Corneal Scarring Research Articles

Safety and Efficacy of Contact Lenses in Eyes After Simple Limbal Epithelial Transplantation.

The aim of this study was to evaluate the safety and efficacy of contact lenses (CLs) in eyes after simple limbal epithelial transplantation (SLET) for limbal stem cell deficiency (LSCD). This retrospective study included 61 eyes with partial or total LSCD which underwent SLET and were fitted with corneal or scleral rigid gas-permeable CLs. The primary outcome measure was best-corrected visual acuity (BCVA) with CLs. The median age at presentation was 22 years. The most common cause of LSCD was chemical injury [47/61 eyes (77%)]. Twenty-seven eyes (44%) were fitted with corneal rigid gas-permeable lenses, while 34 eyes (56%) were prescribed scleral lenses. The median duration of interval between SLET and CL trial was 10 months (interquartile range: 4-17). The median preoperative BCVA was logarithm of minimal angle of resolution (logMAR) 1.8. This improved to logMAR 1 (P < 0.001) after SLET and to logMAR 0.6 (P < 0.001) with CLs. Eyes with chemical injury (logMAR 1 vs. 0.6, P = 0.0001), grade 1 (logMAR 0.8 vs. 0.4, P < 0.0001), and grade 2 (logMAR 0.9 vs. 0.6, P = 0.004) corneal scarring had better improvement in BCVA with CLs. No complications were noted until the last follow-up visit. CLs, both corneal and scleral lenses, provide significant visual improvement in eyes after SLET with residual corneal scarring. These can be safely prescribed in such eyes without any adverse effects. This option can be considered before offering keratoplasty in these eyes.

Femtosecond Laser Capsulotomy in Previous Radial Keratotomy.

The aim of this study was to describe clinical experience using femtosecond laser-assisted anterior capsulotomy in eyes with previous radial keratotomy. Eyes of patients with previous radial keratotomy and cataract-related vision impairment who underwent phacoemulsification and intraocular lens implantation were retrospectively reviewed. Eyes with any vision impairment cause other than cataract or previous radial keratotomy were excluded. Sixteen postradial keratotomy eyes were included. In 5 patients, manual anterior capsulectomy was successfully performed. Six eyes underwent femtosecond laser capsulotomy using routine parameters (incision depth 500 μm and 4 μJ power), of which in 3 eyes capsulotomies were complete, whereas in the other 3 eyes incomplete capsulotomy was evident. In 3 patients, both incision depth and power parameters were doubled (incision depth 1000 μm and 8 μJ power), whereas in 2 patients, only the pulse energy was doubled (8 μJ power) and in all 6 cases, the capsulotomy was successfully completed. At the last follow-up, all capsulotomies were intact without radial tears, and the intraocular lenses were stable and central. Radial corneal scars after previous radial keratotomy may interfere with femtosecond laser-assisted anterior capsulotomy using routine parameters. Surgeons should be alert and ready to convert to manual anterior capsulectomy. Modification of the laser parameters may overcome this potential complication.

Disulfiram Ophthalmic Solution Inhibited Macrophage Infiltration by Suppressing Macrophage Pseudopodia Formation in a Rat Corneal Alkali Burn Model

FROUNT is an intracellular protein that promotes pseudopodia formation by binding to the chemokine receptors CCR2 and CCR5 on macrophages. Recently, disulfiram (DSF), a drug treatment for alcoholism, was found to have FROUNT inhibitory activity. In this study, we investigated the effect of DSF eye drops in a rat corneal alkali burn model. After alkali burn, 0.5% DSF eye drops (DSF group) and vehicle eye drops (Vehicle group) were administered twice daily. Immunohistochemical observations and real-time reverse transcription-polymerase chain reaction (RT-PCR) analyses were performed at 6 h and 1, 4, and 7 days after alkali burn. Results showed a significant decrease in macrophage accumulation in the cornea in the DSF group, but no difference in neutrophils. RT-PCR showed decreased expression of macrophage-associated cytokines in the DSF group. Corneal scarring and neovascularization were also suppressed in the DSF group. Low-vacuum scanning electron microscopy imaging showed that macrophage length was significantly shorter in the DSF group, reflecting the reduced extension of pseudopodia. These results suggest that DSF inhibited macrophage infiltration by suppressing macrophage pseudopodia formation.

Short-term visual outcome with sclerocorneal contact lens on irregular cornea.

The purpose is to study the change in visual acuity obtained with sclerocorneal contact lens (SCL) in patients with irregular corneal astigmatism. A prospective pre-post observational study was designed to include consecutive consenting patients with irregular corneal astigmatism and best-corrected visual acuity worse than 6/12 and fitted with SCL. Visual acuity was assessed using Snellen charts before fitting SCL and 1 week after the fit and converted to the equivalent logMAR units for analysis. We included 51 eyes of 41 patients with a mean age of 26.31 ± 8.86 of which 32 (78%) were men. Keratoconus was the most common indication (n = 42 eyes, 82.35%), followed by corneal scar (n = 3, 4%), post keratoplasty (n = 2, 4%), high myopia (n = 2, 4%), pellucid marginal degeneration (n = 1, 2%), and aphakia (n = 1, 2%). The mean overall uncorrected visual acuity improved significantly (P < 0.001) with SCL from 1.18 ± 0.34 logMAR (6/120 Snellen's equivalent) to 0.27 ± 0.15 (6/9 Snellen's equivalent) at 1-week post-SCL fitting. The mean overall best spectacle-corrected visual acuity improved from 0.89 ± 0.45 logMAR (6/36 Snellen's equivalent) to 0.26 ± 0.15 (6/9 Snellen's equivalent) at 1-week post-SCL fitting. Sclerocorneal contact lens improves visual acuity significantly in patients with irregular corneal astigmatism and reduces the need for corneal transplantation.

Study to Assess the Knowledge and Attitude Regarding Eye Donation Among Teaching Faculty of Selected Colleges in Hubli, Dharwa

Background The alteration in transparency of cornea leads to corneal scarring and blindness. Corneal blindness can be cured by transplantation. Donated cornea can give sight to four cornea blind patients yet the benefit of eye donation awareness is inadequate. The present study was designed to assess the knowledge and attitude towards eye donation.Objective To evaluate the knowledge and attitude towards eye donation among teaching faculty working in selected colleges.Methodology A descriptive study was designed to assess the knowledge and attitude of teaching faculty towards eye donation. A total of 100 teaching faculty from various colleges were selected using probability simple random sampling technique. A structured knowledge questionnaire and modified Likert attitude scale were designed to assess the objectives. The questionnaire showed content validity index of knowledge and attitude scale of 70 and 78 reliability for knowledge and attitude scale was 0.8 and 0.79 respectively. Results The results of the present study revealed that many participants had average knowledge and favorable attitude towards eye donation and there was no significant correlation between knowledge and attitude scores of the teaching faculty regarding eye donation.Conclusion Results of the study revealed that teaching staff had average knowledge and favorable attitude towards eye donation and there was no significant relation between knowledge and attitude implying the need to improve knowledge of teachers regarding eye donation and providing information on its benefits to the community.

Role of intracameral Caspofungin in the management of Aspergillus keratitis: A case report

Abstract A 48-year-old male patient with a history of fall of dust in his right eye while driving came for a second opinion. On examination, he had a dry-looking ulcer with feathery margins and a hypopyon, suggestive of fungal keratitis. Scraping showed septate fungal filaments. Aspergillus niger grew in culture, and the patient was asked to use frequent natamycin eye drops. However, the hypopyon continued to increase, so ketoconazole tablets were added. Intracameral injection of Amphotericin B was advised, but in view of a severe shortage of the drug in the region, injection of Caspofungin (CAS) was given intracamerally with patient consent. With a combination of oral, topical, and intracameral antifungal medication, the ulcer slowly resolved over a period of 1 month, leaving behind a nebulomacular corneal scar in a quiet eye. Intracameral CAS may provide a safe and effective alternative to voriconazole and amphotericin B in the setting of Aspergillus keratitis.

Monkeypox: An Uncommon Re-emerging Virus- Threat to Mankind

Monkeypox Virus (MPV) causes rare zoonotic illness. The Central African (or Congo Basin) clade and the West African clade are its two genetic subgroups, of which Central African subgroup is more lethal. To distinguish between the lineages, sequencing is crucial. As it was first isolated from captive monkeys that is why it is named as MPV. Its clinical features are similar to small pox. Undiagnosed acute rash with one or more symptoms, such as headache, fever, lymphadenopathy, myalgia, back pain, or asthenia, are considered common clinical findings. Real-Time Polymerase Chain Reaction (RT-PCR) is used in the laboratory diagnosis. There are various complications of monkeypox disease that includes bacterial infection of skin, skin scarring, hyper or hypopigmentation, permanent corneal scarring (vision loss), pneumonia, dehydration, sepsis, encephalitis and death. The drug of choice includes Tecovirimat, Cidofovir, Vaccinia Immune Globulin Intravenous (VIGIV), Brincidofovir. ACAM2000, LC16m8 and modified vaccinia Ankara are few options for vaccines but still under investigation. Though the disease is self-limiting but may complicate and has morbidity as well as mortality. So, it’s better to prevent the spread of the disease by early identification, contact tracing, isolation with stringent hospital infection control practices with early initiation of treatment.

Topical losartan inhibits corneal scarring fibrosis and collagen type IV deposition after Descemet's membrane-endothelial excision in rabbits

Topical losartan inhibits corneal scarring fibrosis and collagen type IV deposition after Descemet's membrane-endothelial excision in rabbits

Partial-thickness compression sutures without descemetopexy for management of acute hydrops in keratoconus: A novel surgical technique.

This article reports a novel surgical technique of partial-thickness compression sutures without descemetopexy with air or gas for the management of acute hydrops in keratoconus. Two patients presented with localized corneal edema with a Descemet membrane (DM) tear in the left eye. Tomography of the right eye revealed localized steepening with increased maximum keratometry and decreased central pachymetry. They were diagnosed with keratoconus in the right eye and acute corneal hydrops (ACH) in the left eye. Compression sutures were passed through the stroma without touching the DM. The anterior chamber was not entered at all at any point during the surgery. Resolution of edema was noted intraoperatively itself. Further resolution of edema was noted from the first postoperative day which markedly reduced within the first week. A corneal scar with no edema was seen at six weeks. In both the patients, vision at presentation was counting fingers close to face which improved to 20/60 and 20/50, respectively, at the last visit.

Corneal epithelial ingrowth after perforating corneal injury: a case report

BackgroundEpithelial ingrowth is a rare complication after ocular perforation and can become manifest many years after the primary trauma.Case presentationA 49-year-old patient presented with a positive Seidel test of unclear origin at her left eye, as well as a sharply defined anterior-stromal corneal scar at both eyes. Prior operations included a bilateral laser-assisted blepharoplasty 3 months earlier. The patient indicated to have been on holiday to France 5 months earlier, during an ongoing oak processionary moth caterpillars infestation.The examination using confocal microscopy confirmed a corneal perforation at the left eye and revealed corneal epithelial ingrowth capped with scarred stroma in both eyes. We performed a penetrating keratoplasty at the left eye. The scarred and perforated host cornea was divided into 4 pieces for further investigation: microbiology (negative), virology (negative), histology and transmission electron microscopy (TEM). Histology revealed differently structured epithelium, centrally inverted into the stroma through defects in Bowman’s layer. TEM revealed full thickness corneal perforation with an epithelial plug extending to the lower third of the cornea, but without evidence of epithelial cell migration into the anterior chamber.Our differential diagnosis of the unclear positive Seidel test with epithelial ingrowth was as follows: (1) corneal perforation by hairs of the oak processionary moth caterpillar, although no hairs could be found histologically; (2) corneal perforation during laser-assisted blepharoplasty, which may be supported by the presence of pigmented cells on the posterior surface of Descemet´s membrane, pointing to a possible iris injury.ConclusionConsequently, we highlighted that contact lenses can be useful, safe and inexpensive protective devices in upper eyelid procedures to protect the cornea against mechanical iatrogenic trauma.

En Bloc Keratolimbal Allograft and Central Penetrating Keratoplasty: A Novel Surgical Technique in Severe Limbal Stem Cell Deficiency.

The purpose of this study was to present a novel surgical technique combining 360-degree keratolimbal allograft (KLAL) and simultaneous central keratoplasty termed en bloc KLAL with the central penetrating keratoplasty (PKP) performed in those cases with total limbal stem cell deficiency (LSCD) and corneal scars. Nine eyes of 9 patients underwent en bloc KLAL and central PKP between 2014 and 2016. All patients had bilateral total LSCD with total corneal opacity due to different etiologies. The exclusion criteria were previous limbal stem cell transplantation and the presence of active and uncontrolled ocular surface inflammation. The same donor globe was used for harvesting 360-degree KLAL and central PKP. The 1-piece integrity of the KLAL and PKP graft was preserved during the described technique. All patients received modified immunosuppressive regimens compatible with the Cincinnati solid organ transplantation protocol. The average age of patients was 58.6 ± 18.6 years. The diagnosis was mustard gas keratopathy in 6, herpes simplex keratitis in 1, and severe acid chemical burn in 2 patients. Seven patients were male. An integrated ocular surface without epitheliopathy and a clear cornea was achieved in 8 patients (88.8%) with an average of 6.5 years in follow-up. The average best-corrected visual acuity was 1.89 ± 0.18 (20/1600) preoperatively which improved to 1.02 ± 0.64 (20/200) logMAR in the postoperative period. Endothelial immune rejection episodes were observed in 3 patients. KLAL rejection was not observed in any patient. One patient required repeat PKP due to corneal graft failure. En bloc 360-degree KLAL and central PKP could simultaneously be performed in patients with total LSCD and corneal opacification.

Infectious crystalline keratopathy following Descemet's stripping automated endothelial keratoplasty.

We describe this first case of Staphylococcus epidermidis causing infectious crystalline keratopathy (ICK) following Descemet stripping endothelial keratoplasty (DSAEK), that resolved after 5 weeks of topical antibiotic and corticosteroid treatment. An 80-year-old woman presented with blurred vision, redness, and ocular pain 9 months after successful DSAEK. Slit lamp examination revealed the presence of white, non-suppurative, deep-branching stromal infiltrates, and a clinical diagnosis of ICK was made. Cultures of corneal scapings isolated multidrug-resistant Staphylococcus epidermidis. No subsequent surgical procedures were performed. Based on antibiotic sensitivity analysis, she was treated successfully with topical vancomycin and chloramphenicol for 5 weeks. Complete resolution of the infection with minor anterior stromal corneal scarring of the host cornea was noted after 5 weeks of treatment. This case report describes the diagnosis and management of ICK after DSAEK and reviews the relevant literature regarding the occurrence of ICK after DSAEK. In this case, vancomycin and chloramphenicol allowed for the uncomplicated resolution of infection with only minor visual impairment from baseline.

Vogt striae: Demystified

BackgroundTo study the correlation of different variables of Vogt striae to other attributes of keratoconus and to suggest a new grading system for Vogt striae to exactly represent the configuration and extent in each individual keratoconic cornea. MethodsThe study was an observational and data review study. A total of 386 eyes of 207 keratoconus patients were screened from February 2016 to August 2018. Patients with prior history of collagen cross linking were excluded from the study as measurement of corneal thickness is less reliable for many months after collagen cross linking, and patients may have superficial corneal striae and scarring after collagen cross linking. Patients with history or clinical features suggestive of corneal hydrops or who had undergone lamellar or full thickness corneal transplants and intracorneal ring segments were also excluded from the study. ResultsOf total 52 eyes with Vogt striae, 31 eyes (59.6%) had vertical orientation, 3 (5.8%) had horizontal, 11 (21.2%) had oblique while 7 eyes (13.5%) had mixed orientation of Vogt striae. Mean uncorrected distance visual acuity (UCVA) in the vertical group was 0.76 logMAR, horizontal group was 0.80 logMAR, oblique group was 0.65 logMAR, and mixed group was 1.17 logMAR units. Corneal scarring was present in 15 eyes (28.8%) and absent in 37 (71.2%) eyes with Vogt striae. In the mixed Vogt striae group, 85.7% eyes (6 eyes of 7) had corneal scarring, while 16.1% in vertical group (5 eyes of 31), and 27.3% in oblique group (3 of 11) had corneal scarring. Based on three attributes of Vogt striae, that is orientation, number, and corneal scarring, a new grading for Vogt striae was also suggested. ConclusionThis is the first study to report the presence of mixed Vogt striae (combination of horizontal and/or vertical and/or oblique Vogt striae in a single cornea) in cases of keratoconus. For the first time, oblique Vogt striae have been described, and clear limits have been set to call it horizontal, oblique, or vertical striae. A new grading for Vogt striae is also suggested.

The TGM2 inhibitor cysteamine hydrochloride does not impact corneal epithelial and stromal wound healing in vitro and in vivo

Corneal wound healing is integral for resolution of corneal disease or for post-operative healing. However, corneal scarring that may occur secondary to this process can significantly impair vision. Tissue transglutaminase 2 (TGM2) inhibition has shown promising antifibrotic effects and thus holds promise to prevent or treat corneal scarring. The commercially available ocular solution for treatment of ocular manifestations of Cystinosis, Cystaran®, contains the TGM2 inhibitor cysteamine hydrochloride (CH). The purpose of this study is to assess the safety of CH on corneal epithelial and stromal wounds, its effects on corneal wound healing, and its efficacy against corneal scarring following wounding. Quantitative polymerase chain reaction (qPCR) and immunohistochemistry (IHC) were first used to quantify and localize TGM2 expression in the cornea. Subsequently, (i) the in vitro effects of CH at 0.163, 1.63, and 16.3 mM on corneal epithelial cell migration was assessed with an epithelial cell migration assay, and (ii) the in vivo effects of application of 1.63 mM CH on epithelial and stromal wounds was assessed in a rabbit model with ophthalmic examinations, inflammation scoring, color and fluorescein imaging, optical coherence tomography (OCT), and confocal biomicroscopy. Post-mortem assessment of corneal tissue post-stromal wounding included biomechanical characterization (atomic force microscopy (AFM)), histology (H&E staining), and determining incidence of myofibroblasts (immunostaining against α-SMA) in wounded corneal tissue. TGM2 expression was highest in corneal epithelial cells. Application of the TGM2 inhibitor CH did not affect in vitro epithelial cell migration at the two lower concentrations tested. At 16.3 mM, decreased cell migration was observed. In vivo application of CH at 57 mM was well tolerated and did not adversely affect wound healing. No difference in corneal scarring was found between CH treated and vehicle control eyes. This study shows that the TGM2 inhibitor CH, at the FDA-approved dose, is well tolerated in a rabbit model of corneal wound healing and does not adversely affect epithelial or stromal wound healing. This supports the safe use of this medication in Cystinosis patients with open corneal wounds. CH did not have an effect on corneal scarring in this study, suggesting that Cystaran® administration to patients with corneal wounds is unlikely to decrease corneal fibrosis.

Femtosecond laser-assisted Bowman layer transplantation for advanced keratoconus.

To assess the technical feasibility and outcomes of femtosecond laser-assisted Bowman layer transplantation (FLABOLT) in stabilizing progressive, advanced keratoconus, which is ineligible for corneal crosslinking. This single-center retrospective study included 50 eyes of 49 patients with progressive advanced keratoconus, ineligible for corneal crosslinking, that underwent FLABOLT with both the donor graft and recipient mid-stromal pocket using a femtosecond laser. The mean follow-up was 13.2 ± 4.9 months (range 7-35 months). Donor graft preparation and accurate dissection of the recipient mid-stromal pocket were successful in 96% and 100% of cases, respectively. The mean maximum keratometry decreased by 1.93 D at 6 months after surgery and there was no change in the mean preoperative best contact lens-corrected visual acuity (BCLVA). Three eyes developed hydrops postoperatively and recovered after clinical treatment. One eye that achieved useful BCLVA postoperatively, worsened 2 years after the surgery due to progressive corneal scarring and required corneal transplantation for visual rehabilitation. Preoperative corneal scarring was a risk factor for BCLVA loss. All other eyes remained stable (92%), and no other procedure was required until the last follow-up. In this series, FLABOLT was successfully performed as an alternative to stabilize advanced progressive keratoconus. This technique is highly reproducible for graft preparation and recipient pocket dissection when assisted by femtosecond laser. Despite promising initial results, more studies with longer follow-up periods are needed to evaluate the effectiveness of FLABOLT in stabilizing advanced progressive keratoconus.

The Soluble Guanylate Cyclase Stimulator BAY 41-2272 Attenuates Transforming Growth Factor β1-Induced Myofibroblast Differentiation of Human Corneal Keratocytes

Corneal transparency, necessary for vision and depending on the high organization of stromal extracellular matrix, is maintained by keratocytes. Severe or continuous corneal injuries determine exaggerated healing responses resulting in the formation of irreversible fibrotic scars and vision impairment. Soluble guanylate cyclase (sGC) stimulation demonstrated antifibrotic effects in both experimental fibrosis and human lung and skin fibroblasts. Here, we assessed whether sGC stimulation with BAY 41-2272 could attenuate transforming growth factor β1 (TGFβ1)-induced myofibroblast differentiation of human corneal keratocytes. Cells were challenged with TGFβ1, with/without BAY 41-2272 preincubation, and subsequently assessed for viability, proliferation, migration, chemoinvasion, as well for the expression of myofibroblast/fibroblast activation markers and contractile abilities. Treatment with BAY 41-2272 did not affect keratocyte viability, while preincubation of cells with the sGC stimulator was able to inhibit TGFβ1-induced proliferation, wound healing capacity, and invasiveness. BAY 41-2272 was also able to attenuate TGFβ1-induced myofibroblast-like profibrotic phenotype of keratocytes, as demonstrated by the significant decrease in ACTA2, COL1A1, COL1A2, FN1 and PDPN gene expression, as well as in α-smooth muscle actin, α-1 chain of type I collagen, podoplanin, vimentin and N-cadherin protein expression. Finally, BAY 41-2272 significantly counteracted the TGFβ1-induced myofibroblast-like ability of keratocytes to contract collagen gels, reduced phosphorylated Smad3 protein levels, and attenuated gene expression of proinflammatory cytokines. Collectively, our data show for the first time that BAY 41-2272 is effective in counteracting keratocyte-to-myofibroblast transition, thus providing the rationale for the development of sGC stimulators as novel promising modulators of corneal scarring and fibrosis.

The chameleon of herpetic keratitis

AbstractIn Europe, herpes simplex virus type I (HSV) is a common cause of keratitis. The disease may be well treated if the ophthalmologist is aware of the various types of clinical expressions of this typical unilateral chameleon, and treatment is adjusted accordingly. Types of expression include 1. epithelial keratitis (dendritica/ geographica), 2. stromal keratitis (necrotizing “ulcer” “vs. non‐necrotizing = interstitial keratitis”), 3. endotheliitis (= “disciform keratitis”), 4. so‐called “metaherpetic keratitis” (= neurotrophic keratopathy), 5. (vascularized) corneal scars. In the acute phase, concomitant ocular hypertension should be treated predominantly without surgery (no prostaglandin analoga!). After keratoplasty and in case of severe recurrences of herpetic keratitis, systemic acyclovir application (2 × 400 mg/day) for at least 1 year is indispensable! In 1.5% of corneal excisions during keratoplasty, HSV PCR is positive without clinical suspicion of herpetic keratitis. This may be one reason for primary or secondary graft failure and needs adequate treatment.

Cytokine profile of human limbal myofibroblasts: Key players in corneal antiviral response.

Corneal transparency may be compromised by viral infections causing corneal scarring, edema, and neovascularization. Ocular injury results from collateral damage induced by exacerbated immune response in corneal stroma. Myofibroblasts play a key role in this process by producing a disorganized extracellular matrix and inflammatory mediators. However, the immune response profile of myofibroblasts during viral infections is still under study. The aim of this work was to analyze the cytokine profile of human limbal myfibroblasts (HLMs) stimulated with the double-stranded RNA analog polyinosinic:polycytidylic acid (poly I:C) and to identify their signaling pathways. HLMs were isolated from cadaveric sclera-corneal rims and stimulated with poly I:C (10μg/ml) for 12h. The secretion of 36 cytokines was measured using the Human Cytokine Array Panel A. The secretion of IFN-β was quantified by ELISA. The expression of pattern recognition receptors (PRRs) such as TLR3, RIG-1 and MDA5 were analyzed by western blot assays. Furthermore, translocation of the nuclear factors NF-κB, IRF3, and IRF7 was assessed by fluorescence staining. In addition, the differentially expressed cytokines were analyzed using the Core Analysis Tool of the Ingenuity Pathway Analysis IPA software. HLMs stimulated with poly I:C increased (fold change&gt;2) the secretion of G-CSF, sTREM-1, CXCL1, CCL1, CXCL8, CXCL10, CXCL11, CCL2, CCL5, IL-13, IL-6, IL-1ra, and IFN-β compared with HLMs under basal conditions. Poly I:C stimulation also induced the expression of RIG-1 (p&lt;0.001), but the expression of TLR3 and MDA5 was unmodified. Finally, HLMs increased nuclear translocation of NF-κB, IRF3, and IRF7 after poly I:C stimulation. Bioinformatic analysis identified canonical signaling pathways associated with cell adhesion and diapedesis, chemokine signaling, and activation of IRFs by cytosolic pattern recognition receptors. These results demonstrate that HLMs secrete cytokines involved in immune cell activation and chemotaxis. The data suggest a key role for HLMs during viral infections in cornea and extend our knowledge about the signaling pathways they trigger.

Targeting corneal dystrophies for genetic treatment; challenges and limitations

AbstractThe cornea is an ideal organ for gene therapy. Its immune‐privileged status, effortless accessibility for treatment with gene therapy agents and visual monitoring are significant aspects for gene therapy. Various viral and non‐viral vectors have been tested for delivering genes to the cornea. Viral vectors offer several fold higher transduction efficiencies and long‐term gene expression compared to non‐viral vectors.Gene therapy is also an attractive approach for the treatment of ocular surface disorders such as corneal scarring and neovascularization. Over‐expression of vasoinhibin‐1 or decorin, can reduce corneal neovascularization.Genetic engineering for corneal dystrophies treatment is at the very early stage. Potential treatments for FECD and TGFBI‐related corneal dystrophies may provide some therapeutic benefit.

Straylight in clinical practice

AbstractStraylight is an optical phenomenon where light is scattered in the eye. This causes a veil of light over the retina and thereby reduces the contrast of the image projected on the retina. Clinically, it may cause disability glare where people are blinded by a sun that sits low in the sky or by headlights of upcoming cars at night. Various ocular pathologies may cause an increase in straylight in the eye. Examples are cataract, corneal dystrophies, corneal scars, vitreous opacities, and opacifications of the intraocular lens. However, patients are not always aware that their complaints are (at least partly) due to increased straylight. In addition, it is not always recognized by clinicians that patients are bothered by straylight. Furthermore, interestingly, cataract surgery may actually increase straylight in the eye when surgery is performed too early. In this presentation, I will focus on various ocular pathologies that may cause increased straylight, and how to use straylight in clinical decision making.