously identified in the AH and for several their potential role in the AH has been investigated; however, the majority of identified proteins were novel and only speculative roles can be suggested. The AH was abundant in anti-oxidant and immunoregulatory proteins as well as anti-angiogenic proteins, which may be involved in maintaining the avascular tissues. This is the first known report to extensively characterize and describe the human AH proteome and lays the foundation for future work regarding its function in homeostatic and pathologic states.