Cornea最新文献

{"title":"Wide-Field Contact Specular Microscopy Can Reliably and Repeatedly Image the Same Corneal Endothelial Location.","authors":"Elias H Kahan, Maria de Los Angeles Ramos Cadena, Ting-Fang Lee, Kathryn Colby","doi":"10.1097/ICO.0000000000003904","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003904","url":null,"abstract":"<p><strong>Purpose: </strong>To assess whether slit-scanning specular microscopy (CellChek C; Konan Medical) can repeatedly image the same corneal location using anatomic landmarks (posterior corneal rings and corneal undulations) and unique cells identified during imaging.</p><p><strong>Methods: </strong>A total of 203 eyes (113 patients) with and without corneal pathology were imaged to assess the prevalence of anatomic landmarks. A subcohort of 20 healthy eyes was used to identify unique cells adjacent to anatomic landmarks. Landmarks were then used to locate the same cells on repeat imaging approximately 1 week later. Endothelial cell density (ECD), coefficient of variation, and percent hexagonality were calculated. Intraclass correlation coefficient and 95% limits of agreement were used to measure variability and reproducibility of imaging.</p><p><strong>Results: </strong>Approximately 91% of eyes had either posterior corneal rings or undulations present. Undulations were more common than posterior corneal rings in both healthy and diseased corneas. Among subcohort eyes, unique cells were found adjacent to anatomic landmarks in 100% of eyes. Landmarks were used to reimage the same cells in 75% of eyes. There was minimal variation in ECD, coefficient of variation, and hexagonality; intraclass correlation coefficient and 95% confidence intervals were 0.891 [0.715-0.962], 0.612 [0.179-0.849], and 0.793 [0.499-0.925], respectively. The 95% limits of agreement for ECD was -359.9-260.98.</p><p><strong>Conclusions: </strong>Landmarks identified with slit-scanning specular microscopy allowed reliable reimaging of the same endothelial location, providing a powerful tool to better understand the role of the peripheral endothelium in health and disease.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Options for Alkali Burn-Induced Corneal Neovascularization: A Comparative Analysis of Two Tyrosine Kinase Inhibitors.","authors":"Titas Gladkauskas, Ida Marie Rundgren, Ileana Cristea, Tone Bukve, Eyvind Rødahl, Cecilie Bredrup","doi":"10.1097/ICO.0000000000003890","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003890","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy of topical dasatinib and axitinib for treating experimentally induced corneal neovascularization (CNV) in a mouse alkali burn model, and to compare these treatments to established therapies like dexamethasone and bevacizumab.</p><p><strong>Methods: </strong>Thirty-six C57BL/6; 129 Sv mice underwent a standardized alkali burn to induce CNV in both eyes by applying a paper disc soaked in 1M NaOH to the cornea for 20 seconds. The mice were randomly assigned to one of 6 treatment groups: saline (0.9% sodium chloride), DMSO (5%), dexamethasone (0.1%), bevacizumab (0.5%), dasatinib (0.5%), or axitinib (0.5%). Treatments were applied topically 3 times daily. After 2 weeks of treatment, the mice were sacrificed. CNV assessments, including corneal neovascularization area (CNA), vessel length index (VLI), and limbus vasculature thickness, were conducted postmortem using corneal flat-mounts stained with a CD31 antibody for immunohistochemistry.</p><p><strong>Results: </strong>Dexamethasone proved the most effective in inhibiting alkali burn-induced CNA (P < 0.0001), with bevacizumab showing comparable efficacy (P < 0.001). Axitinib also effectively reduced CNA (P < 0.001) and VLI (P < 0.01). In contrast, dasatinib did not significantly reduce CNA (P = 0.74) or VLI (P = 0.98). All eyes in the dexamethasone group developed cataracts compared with 25%-41.7% in the other groups.</p><p><strong>Conclusions: </strong>Axitinib reduced CNA and VLI, although not as effectively as other established treatment modalities, whereas dasatinib did not demonstrate significant effects.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Graft Failure After Pediatric Penetrating Keratoplasty in the United States.","authors":"Isdin Oke, Lyvia J Zhang, Tobias Elze, Alice C Lorch, Joan W Miller, Reza Dana, Thomas H Dohlman","doi":"10.1097/ICO.0000000000003898","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003898","url":null,"abstract":"<p><strong>Purpose: </strong>In contrast to adult patients, corneal transplants performed in pediatric patients tend to fare poorly, with relatively higher graft failure rates. The purpose of this study was to analyze the indications and outcomes of pediatric patients undergoing penetrating keratoplasty (PK).</p><p><strong>Methods: </strong>This retrospective cohort study included children ≤18 years in the IRIS Registry (Intelligent Research in Sight) who underwent PK (January 1, 2013-December 31, 2020). Corneal graft failure was identified using International Classification of Diseases codes. The Kaplan-Meier estimated 5-year cumulative incidence of graft failure after PK. Hazard ratios (HR) derived from multivariable Cox regression models were used to evaluate the association of graft failure with sociodemographic and clinical factors.</p><p><strong>Results: </strong>Five hundred forty-four children underwent PK (median age 15 years; 43% [234] female). Indications for surgery included nontraumatic acquired (58%, N = 318), congenital (18%, N = 100), other (9.6%, N = 52), and traumatic acquired (8.6%, N = 47). The cumulative incidence of graft failure within 5 years of PK was 50% (95% confidence intervals [CI], 45%-56%). The incidences did not differ between patients in various etiology groups. Graft failure was associated with glaucoma (HR, 1.46; 95% CI, 1.05-2.01; P = 0.023), dry eye disease (HR, 1.86; 95% CI, 1.18-2.92; P = 0.007), and corneal neovascularization (HR, 1.76; 95% CI, 1.00-3.08; P = 0.050).</p><p><strong>Conclusions: </strong>Approximately half of children undergoing PK in the IRIS Registry experienced graft failure within 5 years of transplantation. The association of graft failure with ocular conditions such as glaucoma and dry eye disease suggests potential avenues to decrease the high incidence of graft failure in this population.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Assessment of FECD in the National Advanced Driving Simulator: Initial Study of Nighttime Glare and Scheimpflug Imaging.","authors":"Simran R Sarin, Matthew Kigin, Evan Balk, Ryan Diel, Jennifer Ling, Mark A Greiner, Elliott H Sohn, Mark E Wilkinson, Timothy Brown, Christopher S Sales","doi":"10.1097/ICO.0000000000003894","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003894","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to quantify nighttime driving differences in patients with Fuchs endothelial corneal dystrophy (FECD) using the FDA-validated National Advanced Driving Simulator MiniSim.</p><p><strong>Methods: </strong>We conducted a pilot study to calculate sample size, followed by a prospective study with 6 patients with FECD and 6 controls. Participants underwent Snellen visual acuity (VA) testing, Mars contrast sensitivity (CS) assessment, and Scheimpflug tomography. Participants completed 3 simulated driving scenarios, identifying hazards while detection distances were tracked. Driving scenarios simulated glare conditions from oncoming headlights at night: \"variable glare\" modulated glare intensity with passing traffic, \"constant glare\" kept glare intensity fixed, and \"no glare.\" The primary outcome was hazard recognition under \"variable glare.\"</p><p><strong>Results: </strong>Age, CS, and VA did not differ significantly between groups. Anterior and posterior densitometry were worse in the FECD group versus controls (anterior: 37.9 ± 6.0 vs. 28.9 ± 1.5, P = 0.01; posterior: 20.1 ± 3.1 vs. 16.5 ± 1.0, P = 0.02). Patients with FECD recognized 14% fewer hazards than controls (variable glare: 81.8 ± 12.1 vs. 95.8 ± 4.7%, P = 0.03). Patients with FECD required being nearly twice as close to hazards to recognize them versus controls (76.5 ± 38.8 vs. 137.7 ± 51.9 ft; P = 0.04). Tomographic markers of subclinical corneal edema (r = -0.61, P = 0.03) and higher anterior densitometry values (r = -0.61; P = 0.04) correlated with shorter hazard detection distance under \"constant glare.\" Thicker central corneal thickness (variable glare: r = -0.60, P = 0.04) and higher posterior densitometry values correlated with lower hazard recognition scores (variable glare: r = -0.67, P = 0.02; constant glare: r = -0.65, P = 0.02).</p><p><strong>Conclusions: </strong>Despite normal VA and CS, patients with FECD performed significantly worse in driving simulations than controls. Driving disability was associated with tomographic measures of subclinical corneal edema and abnormal corneal densitometry.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femtosecond Descemet Membrane Endothelial Keratoplasty for Failed Deep Anterior Lamellar Keratoplasty: A Case Series.","authors":"Dana Barequet, Mor Bareket, Mobin Abdi, Adi Einan-Lifshitz, Nir Sorkin, Manokamna Agarwal, Marcela Huertas-Bello, Ae Ra Kee, Clara C Chan, David S Rootman","doi":"10.1097/ICO.0000000000003902","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003902","url":null,"abstract":"<p><strong>Purpose: </strong>To suggest a new surgical approach for the treatment of failed deep anterior lamellar keratoplasty (DALK) because of posterior opacities or persistent Descemet membrane (DM) detachment and to report the outcome of femtosecond intralase-enabled Descemet membrane endothelial keratoplasty (FE-DMEK) in a series of patients with DALK graft failure.</p><p><strong>Methods: </strong>A retrospective case series of eight patients who underwent FE-DMEK for failed DALK at Toronto Western Hospital.</p><p><strong>Results: </strong>Eight eyes of eight patients (four female and four male) aged 63.91 ± 9.66 years were included. Average follow-up time after DMEK surgery was 30.0 months (range 3.8-93.1). Indications for DALK surgery were corneal dystrophy in four patients, corneal scars in two patients, and keratoconus in two patients. DALK failure was because of endothelial/stromal scarring in three patients, recurrence of corneal dystrophy in the stromal interface in three patients, endothelial decompensation in one patient, and persistent DM detachment that created a double chamber in one patient. All DMEK procedures were uneventful. Rebubbling was indicated in 5/8 (62.5%) patients, performed at a mean time of 15.6 days (range 3-26 days). Mean best-corrected distance visual acuity at 12 months and final visit was 0.37 ± 0.10 logMAR (Snellen equivalent ∼20/45) and 0.25 ± 0.16 logMAR (Snellen equivalent ∼20/35), respectively. Endothelial cell-loss rates were 39% at 1 year.</p><p><strong>Conclusions: </strong>FE-DMEK is effective in managing DALK graft failure in selected cases. Postoperative outcomes are favorable, with detachment and rebubbling rates comparable with those reported for DMEK after failed PK.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Keratolimbal Allograft Outcomes: Optical Coherence Tomography Analysis of Donor Graft Phenotypes in Limbal Stem Cell Deficiency.","authors":"Wenyu Wu, Szy Yann Chan, Haozhe Yu, Qiaoyu Li, Yun Feng","doi":"10.1097/ICO.0000000000003899","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003899","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the morphology of donor grafts and limbal microstructure after keratolimbal allograft (KLAL) surgery using anterior segment optical coherence tomography (AS-OCT) and to explore the relationship between graft shape and clinical outcomes.</p><p><strong>Methods: </strong>This retrospective study included patients with limbal stem cell deficiency from severe ocular surface burns who underwent KLAL with or without concurrent keratoplasty. AS-OCT was used to assess graft morphology and the graft-recipient interface. Grafts were classified into 3 types-wedge-shaped, trapezoidal, and irregular-shaped-based on AS-OCT imaging. Postoperative clinical outcomes, including neovascularization, conjunctivalization, and corneal opacity, were recorded and compared across graft types.</p><p><strong>Results: </strong>Among 26 eyes from 23 patients, wedge-shaped grafts showed significantly higher success rates, with fewer complications of neovascularization, conjunctivalization, and corneal opacity, compared with trapezoidal and irregular-shaped grafts. Specifically, wedge-shaped grafts had superior outcomes in neovascularization (vs. trapezoidal: χ2 = 5.658, P = 0.017; vs. irregular: χ2 = 6.062, P = 0.014), conjunctivalization (vs. trapezoidal: χ2 = 5.855, P = 0.016; vs. irregular: χ2 = 6.814, P = 0.009), and corneal opacity (vs. trapezoidal: χ2 = 7.088, P = 0.008). AS-OCT imaging showed closer adherence of wedge-shaped grafts to the recipient bed, potentially enhancing stability, whereas trapezoidal and irregular-shaped grafts exhibited gaps that may hinder attachment.</p><p><strong>Conclusions: </strong>AS-OCT imaging effectively visualizes donor graft morphology and graft-recipient microstructure, providing insights into KLAL outcomes. Wedge-shaped grafts, which align more closely with natural limbal anatomy, show greater ocular surface stability.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ocular Graft-Versus-Host Disease in Allogeneic Stem Cell Transplant Recipients: A Longitudinal Cohort Study Evaluating Ocular Surface Parameters Before and After Transplantation.","authors":"Dimitri Roels, Anke Delie, Dominiek Mazure, Katrien De Grove, Ineke van Gremberghe, Joke Deprez, Isabelle Peene, Dirk Elewaut, Bart Leroy, Ilse Claerhout, Tessa Kerre","doi":"10.1097/ICO.0000000000003897","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003897","url":null,"abstract":"<p><strong>Purpose: </strong>The objective of this longitudinal cohort study was to identify predictors of progression to ocular graft-versus-host disease in allogeneic hematopoietic stem cell transplant recipients.</p><p><strong>Methods: </strong>Patients (n = 49) were examined before hematopoietic stem cell transplantation (HSCT) and 3, 6, 12, 24, and 36 months after HSCT. Outcome measures included ocular surface disease index questionnaire, Schirmer I test, corneal fluorescein staining, tear break-up time, and tear cytokine concentration. Diagnosis of ocular GVHD (oGVHD) was made in accordance with the International Consensus Criteria for chronic oGVHD. A group of healthy controls (n = 20) without dry eye disease was recruited for comparison.</p><p><strong>Results: </strong>At baseline, the intended HSCT group had a lower Schirmer test value, a higher corneal fluorescein staining score, and a lower tear film break-up time compared with the control group. There was no significant difference in ocular surface disease index score. The intended HSCT group had significantly higher tear interleukin (IL)-1, IL-6, IL-8, IL-10, interferon gamma-induced protein (IP)-10, and TNF-α concentrations at baseline. When considering an increase of at least 2 points of the International Consensus Criteria for chronic oGVHD score after HSCT to exclude preexisting dry eye disease, only 19% (n = 7) developed either probable (11%, n = 4) or definite (8%, n = 3) oGVHD. In a longitudinal analysis, a significant association between progression to oGVHD and tear IL-6, IL-8, IL-17A, and IP-10 concentration was detected.</p><p><strong>Conclusions: </strong>This study highlights the added value of performing a baseline ophthalmological examination in intended HSCT recipients. Posttransplant oGVHD rates may be overestimated if pretransplant ocular surface disease is not considered. Longitudinal tear cytokine analysis in our cohort suggests that IL-6, IL-8, IL-17A, and IP-10 may be useful as biomarkers for oGVHD.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Corneal Ulceration After Cosmetic Keratopigmentation.","authors":"Olivia Uddin, Yesha Shah, Shahriyar Majidi, Frank Mei, Allen O Eghrari, Esen Akpek","doi":"10.1097/ICO.0000000000003895","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003895","url":null,"abstract":"<p><strong>Purpose: </strong>Keratopigmentation is a well-described procedure often used to address corneal opacities. Purely cosmetic keratopigmentation, in the absence of underlying corneal pathology has increased in popularity recently, with the intention of changing eye color appearance. In the context of this increased popularity, public knowledge and data regarding the risks of this procedure are lacking.</p><p><strong>Methods: </strong>This study is a case report conducted at a single academic institution.</p><p><strong>Results: </strong>Here we present a case of a patient who underwent purely cosmetic keratopigmentation and who developed severe corneal ulceration as a sequela. We outline the clinical course and management of this ulceration, which ultimately resolved with amniotic membrane grafting as well as oral and topical steroids.</p><p><strong>Conclusions: </strong>This case serves as an important illustration of the risks that may be associated with purely cosmetic keratopigmentation.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Report of Descemet-Sparing Technique for Boston Type I Keratoprosthesis With Clinical Follow-Up.","authors":"Mayan M Elammary, Pratima Vishwakarma, Roberto Pineda","doi":"10.1097/ICO.0000000000003896","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003896","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to describe the long-term outcome following a modified technique of the Boston type I keratoprosthesis (KPro) placement over a period of 7 years.</p><p><strong>Method: </strong>Deep anterior lamellar keratoplasty combined with Boston type I KPro Click-On implantation was performed in a patient with history of uveitic glaucoma, glaucoma drainage device placement, and multiple graft failures including four Descemet stripping automated endothelial keratoplasty procedures for pseudophakic bullous keratopathy followed by penetrating keratoplasty.</p><p><strong>Result: </strong>Using this modified surgical approach, the patient's right eye vision improved from hand motion preoperatively to 20/150 on postoperative day 1. Six months later, he underwent Nd:YAG laser of an opacified central Descemet membrane, after which vision improved to 20/80 and was maintained over 7 years. No other postoperative common KPro complications occurred. A recent contact lens trial with a correction of -9D improved vision further to 20/30.</p><p><strong>Conclusions: </strong>This modified surgical technique for placement of Boston type I KPro is less invasive compared with conventional methods and may prevent complications associated with an open-sky surgery, making it a safer alternative. Furthermore, when combined with Nd:YAG laser membranectomy of the Descemet membrane, vision can be further improved.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Latin American Consensus on Ocular Lubricants and Dry Eye Disease (LUBOS): A Report on Severity Classification, Diagnosis, and Therapy.","authors":"Alejandro Rodriguez-Garcia, Maria Ximena Nuñez, José Alvaro Pereira-Gomes, Maria A Henriquez, Manuel Garza-Leon, Alejandro Aguilar","doi":"10.1097/ICO.0000000000003886","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003886","url":null,"abstract":"<p><strong>Purpose: </strong>This consensus aims to establish a practical severity classification for applying a tailored stepladder treatment algorithm helpful to any clinician.</p><p><strong>Methods: </strong>A modified Delphi methodology was used to establish a consensus on the definition, diagnosis, severity classification, and treatment algorithms for dry eye disease (DED) adapted to the needs of Latin America. The consensus focused on promoting the effective use of lubricants and providing straightforward, practical guidance for ophthalmologists treating dry eyes. Twenty-eight corneal specialists from representative Latin American countries reviewed the scientific evidence and drew on their expertise to answer specifically designed open-ended questions.</p><p><strong>Results: </strong>A simple diagnostic algorithm (clinical history, DED questionnaire, and dry eye clinical tests) identified patients with the disease. A practical severity classification system of four grades: mild, moderate, severe, and LUBOS plus DED was based on four criteria: OSDI, film break-up time, Sjögren International Collaborative Clinical Alliance ocular surface staining score, and international workshop on meibomian gland dysfunction meibomian gland functionality test. For classification, ≥2 criteria of the highest severity grade from the worse eye were considered. A stepladder therapeutic algorithm aligned with disease severity consisted of 5 steps, each with proposed and recommended treatment alternatives. Patient education, lifestyle recommendations, adverse environment avoidance, lubricants, and eyelid therapy were reinforced during the therapy period.</p><p><strong>Conclusions: </strong>The LUBOS expert panel consensus considered the diverse geoenvironmental, socioeconomic, cultural, and ethnic factors pertinent to Latin America. This consensus offers an accessible and cost-effective tool, enabling professionals to detect, evaluate, and grade the severity of dry eye disease effectively for planning adequate therapeutic strategies that can be monitored with confidence.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}