Complete Epithelial Healing Research Articles

Cryotherapy in Dendritic Keratitis.

This study evaluates the effectiveness of cryotherapy in the treatment of Dendritic Keratitis where antiviral agents are not available. The result show some improvement in visual acuity while one patient has a drop in vision. The extent of corneal scarring appears to depend on the duration of the disease and extent of stroma involvement. A coparative study with antiviral agents is recommended. To evaluate the effectiveness of cryotherapy in the treatment of Dendritic Keratitis where antiviral agents are not available. Ten patients with Dendritic Keratitis underwent cryotherapy by a freeze thaw technique at a temperature of between –40oC to –60oC. Six patient records were reviewed while the remaining four were prospectively followed up. Patients had Gutt atropine sulphate 1.0% and Oc. Chloramphenicol 1.0% in addition to their treatment. There was an improvement in the visual outcome of most patients with complete epithelial healing within ten days of the procedure. We recommended a comparative study with antiviral agents though cryotherapy can be considered where antiviral agents are not available.Nigerian Journal of Ophthalmology Vol. 9, No.1 (August 2001): pp 25-27KEY WORDS: Dendritic keratitis, cryotherapy, antiviral agents.

Corneal Wound Healing after Superficial Foreign Body Injury: Vitamin A and Dexpanthenol versus a Calf Blood Extract

A prospective randomized double-blind clinical study was performed to investigate corneal wound healing after treatment either with an eye gel containing calf blood extract or an eye ointment containing vitamin A and dexpanthenol. A total of 54 outpatients were included in this study, all treated for corneal foreign body injury. The size of the corneal lesions was measured by planimetry on days 0, 1, and on the following days until complete epithelial healing occurred. Results showed the calf blood extract eye gel to be statistically more effective in promoting corneal wound healing, especially in patients with wound areas larger than 6 mm².

Dilute Topical Proparacaine for Pain Relief after Photorefractive Keratectomy

The purpose of the study is to determine whether there is a nonanesthetic and nontoxic concentration of topical proparacaine that can be applied repeatedly to the cornea to reduce pain after photorefractive keratectomy (PRK). Part I: To determine a nonanesthetic concentration, the corneal sensitivity of 50 healthy volunteers was assessed using aesthesiometry before and after a drop of either 0.01%, 0.025%, 0.05%, 0.1%, or 0.2% topical proparacaine. Ten volunteers similarly were tested with multiple doses of 0.05% proparacaine. To evaluate toxicity, ten healthy volunteers self-administered 0.05% proparacaine to one eye and placebo to the other eye every 15 minutes for 12 hours on day 1 and every hour for 12 hours on days 2 through 7. Subjects were assessed throughout the week using visual acuity, slitlamp examination, aesthesiometry, and ultrasonic pachometry. Part II: In a prospective, double-masked study, 34 patients who underwent PRK (48 eyes) self-administered either topical 0.05% proparacaine or placebo for 1 week after PRK as needed to reduce pain. Patients recorded their pain score before and after drop use and answered a pain-relief questionnaire. Part I: Proparacaine concentrations greater than or equal to 0.1% eliminated sensation from some corneas; concentrations of less than or equal to 0.05% were never fully anesthetic. No corneal toxicity was observed except for some minimal punctate staining in both treatment and placebo eyes. Part II: Patients in the treatment group had significantly more pain relief (P < 0.001) for a longer period (P < 0.001) than did patients in the control group. Average change in pain score was significantly greater in the treatment group (P < 0.002). No significant difference in the number of days needed to reach complete epithelial healing was found between the two groups (P < 0.18). Dilute (0.05%) topical proparacaine is nonanesthetic and nontoxic, and can be used safely for at least 1 week to reduce pain after PRK.

Treatment of chronic postoperative otorrhea with cultured keratinocyte sheets.

Cultured allogeneic ear keratinocyte sheets were used to treat 26 ears presenting with long-standing (average 37 months) chronic otorrhea, resistant to regular treatment, long after surgery for atresia (n = 8), cholesteatoma (n = 10), and chronic otitis media (n = 8). Complete epithelial healing and cessation of otorrhea were obtained in 18 cases (69%), following an average of 2.2 weekly applications. Temporary epithelial healing lasting at least 3 months was observed in 3 patients (12%) subsequently needing repeated applications. Lack of complete epithelialization was documented in 5 cases (19%). In 3 of those 5 cases, a reason could be determined. The authors speculate that the allocultured keratinocytes are able to promote migration and proliferation of resident cells at the wound edges, despite their short survival time, by release of keratinocyte-stimulating factors.

Corneal Wound Healing Modulation Using Basic Fibroblast Growth Factor After Excimer Laser Photorefractive Keratectomy

Photorefractive keratectomy with the 193-nm excimer laser is one of the most promising innovations in refractive surgery. However, routine clinical application is hindered by two main obstacles, i.e., postoperative subepithelial opacity and possible regression of the refractive result. Because we have previously demonstrated beneficial effects of basic fibroblast growth factor (bFGF) on corneal epithelial healing in different in vivo models, we investigated the influence on both epithelial and stromal healing of topical bFGF after excimer laser keratomileusis in a rabbit model. After 7-mm circular deepithelialization, the eyes of 24 New Zealand White rabbits received identical deep stromal laser ablations (depth 50 microns, 6 D, diameter 5 mm) and were randomly assigned to one of four treatment groups [control (phosphate-buffered saline, PBS), bFGF 10 micrograms/application, dexamethasone 0.1%, bFGF + dexamethasone, n = 12 eyes/group]. All treatments were administered four times daily--bFGF until complete epithelial healing, dexamethasone and PBS until 3 months postsurgery. Wound surface regression on time was determined by means of computer-assisted image analysis of fluorescein-stained corneas. Corneal opacity was observed biomicroscopically and graded using a previously established scoring system. After bFGF application for 2-3 days only, a highly significant acceleration in epithelial wound healing speed was found compared with the rate of the other three treatment groups (p < 0.001). A combined therapy (bFGF + steroid) had no effect on the healing rate. Compared with control values, mean scores for subepithelial haze in the other groups were found to be nearly 50% lower during the first 2 postoperative months.(ABSTRACT TRUNCATED AT 250 WORDS)

The Effect of a Collagen Bandage Lens on Corneal Wound Healing: A Preliminary Report

Collagen bandage lenses were inserted in 24 eyes of white New Zealand rabbits following 8-incision radial keratotomy. Specimens were examined at eight and 24 hours by light and electron microscopy. Treated eyes demonstrated more complete epithelial healing, as evidenced by surface microvilli and differentiation into multi-layers. In the treated eyes there was reduced stromal edema at the wound site, and reactive keratocytes were limited to the wound margins. Collagen bandage lenses therefore may be useful in the treatment of a variety of ocular surface problems.

External Diseases

Debridement may be a useful adjunct to antiviral therapy for the treatment of herpes simplex dendritic keratitis. Impression debridement may be superior to presently accepted forms of mechanical debridement including blunt spatula and minimal wiping since it avoids damage to the basement membrane, avoids spread of infectious viral particles, and allows the immediate initiation of antiviral therapy. Impression debridement is performed by application of cellulose acetate filter paper to the dendrite. Infected cells adhere to the filter paper and are lifted off while uninfected epithelial cells remain on the corneal surface. Patient discomfort is minimal avoiding the need for patching. Impression debridement was applied to dendritic lesions produced in six BALB/c mice and to the corneas of four normal BALB/c mice. Immunoperoxidase histochemical staining techniques readily demonstrated herpes simplex virus (HSV) antigen-bearing cells adherent to the filter paper in all six infected mice. The four controls showed no staining. Five patients with herpes simplex dendritic keratitis were treated with impression debridement combined with trifluorothymidine therapy. Complete epithelial healing occurred in all five cases within four days without observed recurrences.

A Randomized Trial of Topical Corticosteroids in Epithelial Healing after Keratoplasty

A prospective randomized trial evaluating the effect of topical 1% prednisolone acetate on epithelial defects after keratoplasty in 39 patients (18 in the untreated group and 21 in the treated group) failed to reveal any significant differences in healing between the two groups (p less than 0.16 to p less than 0.54 on post-operative days 1-5). The mean time needed for complete healing was 1.94 days in the untreated group and 2.81 days in the steroid treated group (p less than 0.09). Patients given subconjunctival methylprednisolone sodium succinate had larger initial defects (mean 33.5 mm2) than those not given subconjunctival steroids (mean 16.1 mm2), but the time for complete epithelial healing did not differ significantly (2.75 days vs. 1.91 days; p less than 0.14). As clinically used post-keratoplasty topical steroids do not appear to significantly delay epithelial healing in most patients.