Cornea
Herpetic Eye Disease Study (HEDS 1, HEDS2), 1994 and after ⏩ and ⏩
n=260
Various treatments for herpetic corneal disease.
Topical steroids for stromal keratitis: Topical steroids (q8d)+trifluridine vs trifluridine alone. Results: Steroid group had faster resolution, 68% less progression for anterior-kerato-uveitis cases. Taper of 8w. Delaying steroidal treatment had no effect on final VA at 6mo.
Oral Acyclovir for stromal keratitis: 400mg acyclovir *5 versus placebo for 10w. Topical steroidal for both groups. Follow-up 6m. Results: oral acyclovir had no effect on time to resolution or final VA.
Oral acyclovir for herpes simplex virus iritis: 400mg acyclovir *5 versus placebo for 10w. Topical steroidal tx and trifluridine for both groups. Follow-up 6m. Results: Treatment failure occurred in 50% in acyclovir vs 68% of placebo. Too small for statistic significance.
Oral acyclovir for prevention of stromal keratitis or iritis in patients with epithelial herpes simplex virus: All got opical trifluridine. 400mg acyclovir*5/d vs placebo for 3w. Results: No apparent benefit of a 3-week course of oral acyclovir in preventing HSV stromal keratitis or iritis, 1y followup.
Oral acyclovir for prevention of recurrent herpes simplex virus and prophylaxis..
400 mg oral acyclovir q2d versus placebo for 12 months Resutls: recurrence rate of any type of ocular HSV during that period of treatment was 19% vs 32%.
Predictors of recurrent herpes simplex virus keratitis. 18% developed recurrent epithelial keratitis and 18% developed recurrent stromal keratitis. Hx of epithelial keratitis not a risk factor. Hx stromal keratitis increased the risk of stromal keratitis (strongly related to the number of previous episodes)
Demographics, age, sex, ethnicity, nonocular herpes, psychological stress, systemic infection, sunlight exposure, eye injury, menstruation, contact lens wear were not significant.
Collaborative Longitudinal Evaluation of Keratoconus Study (CLEK), 2007 ⏩
n=1200, 8y
Study question: Natural history of keratoconus. Annual checkups. Study results: Mean age 39. 65% use rigid contacts. 15% FHx. 19% had 10+ letter loss in BCVA. Mean increase of 1.6D of flat corneal meridian, with 24% with more than 3D. 20% had corneal scarring. Younger patients have more severe disease.
Tear Film & Ocular Surface Society Dry Eye Workshop I (TFOS DEWS I), 2007
Goal: Update the definition and classification of DED, Evaluate the epidemiology, pathophysiology, mechanism, and impact of DED, Develop recommendations for the diagnosis, management and therapy, Recommend the design of clinical trials. See TFOS DEWS II from 2017 below.
Mycotic Ulcer Treatment Trial 1 (MUTT 1), 2010 Click on me ð or me ð
n=260
Various treatments for herpetic corneal disease.
Topical steroids for stromal keratitis: Topical steroids (q8d)+trifluridine vs trifluridine alone. Results: Steroid group had faster resolution, 68% less progression for anterior-kerato-uveitis cases. Taper of 8w. Delaying steroidal treatment had no effect on final VA at 6mo.
Oral Acyclovir for stromal keratitis: 400mg acyclovir *5 versus placebo for 10w. Topical steroidal for both groups. Follow-up 6m. Results: oral acyclovir had no effect on time to resolution or final VA.
Oral acyclovir for herpes simplex virus iritis: 400mg acyclovir *5 versus placebo for 10w. Topical steroidal tx and trifluridine for both groups. Follow-up 6m. Results: Treatment failure occurred in 50% in acyclovir vs 68% of placebo. Too small for statistic significance.
Oral acyclovir for prevention of stromal keratitis or iritis in patients with epithelial herpes simplex virus: All got opical trifluridine. 400mg acyclovir*5/d vs placebo for 3w. Results: No apparent benefit of a 3-week course of oral acyclovir in preventing HSV stromal keratitis or iritis, 1y followup.
Oral acyclovir for prevention of recurrent herpes simplex virus and prophylaxis..
400 mg oral acyclovir q2d versus placebo for 12 months Resutls: recurrence rate of any type of ocular HSV during that period of treatment was 19% vs 32%.
Predictors of recurrent herpes simplex virus keratitis. 18% developed recurrent epithelial keratitis and 18% developed recurrent stromal keratitis. Hx of epithelial keratitis not a risk factor. Hx stromal keratitis increased the risk of stromal keratitis (strongly related to the number of previous episodes)
Demographics, age, sex, ethnicity, nonocular herpes, psychological stress, systemic infection, sunlight exposure, eye injury, menstruation, contact lens wear were not significant.
Collaborative Longitudinal Evaluation of Keratoconus Study (CLEK), 2007 ⏩
n=1200, 8y
Study question: Natural history of keratoconus. Annual checkups. Study results: Mean age 39. 65% use rigid contacts. 15% FHx. 19% had 10+ letter loss in BCVA. Mean increase of 1.6D of flat corneal meridian, with 24% with more than 3D. 20% had corneal scarring. Younger patients have more severe disease.
Tear Film & Ocular Surface Society Dry Eye Workshop I (TFOS DEWS I), 2007
Goal: Update the definition and classification of DED, Evaluate the epidemiology, pathophysiology, mechanism, and impact of DED, Develop recommendations for the diagnosis, management and therapy, Recommend the design of clinical trials. See TFOS DEWS II from 2017 below.
Mycotic Ulcer Treatment Trial 1 (MUTT 1), 2010 Click on me ð or me ð
n=120, 3m
Study question: RCT, topical natamycin VS topical voriconazole with or without repeated scraping of the epithelium for fungal keratitis (VA 20/40 to 20/400)
Study results: BSCVA was better (1.4 lines, not statistically significant) in the natamycin group. Smear-positive Fusarium patients were 4.1 lines better in the Natamycin group compared to those treated with voriconazole. Corneal perforation and/or the TPK was more likely in patients who received voriconazole. Reepithelialization time and 3- month infiltrate or scar size were not significantly different. Natamycin was more effective in clearing culture positivity after 6 days (15% vs. 48%). Fungal corneal ulcer cases with filamentous fungal keratitis, particularly the Fusarium species, natamycin had a better outcome. See also MUTT 2
Corticosteroids for bacterial keratitis: the Steroids for Corneal Ulcers Trial (SCUT), 2012 ⏩ and ⏩
n=500, 3m
Study question: Randomized, placebo-controlled, double-masked, multicenter clinical trial comparing prednisolone sodium phosphate, 1.0%, to placebo as adjunctive therapy for the treatment of bacterial corneal ulcers. Study results: No significant difference was observed in the 3-month BCVA, infiltrate/scar size, time to reepithelialization or corneal perforation. Significantly better final BCVA for Steroidal tx in patients with baseline vision of counting fingers or worse and in patients with a central ulcer (+0.17 and 0.2+ logMAR). Less IOP in steroidal tx. Pseudomonas had a trend for better outcome w\ steroids. Nocardia had significantly worse with steroids (-1 line).
Long-term results of deep anterior lamellar versus penetrating keratoplasty, 2012 ⏩
n=284, 42-80m
Study question: Postoperative endothelial cell loss and long-term predicted graft survival PKP VS DALK. Study results: The average 5-year postoperative endothelial cell loss was -22.3% in the DALK group and -50.1% in the PK group. Median predicted graft survival was 49.0 years in the DALK group and 17.3 years in the PK group. The average VA was lower in the manual dissection subgroup compared with the PK group and with the big-bubble subgroup. The average thickness of the residual recipient stroma (OCT) was 87±26 Ξm in the manual dissection subgroup. Not correlated to VA at any time post-operatively.
Study question: Delphi consensus Study results: Definition of Keratoconus consists of: abnormal posterior elevation, abnormal corneal thickness and non-inflammatory corneal thinning. Keratoconus and PMD are the on the same spectrum of disease. Posterior elevation is essential for early dx. Pachymetry is the least reliable indicator for dx. Ectasia progression defined as progression in 2/3: anterior steepening, posterior steepening or thinning. Change in VS is not required to dx progression. Consider CXL for stable young patients. Improve VA for stable patients with glasses/contacts/scleral lens/ICRS/DALK/PK
n=120, 3m
Study question: RCT, Augmentation with oral voriconazole VS placebo for fungal keratitis. All patients received topical voriconazole 1% and topical natamycin 5%.
Study results: No significant difference in BCVA, perforation, TPK. Decreased rate of perforation or TPK in Fusarium ulcers tx with PO voriconazole. Significantly more adverse events in the oral tx group. See also MUTT 1
Tear Film & Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II), 2017 ⏩ or in full
Goal: Update the definition and classification of DED, Evaluate the epidemiology, pathophysiology, mechanism, and impact of DED, Develop recommendations for the diagnosis, management and therapy, Recommend the design of clinical trials. Results: DED is classified etiologically into two predominant and non-mutually exclusive categories: aqueous deficient (ADDE) and
evaporative (EDE) (Figure 1). Most DED is evaporative in nature. Dx is based on symptoms DEQ5 >=6 or OSDI >=13 and at least one hemostasis marker (TBUT<10s, Osmolarity >=308, staining of >5 corneal spots)
Abbreviations used on this page:
BCVA - Best corrected visual acuity
CXL - Corneal Cross linking
DALK - Deep anterior lamellar keratoplasty
DED - Dry eye disease
DEQ5 - The Dry Eye Questionnaire 5 see also this list
dx - diagnosis
FHx - Family history
HSV - Herpes simplex virus
ICSR - Intra corneal stromal rings
OCT - optical coherence tomography
OSDI - Ocular Surface Disease Index (OSDI)
PMD - Pellucid marginal degeneration
PK or PKP - Penetrating Keratoplasty
qwd - twice a day
TBUT - Tear break up time
VA - visual acuity
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