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      Corneal Biomechanics Determination in Healthy Myopic Subjects

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          Abstract

          Purpose. To determine the corneal biomechanical properties by using the Ocular Response Analyzer and to investigate potential factors associated with the corneal biomechanics in healthy myopic subjects. Methods. 135 eyes from 135 healthy myopic subjects were included in this cross-sectional observational study. Cornea hysteresis (CH), corneal resistance factor (CRF), cornea-compensated intraocular pressure (IOPcc), and Goldmann-correlated intraocular pressure (IOPg) were determined with the Reichert Ocular Response Analyzer (ORA). Univariate and multivariate regression analyses were performed to investigate factors associated with corneal biomechanics. Results. The mean CH and CRF were 9.82 ± 1.34 mmHg and 9.64 ± 1.57 mmHg, respectively. In univariate regression analysis, CH was significantly correlated with axial length, refraction, central corneal thickness (CCT), and IOPg ( r = −0.27, 0.23, 0.45, and 0.21, resp.; all with p ≤ 0.015), but not with corneal curvature or age; CRF was significantly correlated with CCT and IOPg ( r = 0.52 and 0.70, resp.; all with p < 0.001), but not with axial length/refraction, corneal curvature, or age. In multivariate regression analysis, axial length, IOPcc, and CCT were found to be independently associated with CH, while CCT and IOPg were associated with CRF. Conclusions. Both CH and CRF were positively correlated with CCT. Lower CH but not CRF was associated with increasing degree of myopia. Evaluation of corneal biomechanical properties should take CCT and myopic status into consideration.

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          Most cited references44

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          Determining in vivo biomechanical properties of the cornea with an ocular response analyzer.

          David Luce (2005)
          To study the results of an ocular response analyzer (ORA) to determine the biomechanical properties of the cornea and their relationship to intraocular pressure (IOP). Reichert Inc., Depew, New York, USA. The ORA (Reichert) makes 2 essentially instantaneous applanation measurements that permit determination of corneal and IOP effects. Measurements of several populations indicate that corneal hysteresis, a biomechanical measure, varied over a dynamic range of 1.8 to 14.6 mm Hg and was only weakly correlated with corneal thickness (r(2)=0.12); this is related to the observation that some subjects with relatively thick corneas have less-than-average corneal hysteresis. Corneal hysteresis changes diurnally, presumably as a result of hydration changes. Keratoconus, Fuchs' dystrophy, and post-LASIK patients demonstrated low corneal hysteresis. The corneal hysteresis biomechanical measure may prove valuable for qualification and predictions of outcomes of refractive surgery and in other cases in which corneal biomechanics are important.
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            Corneal biomechanical properties in normal, post-laser in situ keratomileusis, and keratoconic eyes.

            To compare the biomechanical properties of normal, post-laser in situ keratomileusis (LASIK), and keratoconic corneas evaluated by corneal hysteresis and the corneal resistance factor measured with the Reichert Ocular Response Analyzer (ORA). Instituto Oftalmológico de Alicante, Vissum, Alicante, Spain. Two hundred fifty eyes were divided into 3 groups: normal (control group), post-LASIK, and keratoconus. The corneal biomechanical properties were measured with the ORA, which uses a dynamic bidirectional applanation process. The main outcome measures were intraocular pressure, corneal hysteresis, and the corneal resistance factor. The control group had 165 eyes; the LASIK group, 65 eyes; and the keratoconus group, 21 eyes. In the control group, the mean corneal hysteresis value was 10.8 mm Hg +/- 1.5 (SD) and the mean corneal resistance factor, 11.0 +/- 1.6 mm Hg. The corneal hysteresis value was lower in older eyes, and the difference between the youngest age group (9 to 14 years) and oldest age group (60 to 80 years) was statistically significant (P = .01, t test). One month after LASIK, corneal hysteresis and the corneal resistance factor decreased significantly, from 10.44 to 9.3 mm Hg and from 10.07 to 8.13 mm Hg, respectively. In the keratoconus group, the mean corneal hysteresis was 7.5 +/- 1.2 mm Hg and the mean corneal resistance factor, 6.2 +/- 1.9 mm Hg. There were statistically significant differences in both biomechanical parameters between keratoconic eyes and post-LASIK eyes (P<.001, t test). The corneal hysteresis and corneal resistance factor values were significantly lower in keratoconic eyes than in post-LASIK eyes. Future work is needed to determine whether these differences are useful in detecting keratoconus when other diagnostic tests are equivocal.
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              Risk factors and prognosis for corneal ectasia after LASIK.

              To review cases of corneal ectasia after laser in situ keratomileusis (LASIK), identify preoperative risk factors, and evaluate methods and success rates of visual rehabilitation for these cases. Retrospective nonrandomized comparative trial. Ten eyes from seven patients identified as developing corneal ectasia after LASIK, 33 previously reported ectasia cases, and two control groups with uneventful LASIK and normal postoperative courses: 100 consecutive cases (first control group), and 100 consecutive cases with high myopia (> 8 diopters [D]) preoperatively (second control group). Retrospective review of preoperative and postoperative data for each case compared with that of previously reported cases and cases with uneventful postoperative courses. Preoperative refraction, topographic features, residual stromal bed thickness (RSB), time to the development of ectasia, number of enhancements, final best-corrected visual acuity (BCVA), and method of final correction. Length of follow-up averaged 23.4 months (range, 6-48 months) after LASIK. Mean time to the development of ectasia averaged 16.3 months (range, 1-45 months). Preoperative refraction averaged -8.69 D compared with -5.37 D for the first control group (P = 0.005). Preoperatively, 88% of ectasia cases met criteria for forme fruste keratoconus, compared with 2% of the first control group (P < 0.0000001) and 4% of the second control group (P = 0.0000001). Seven eyes (70%) had RSB <250 microm, as did 16% of eyes in the first control group and 46% of the second control group. The mean RSB for ectasia cases (222.8 microm) was significantly less than that for the first control group (293.6 micro m, P = 0.0004) and the second control group (256.5 microm; P = 0.04). Seven eyes (70%) had enhancements. Only 10% of eyes lost more than one line of BCVA, and all patients eventually achieved corrected vision of 20/30 or better. One case required penetrating keratoplasty (10%), while all others required rigid gas-permeable contact lenses for correction. Significant risk factors for the development of ectasia after LASIK include high myopia, forme fruste keratoconus, and low RSB. All patients had at least one risk factor other than high myopia, and significant differences remained even when controlling for myopia. Multiple enhancements were common among affected cases, but their causative role remains unknown. We did not identify any patients who developed ectasia without recognizable preoperative risk factors.
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                Author and article information

                Journal
                J Ophthalmol
                J Ophthalmol
                JOPH
                Journal of Ophthalmology
                Hindawi Publishing Corporation
                2090-004X
                2090-0058
                2016
                21 July 2016
                : 2016
                : 2793516
                Affiliations
                Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong Province 515041, China
                Author notes

                Academic Editor: Suphi Taneri

                Author information
                http://orcid.org/0000-0001-9032-7274
                Article
                10.1155/2016/2793516
                4972914
                27525109
                7eb9b26f-26f9-4fe0-9b41-227cc35c5dbc
                Copyright © 2016 Kunliang Qiu et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 May 2016
                : 22 June 2016
                : 28 June 2016
                Funding
                Funded by: National Natural Science Foundation of China
                Award ID: 81486126
                Funded by: Science and Technology Planning Project of Guangdong Province
                Award ID: 2013B022000091
                Funded by: Joint Shantou International Eye Center
                Award ID: 10-004
                Funded by: Clinical Research Upgrading Plan of SUMC
                Award ID: 201417
                Funded by: Foundation for Distinguished Young Talents in Higher Education of Guangdong
                Award ID: 2014KQNCX075
                Categories
                Research Article

                Ophthalmology & Optometry
                Ophthalmology & Optometry

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