In view of the problem that there is no standard diagnosis for early stage keratoconus disease,at the same time to assist the special examiner and ophthalmologist to make the early diagnosis effectively,the advantages and disadvantages of each testing instrument were analyzed.In order to construct an assistant system for early diagnosis of keratoconus,a deep learning technique was applied in corneal OCT examination.The system used improved VGG-16 to realize the recognition accuracy of about 68% keratoconus keratopathy,and the clinical results showed that the system can help doctors to give diagnosis confidence to a certain extent.At the same time,the physician's re-marking of OCT can help train the system for more accurate judgment.
Corneal Topography ; Deep Learning ; Early Diagnosis ; Humans ; Keratoconus ; diagnostic imaging ; Tomography, Optical Coherence

OBJECTIVE: To investigate the effects of corneal thickness distribution and apex position on postoperative refractive status after full-bed deep anterior lamellar keratoplasty (FBDALK). METHODS: This is a retrospective analysis of patients who were diagnosed with advanced keratoconus between 2011 and 2014 in our hospital. The base of the cone in all patients did not exceed the central cornea at a 6-mm range. The FBDALK was performed by a same surgeon. All patients had a complete corneal suture removal and the follow-up records were intact. Patients who had graft-bed misalignment or who were complicated with a cataract or glaucoma were excluded. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), and Pentacam examination data were recorded at two years postoperatively. The recorded data included the superior-inferior (S-I) and nasal-temporal (N-T) corneal thickness differences in 2, 4, 6, and 8 mm diameter concentric circles with the corneal apex as the center (S-I_{2 mm}, S-I_{4 mm}, S-I_{6 mm}, S-I_{8 mm}, N-T_{2 mm}, N-T_{4 mm}, N-T_{6 mm}, and N-T_{8 mm}), the linear, X-axis, and Y-axis distance between the corneal pupillary center and the cornea apex, total corneal astigmatism at a zone of 3 mm diameter from the corneal apex (TA_{3 mm}), the astigmatic vector values J₀ and J₄₅, and the corneal total higher-order aberration for 3 and 6 mm pupil diameters (HOA_{3 mm} and HOA_{6 mm}). Statistical analysis was performed by SPSS 15.0. RESULTS: A total of 47 eyes of 46 patients met the criteria and were included in this study. The mean follow-up time was (28±7) months. The mean UCVA was 0.45±0.23 (logMAR) (MAR: minimum angle of resolution) and the mean BSCVA was 0.19±0.15 (logMAR), which were all significantly positively correlated with postoperative TA_{3 mm} and HOA_{3 mm}. The mean S-I corneal thickness differences were (44.62±37.74) μm, and the mean N-T was (38.57±32.29) μm. S-I_{2 mm} was significantly positively correlated with J₀ (r=0.31), J₄₅ (r=0.42), HOA_{3 mm} (r=0.37), and HOA_{6 mm} (r=0.48). S-I_{4 mm} and S-I_{8 mm} were significantly positively correlated with HOA_{3 mm} (r=0.30, r=0.40) and HOA_{6 mm} (r=0.46, r=0.35). The X-axis distance between corneal pupillary center and corneal apex was significantly positively correlated with J₄₅ (r=0.29). CONCLUSIONS In patients with advanced keratoconus after FBDALK, the unevenly distributed thickness at corneal pupillary area and the misalignment of corneal apex and pupillary center might cause significant regular and irregular astigmatism, which affected the postoperative visual quality.
Adolescent ; Adult ; Cornea/surgery* ; Corneal Transplantation/methods* ; Cryopreservation ; Female ; Follow-Up Studies ; Humans ; Keratoconus/diagnosis* ; Keratoplasty, Penetrating/methods* ; Male ; Retrospective Studies ; Visual Acuity ; Young Adult

A 49-year-old man with an uncorrected visual acuity (UCVA) of 20 / 1000, a best spectacle-corrected visual acuity (BSCVA) of 20 / 400, keratometric readings of K1 = 59.88 x 82degrees / K2 = 45.88 x 172degrees, and an inferior steepening that was consistent with keratoconus in his left eye was treated with clear-cornea phacoemulsification and an intraocular lens (IOL) implantation after insertion of keraring intrastromal corneal ring segments for severe keratoconus and cataract. An asymmetrical pair of kerarings was implanted with the assistance of a femtosecond laser in September 2008; the one segment was 250 microm and the other was 150 microm and both were placed at 70degrees. Three months after the kerarings were implanted, clear-cornea phacoemulsification and IOL implantation were performed on the left eye. After surgery, both the UCVA and the BSCVA of the left eye improved by eight lines. Postoperative central keratometry showed a decrease of 7.35 diopters in the left eye. Both the postoperative refraction (-0.75 -0.75 x 60degrees) and the keratometric reading (K1 = 50.05 x 93degrees / K2 = 48.83 x 3degrees) remained stable one month following the procedures. Thus, the sequential order of intrastromal corneal rings implantation and cataract surgery can be considered as a treatment option in patients with severe keratoconus and cataract.
Cataract/*complications/diagnosis ; Corneal Stroma/pathology/*surgery ; Corneal Topography ; Follow-Up Studies ; Humans ; Keratoconus/complications/diagnosis/*surgery ; Lens Implantation, Intraocular/*methods ; Male ; Middle Aged ; Phacoemulsification/*methods ; Severity of Illness Index

Adult ; Disease Progression ; Facial Hemiatrophy ; complications ; diagnosis ; physiopathology ; Female ; Humans ; Keratoconus ; etiology ; physiopathology ; therapy

PURPOSE: To report 8 cases of Noninfectious early anterior chamber reaction after penetrating keratoplasty (PKP), and to review relevant literature. METHODS: Retrospectively, we reviewed medical records of 8 patients who had undergo PKP from March 2001 to May 2004, associated with early severe chamber reaction. RESULTS: Preoperative diagnosis are corneal opacity (4 cases), keratoconus (2 cases), corneal ectasia after LASIK (1 case) and graft failure (1 case). Although they didn't show severe chamber reaction at first day after surgery, the anterior chamber reaction with cornea edema and decreased visual acuity had increased with time. We didn't give the additional treatment except increasing the number of instillation of topical steroid. The inflammation was improved within a week and the complete resolution was achieved during the follow-up in all cases. In all cases posterior synechia and anterior subcapsular opacity were found. CONCLUSIONS: It seems reasonable to conclude that a single common etiologic factor could not responsible for this syndrome. Non-infectious inflammation developing upon PKP may be caused by a multifactorial process like increased IOP, toxic anterior segment syndrome form surgical trauma or hypersensitivity reaction et al and viscoelastics effect.
Anterior Chamber ; Cornea ; Corneal Opacity ; Diagnosis ; Dilatation, Pathologic ; Edema ; Follow-Up Studies ; Humans ; Hypersensitivity ; Inflammation ; Keratoconus ; Keratomileusis, Laser In Situ ; Keratoplasty, Penetrating* ; Medical Records ; Retrospective Studies ; Transplants ; Visual Acuity

PURPOSE: To investigate new diagnostic criteria of keratoconus using Orbscan II Slit Scanning Corneal Topography/Pachymetry System. METHODS: Eighty eyes of 45 patients with keratoconus and 100 randomly selected eyes of 50 patients without any ophthalmologic problem were enrolled in this study. Anterior elevation from BFS, posterior elevation from BFS, Sim K (maximum), and thinnest pachymetric value were evaluated using Orbscan II. Values outside 2 standard deviations from the mean value of each parameter were estimated to the upper or lower limits in diagnosing keratoconus. RESULTS: There were significant differences of all parameters of Orbscan II between the keratoconic eyes and the control (p<0.001). Keratoconus could be diagnosed with 86.3% sensitivity and 99.0% specificity when 3 or more criteria were satisfied and with 96.3% sensitivity and 99.0% specificity when 2 or more criteria were satisfied out of the following 4 criteria; anterior elevation from BFS > 23.3 micro meter, posterior elevation from BFS > 49.8 micro meter, Sim K (maximum) > 47.0 D, thinnest pachymetric value < 455.0 micro meter. CONCLUSIONS: Orbscan II can provide useful information in the diagnosis of keratoconus with high sensitivity and specificity.
Diagnosis ; Humans ; Keratoconus* ; Sensitivity and Specificity

PURPOSE: We collected genomic DNAs of Korean patients with inherited corneal disorders, and identified mutations of the BIGH3 gene related corneal dystrophies in Korean patients: Lattice type I (CDLI), Avellino (ACD), Reis-Buckler's (CDRB). METHODS: Slit-lamp examination of 75 patients and their relatives was carried out to confirm the diagnosis of the disorders. We composed pedigree and extracted genomic DNAs from members of the CDaffected family and individual patients. Genomic DNAs of the patients with mutation in BIGH3 gene were identified using Polymerase chain reaction (PCR) and sequencing. RESULTS: The number of patients was ranked as follows: 30 patients (40.0%) with ACD, 24 patients (32.0%) with keratoconus, 7 patients (9.3%) with CDLI, 5 patients (6.7%) with Fuchs' dystrophy, 3 patients (4.0%) with CDRB. In the genetic examination, we identified R124H mutation in ACD, R124C mutation in CDLI and R555Q mutation in CDRB. During this study, we also identified a polymorphism (F540F) in exon 12. CONCLUSIONS: ACD associated with R124H mutation is the most common form of inherited corneal disorder in Korea. And in Korean patients with CDRB, this study is the first report about mutation R555Q.
Diagnosis ; DNA ; Exons ; Humans ; Keratoconus ; Korea ; Pedigree ; Polymerase Chain Reaction

PURPOSE: To report the confocal morphological changes of keratoconus in comparison with that of normal cornea. METHODS: Confocal microscopy (ConfoScan 2.0, Fortune Technology, Italy) was used to obtain data from healthy volunteers and keratoconus. We evaluated corneal morphological images of the corneal epithelium, Bowman's layer, stromal layer (anterior, middle, and posterior keratocyte), Descemet's membrane, and endothelium. RESULTS: In keratoconus cornea, the wing cells of epithelium had somewhat irregular margin, and the subepithelial nerve bundle was slightly enlarged. Near Bowman's membrane, highly reflective changes and tear like structure were visible. While the anterior stromal keratocyte had nuclei with a highly reflective density and indefinite cell border, posterior keratocyte had a more distinct shape with less cellularity. Near descemet's membrane, vertical fold (Vogt's striae) was observed and keratocytes with long processes arranged nearly in parallel. Morphological change was not observed in the endothelium. CONCLUSIONS: Our confocal microscopic findings of keratoconus may help early diagnosis and assessment of prognosis in the management of keratoconus.
Bowman Membrane ; Cornea ; Descemet Membrane ; Early Diagnosis ; Endothelium ; Epithelium ; Epithelium, Corneal ; Healthy Volunteers ; Keratoconus* ; Microscopy, Confocal ; Prognosis

Orbscan-II anterior system was used for early diagnosis of keratoconus. 48 Eyes of 24 patients with suspicious keratoconus were examined by Orbscan-II anterior system from Dec. 1999 to Dec. 2000 and followed up. The values of Diff and anterior chamber depth (ACD) were recorded. Results indicated that values of Diff and ACD were increased in 4 eyes of 2 patients with keratoconus trend during follow-up. Taking advantage of Orbscan-II anterior system to observe the values of Diff and ACD can early diagnose the sub-clinical keratoconus. The values of Diff and ACD can sensitively report the progression of keratoconus.
Adolescent ; Adult ; Anterior Chamber ; pathology ; Cornea ; pathology ; Corneal Topography ; instrumentation ; methods ; Evaluation Studies as Topic ; Female ; Humans ; Keratoconus ; diagnosis ; diagnostic imaging ; Male ; Ultrasonography

Orbscan-II anterior system was used for early diagnosis of keratoconus. 48 Eyes of 24 patients with suspicious keratoconus were examined by Orbscan-II anterior system from Dec. 1999 to Dec. 2000 and followed up. The values of Diff and anterior chamber depth (ACD) were recorded. Results indicated that values of Diff and ACD were increased in 4 eyes of 2 patients with keratoconus trend during follow-up. Taking advantage of Orbscan-II anterior system to observe the values of Diff and ACD can early diagnose the sub-clinical keratoconus. The values of Diff and ACD can sensitively report the progression of keratoconus.
Anterior Chamber/pathology ; Cornea/pathology ; Corneal Topography/*instrumentation ; Corneal Topography/methods ; Evaluation Studies ; Keratoconus/*diagnosis ; Keratoconus/ultrasonography