Corneal Scarring Research Articles

Role of corneal epithelial mapping, Corvis biomechanical index, and artificial intelligence-based tomographic biomechanical index in diagnosing spectrum of keratoconus.

The aim of the study was to evaluate the utility of epithelial mapping, Corvis biomechanical index (CBI), and tomographic biomechanical index (TBI) in diagnosing the spectrum of keratoconus (KC). This was a retrospective study where KC subjects with an age between 11 and 50 years were enrolled. Subjects with ocular diseases, history of previous corneal surgery, corneal scars or hydrops, ocular trauma, ocular surface disorder, systemic disease, and poor-quality scans were excluded. KC was classified using Belin ABCD classification system. Epithelial thickness, corneal tomography, and corneal biomechanical measurements were recorded using Fourier-domain optical coherence tomography Avanti with corneal adaptor module, Pentacam HR, and Corvis® ST, respectively. To understand the utility of various corneal parameters in diagnosing spectrum of keratoconus, cutoff values for epithelial thickness at the thinnest location and its standard deviation (SD) were considered 45 and 3 microns, respectively, CBI of 0.5 and TBI of 0.29 was considered. Sixty-five eyes (45 - KC, 10 - subclinical KC (SBKC), and 10 - forme fruste [FF]) of 34 patients with a mean ± SD age of 30.73 ± 5.71 were included. In our keratoconic sample, epithelial mapping alone helped diagnose the 77.77% of cases, however, when combined with CBI, it helped diagnose 95.5% cases and when combined with TBI, it was useful in diagnosing 100% of cases. In SBKC group, 40% of cases were detected by epithelial mapping alone, and when combined with CBI, it helped diagnose 70% of cases and TBI further helped diagnose 90% of cases. We did not see any role of epithelial mapping in detecting FFKC cases whereas CBI and TBI helped diagnose 60% and 90% of cases, respectively. The utility of epithelial mapping as a solitary tool is limited in detecting the spectrum of KC, especially SB and FFKC. However, combining it with corneal biomechanical parameters could help improve the efficacy of diagnosis of KC.

Thymosin beta 4: A potential novel adjunct treatment for bacterial keratitis.

Microbial keratitis is a rapidly progressing, visually debilitating infection of the cornea that can lead to corneal scarring, endophthalmitis, and perforation. Corneal opacification or scarring, a complication of keratitis, is among the leading causes of legal blindness worldwide, second to cataracts.Pseudomonas aeruginosaandStaphylococcus aureusare the two bacteria most commonly associated with this type of infection. Risk factors include patients who are immunocompromised, those who have undergone refractive corneal surgery, and those with prior penetrating keratoplasty, as well as extended wear contact lens users. Current treatment of microbial keratitis primarily addresses the pathogen using antibiotics. Bacterial clearance is of utmost importance yet does not guarantee good visual outcome. Clinicians are often left to rely upon the eye's innate ability to heal itself, as there are limited options beyond antibiotics and corticosteroids for treating patients with corneal infection. Beyond antibiotics, agents in use, such as lubricating ointments, artificial tears, and anti-inflammatory drops, do not fully accommodate clinical needs and have many potential harmful complications. To this end, treatments are needed that both regulate the inflammatory response and promote corneal wound healing to resolve visual disturbances and improve quality of life. Thymosin beta 4 is a small, naturally occurring 43-amino-acid protein that promotes wound healing and reduces corneal inflammation and is currently in Phase 3 human clinical trials for dry eye disease. Our previous work has shown that topical Tβ4 as an adjunct to ciprofloxacin treatment reduces inflammatory mediators and inflammatory cell infiltrates (neutrophils/PMN and macrophages) while enhancing bacterial killing and wound healing pathway activation in an experimental model ofP. aeruginosa-induced keratitis. Adjunctive thymosin beta 4 treatment holds novel therapeutic potential to regulate and, optimally, resolve disease pathogenesis in the cornea and perhaps other infectious and immune-based inflammatory disease. We plan to establish the importance of thymosin beta 4 as a therapeutic agent in conjunction with antibiotics with high impact for immediate clinical development.

The Association between Autoimmune Thyroid Disease and Ocular Surface Damage: A Retrospective Population-Based Cohort Study.

Autoimmune thyroid diseases (ATDs) are potentially connected to lacrimal gland dysfunction and ocular surface disruption. This study aimed to evaluate the relationships between ATD, dry eye disease (DED), and corneal surface damage. In a matched nationwide cohort study, we used Taiwan's National Health Insurance research database to compare the incidences of DED and corneal surface damage between subjects with and without ATD. Multivariable Cox proportional hazards regression models were used to estimate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for the ophthalmological outcomes. A total of 50,251 matched pairs with 748,961 person-years of follow-up were included for analysis. The incidence of DED was 16.37 and 8.36 per 1000 person-years in the ATD and non-ATD groups, respectively. ATDs were significantly associated with increased DED (aHR: 1.81, 95% CI: 1.73-1.89, p < 0.0001). This association was generally consistent across the subgroups of age, sex, different comorbidity levels, and use of systemic corticosteroids or not. Furthermore, patients with ATD had a higher risk of corneal surface damage compared with non-ATD subjects (aHR: 1.31, 95% CI: 1.19-1.44, p < 0.0001), including recurrent corneal erosions (aHR: 2.00, 95% CI: 1.66-2.41, p < 0.0001) and corneal scars (aHR: 1.26, 95% CI: 1.01-1.59, p = 0.0432). Other independent factors for corneal surface damage were age, sex, diabetes mellitus, Charlson Comorbidity Index scores, and use of systemic corticosteroids. Our results suggested that ATDs were associated with higher risks of DED and corneal surface damage. Considering the high prevalence of ATD, prophylactic and therapeutic strategies should be further developed to prevent irreversible vision loss in this susceptible population.

Comparison of Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty in Keratoconic Eyes With Previous Hydrops-Related Corneal Scar.

This study aimed to compare the outcomes of deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) procedures in keratoconic eyes with a previous hydrops-related corneal scar. In this retrospective study, the medical records of patients who had hydrops-related corneal scarring and underwent keratoplasty surgery were reviewed. Patients treated with DALK were classified as group 1, and patients treated with PK as group 2. Preoperative and postoperative best-corrected visual acuity, central corneal thickness, keratometry (K), and refractive error values of each group were recorded and compared. Seventy-eight eyes (41 in group 1 and 37 in group 2) were included in this study. The mean follow-up period of the patients was 37.7 ± 30.0 months in group 1 and 51.2 ± 29.4 months in group 2 ( P = 0.06). The preoperative and postoperative best-corrected visual acuity and central corneal thickness values were statistically similar in both groups (each P value >0.05). Keratometry values (K1 and mean keratometry) were significantly steeper in group 1 ( P1 = 0.02 and P2 = 0.03, respectively). Descemet membrane perforation was experienced in 7 (4 macroperforation and 3 microperforation; 15.6%) of 45 eyes that planned to perform DALK. These 4 eyes with macroperforation underwent PK and were excluded from the study. When all postoperative complications were assessed, although the total complication rate was 21% after DALK, it was 43% after PK ( P = 0.04). DALK with a big-bubble technique is a feasible surgery in eyes with corneal scarring due to previous hydrops and is comparable with PK in terms of visual and refractive outcomes. This study suggests that DALK, which is safer than PK with less postoperative complication rates, should be the primary surgical option to avoid serious complications in keratoconic eyes with hydrops-related corneal scarring.

Early Ophthalmology Findings in Nonsyndromic Craniosynostosis.

Craniosynostosis (CS) occurs 1 in 2500 births and surgical intervention is indicated partly due to risk for elevated intracranial pressure (EICP). Ophthalmological examinations help identify EICP and additional vision concerns. This study describes preoperative and postoperative ophthalmic findings in CS patients (N=314) from chart review. Patients included nonsyndromic CS: multisuture (6.1%), bicoronal (7.3%), sagittal (41.4%), unicoronal (22.6%), metopic (20.4%), and lambdoidal (2.2%). Preoperative ophthalmology visits were at M =8.9±14.1 months for 36% of patients and surgery was at M =8.3±4.2 months. Postoperative ophthalmology visits were at age M =18.7±12.6 months for 42% with follow-up at M =27.1±15.1 months for 29% of patients. A marker for EICP was found for a patient with isolated sagittal CS. Only a third of patients with unicoronal CS had normal eye exams (30.4%) with hyperopia (38.2%) and anisometropia (16.7%) at higher rates than the general population. Most children with sagittal CS had normal exams (74.2%) with higher than expected hyperopia (10.8%) and exotropia (9.7%). The majority of patients with metopic CS had normal eye exams (84.8%). About half of patients with bicoronal CS had normal eye exams (48.5%) and findings included: exotropia (33.3%), hyperopia (27.3%), astigmatism (6%), and anisometropia (3%). Over half of children with nonsyndromic multisuture CS had normal exams (60.7%) with findings of: hyperopia (7.1%), corneal scarring (7.1%), exotropia (3.6%), anisometropia (3.6%), hypertropia (3.6%), esotropia (3.6%), and keratopathy (3.6%). Given the range of findings, early referral to ophthalmology and ongoing monitoring is recommended as part of CS care.

Clinical applications of bioengineered tissue-cellular products for management of corneal diseases.

To discuss bioengineered tissue-cellular products for treatment of corneal diseases that are currently in clinical use. These include tissue-cellular products that have received regulatory approval, are being used off-label in clinical practice, or are in active use in clinical trials. Due to the global shortage of donor corneal tissue, significant efforts have been made to develop bioengineering tissue-cellular products that can replace or augment the use of cadaveric tissue for corneal transplantation. The development of carrier substrates to support transplantation of cultivated limbal epithelial transplantation (CLET) has been a growing area of research. CLET offers a promising therapeutic alternative to conventional simple limbal epithelial transplantation and keratolimbal allografts for treatment of limbal stem cell deficiency. Engineered tissue matrices and porcine-derived corneas are potential alternatives to human donor tissue in anterior lamellar keratoplasty for corneal ulcers and scars, as well as intrastromal transplants for advanced keratoconus. For endothelial disease, substrate supported cultured endothelial cell grafts, and synthetic barrier devices are promising alternative to traditional endothelial keratoplasties. There has been increasing interest in cellular and acellular bioengineered tissue-cellular and synthetic products for treatment of corneal diseases, and many of these products have already seen clinical use. Industry and academia have important roles in advancing these products to later phase clinical trials and comparing them to conventional allograft approaches. Future development of full thickness donor corneas with cultivated epithelium, endothelium, and stromal keratocytes in a biosynthetic matrix will likely be an important next step in tissue alternatives. Continued progress in this field will be critical for addressing the global disease burden from corneal blindness.

Bilateral Simultaneous Penetrating Keratoplasty: A 40-Year Odyssey

Purpose: The purpose of this study was to report 40-year follow-up on a case of bilateral simultaneous penetrating keratoplasty (PK) involving a contralateral autograft. Methods: This was a case report. Results: A 39-year-old man developed right corneal scarring and lipid keratopathy from previous herpes zoster keratouveitis with visual acuity of 20/200. The left eye had dense amblyopia with visual acuity of 20/300. In 1980, he underwent right PK using a contralateral autograft and simultaneous left PK with an allograft. The right autograft provided excellent visual acuity until the graft failed 40 years later. The left allograft underwent severe endothelial graft rejection 2 months after surgery with gradual corneal clearance over the next 21 months. The left allograft remained clear through 40 years without graft failure. Conclusions: Long-term useful vision and graft survival were achieved with a penetrating autograft by avoiding endothelial graft rejection in the setting of previous herpes zoster keratitis and the patient being functionally monocular. Despite almost failing from severe endothelial graft rejection in the absence of ocular risk factors, the left allograft recovered and remained clear through 40 years possibly because peripheral host endothelial cells repopulated the donor.

The senescence difference between the central and peripheral cornea induced by sutures

IntroductionCell senescence plays a regulatory role in tissue fibrosis. Corneal scarring is usually more severe in the central cornea based on clinical observation. In this study, we attempted to explore the senescence difference between the central and peripheral cornea in an in vivo mouse model with suture-induced senescence and in an in vitro model of senescence with hydrogen peroxide (H2O2)-induced rabbit corneal fibroblasts.MethodsMale Balb/c mice (6–8 weeks) received sutures in the central, superior, inferior, nasal, and temporal cornea. The sutures were removed on the 14th day. Corneal neovascularization was observed under a slit lamp microscope with a digital camera. The fibroblasts isolated from the central and peripheral rabbit cornea were induced with H2O2 to establish the senescence model in vitro. Senescence was evaluated with SA-β-gal staining and gene expression analysis of p21, p27, and p53.ResultsSenescent cells accumulated in the corneal stroma from the third day to the 14th day after the operation and peaked on the 14th day. More senescent keratocytes were observed in the peripheral cornea of the mouse model. In vitro, the peripheral corneal fibroblasts were more prone to senescence due to H2O2. The polymerase chain reaction results showed that the senescence-related genes p21, p27, and p53 were highly expressed in the peripheral corneal fibroblasts compared with the central corneal fibroblasts.ConclusionsSenescent fibroblasts can limit tissue fibrosis; hence, the senescence difference between the central and peripheral cornea may contribute to the difference in scarring.

Mesenchymal Stem Cell Exosomes as Immunomodulatory Therapy for Corneal Scarring.

Corneal scarring is a leading cause of worldwide blindness. Human mesenchymal stem cells (MSC) have been reported to promote corneal wound healing through secreted exosomes. This study investigated the wound healing and immunomodulatory effects of MSC-derived exosomes (MSC-exo) in corneal injury through an established rat model of corneal scarring. After induction of corneal scarring by irregular phototherapeutic keratectomy (irrPTK), MSC exosome preparations (MSC-exo) or PBS vehicle as controls were applied to the injured rat corneas for five days. The animals were assessed for corneal clarity using a validated slit-lamp haze grading score. Stromal haze intensity was quantified using in-vivo confocal microscopy imaging. Corneal vascularization, fibrosis, variations in macrophage phenotypes, and inflammatory cytokines were evaluated using immunohistochemistry techniques and enzyme-linked immunosorbent assays (ELISA) of the excised corneas. Compared to the PBS control group, MSC-exo treatment group had faster epithelial wound closure (0.041), lower corneal haze score (p = 0.002), and reduced haze intensity (p = 0.004) throughout the follow-up period. Attenuation of corneal vascularisation based on CD31 and LYVE-1 staining and reduced fibrosis as measured by fibronectin and collagen 3A1 staining was also observed in the MSC-exo group. MSC-exo treated corneas also displayed a regenerative immune phenotype characterized by a higher infiltration of CD163+, CD206+ M2 macrophages over CD80+, CD86+ M1 macrophages (p = 0.023), reduced levels of pro-inflammatory IL-1β, IL-8, and TNF-α, and increased levels of anti-inflammatory IL-10. In conclusion, topical MSC-exo could alleviate corneal insults by promoting wound closure and reducing scar development, possibly through anti-angiogenesis and immunomodulation towards a regenerative and anti-inflammatory phenotype.

Expansion and characterization of human limbus-derived stromal/mesenchymal stem cells in xeno-free medium for therapeutic applications

BackgroundMesenchymal stem cells (MSCs) have been proven to prevent and clear corneal scarring and limbal stem cell deficiency. However, using animal-derived serum in a culture medium raises the ethical and regulatory bar. This study aims to expand and characterize human limbus-derived stromal/mesenchymal stem cells (hLMSCs) for the first time in vitro in the xeno-free medium.MethodsLimbal tissue was obtained from therapeutic grade corneoscleral rims and subjected to explant culture till tertiary passage in media with and without serum (STEM MACS XF; SM), to obtain pure hLMSCs. Population doubling time, cell proliferation, expression of phenotypic markers, tri-lineage differentiation, colony-forming potential and gene expression analysis were carried out to assess the retention of phenotypic and genotypic characteristics of hLMSCs.ResultsThe serum-free medium supported the growth of hLMSCs, retaining similar morphology but a significantly lower doubling time of 23 h (*p < 0.01) compared to the control medium. FACS analysis demonstrated ≥ 90% hLMSCs were positive for CD90+, CD73+, CD105+, and ≤ 6% were positive for CD45−, CD34−andHLA-DR−. Immunofluorescence analysis confirmed similar expression of Pax6+, COLIV+, ABCG2+, ABCB5+, VIM+, CD90+, CD105+, CD73+, HLA-DR−andCD45−, αSMA− in both the media. Tri-lineage differentiation potential and gene expression of hLMSCs were retained similarly to that of the control medium.ConclusionThe findings of this study demonstrate successful isolation, characterization and culture optimization of hLMSCs for the first time in vitro in a serum-free environment. This will help in the future pre-clinical and clinical applications of MSCs in translational research.

Keratoprosthesis in dry eye disease.

Bilateral corneal blindness with severe dry eye disease (DED), total limbal stem cell deficiency with underlying corneal stromal scarring and vascularization, combined with adnexal complications secondary to chronic cicatrizing conjunctivitis is a highly complex situation to treat. In such eyes, procedures such as penetrating keratoplasty alone or combined with limbal stem cell transplantation are doomed to fail. In these eyes, keratoprosthesis (Kpro) or an artificial cornea is the most viable option, eliminating corneal blindness even in eyes with autoimmune disorders such as Stevens-Johnson syndrome, ocular mucous membrane pemphigoid, Sjogren's syndrome, and nonautoimmune disorders such as chemical/thermal ocular burns, all of which are complex pathologies. Performing a Kpro in these eyes also eliminates the need for systemic immunosuppression and may provide relatively early visual recovery. In such eyes, the donor cornea around the central cylinder of the Kpro needs to be covered with a second layer of protection to avoid desiccation and progressive stromal melt of the underlying cornea, which is a common complication in eyes with severe DED. In this review, we will focus on Kpro designs that have been developed to survive in eyes with the hostile environment of severe DED. Their outcomes in such eyes will be discussed.

Evaluation of the Therapeutic Efficacy of Perceptual Learning Using the Bartimeus Training Program in the Clinic as an Additional Therapy to Glasses or Patching.

The Bartimeus training program (BT) is a perceptual learning task that consists of a drawing assignment performed in 12 sessions of 30 minutes duration. Here we aim to retrospectively assess visual improvement in children who underwent BT and in whom visual acuity had not improved by glasses or patching in relation to patient age and diagnosis. Retrospective chart analysis of patients who had undergone BT at our institution after consent. Visual acuity prior to and following BT was analyzed, as were diagnosis and age at BT. Thirteen patients (20 eyes) with a mean age of 7 years (range: 3.9 - 10.75) were included. Overall acuity (LogMar) improved in 75%. Six patients aged 6.5 - 7.5 years had a mean improvement of 1.4 lines. The greatest improvement (5 lines crowding acuity) was seen in a 9-year-old with recent onset amblyopia due to corneal scarring. Two patients aged 6 years with deprivation amblyopia following surgery of a congenital cataract and one 5-year-old with retinitis pigmentosa did not benefit from BT. BT is a cheap noninvasive method that may help improve visual outcomes. Further studies with larger numbers are needed to assess optimal indication, timing, and length of treatment.

Severe Complications after Corneal Collagen Cross-Linking (CXL).

To present a case series of rare and severe complications after corneal collagen cross-linking (CXL) of keratoconus patients. Single-center descriptive case series covering the period of 2012 to 2022 at the Department of Ophthalmology at the University Hospital, Zurich, Switzerland. We present four eyes of four patients that showed severe unusual complications within the first month after CXL. Three patients had been treated with the classical epithelium-off "Dresden" protocol. One patient had been treated with the accelerated epithelium-off protocol. One patient presented with extensive corneal edema due to rubbing the eye after treatment. Two patients showed a bacterial infectious keratitis: one due to Streptococcus pneumoniae and the other due to Staphylococcus hominis, Micrococcus luteus, and Streptococcus epidermidis. The latter of the two patients exhibited extensive infectious crystalline keratopathy. The fourth patient showed a severe ulcerative lesion where no infectious cause could be found. Therefore, an autoimmune keratolytic process had to be suspected. Apart from the corneal edema, which resolved ad integrum, the other complications resulted in permanent corneal scarring and thinning. One patient needed an emergency amniotic transplant. Severe complications after CXL remain rare. Most common causes are complications that are not directly associated with the treatment as such. Those indirect complications occur after the treatment during the healing course of the epithelium. Associations with bandage contact lenses, topical steroids, atopic disease, and inappropriate patient behavior are often suspected. Correctly performed corneal scrapings with repeated microbiological analysis and a detailed patient history are essential for establishing the correct diagnosis, especially in complicated cases that do not respond to a standard therapeutic regimen. This case series supports the efforts that are currently taken to improve the CXL technique in a way that postoperative complications are further reduced. A more efficient epithelium-on technique might be a step in that direction.

Corneal Ulcer Impending Perforation et causa Corpus Alienum

Introduction: The cornea is a transparent, avascular tissue that serves as a structural barrier and protects the eye from infection. A corneal ulcer is an inflammatory or, more dangerously, infective disorder involving abnormalities of the cornea’s epithelial layer or stroma. Corneal ulcers can develop due to contact lenses, trauma, adnexal illnesses, or ocular surface abnormalities. Despite aggressive nonsurgical therapies, corneal perforation frequently occurs in the event of resistant corneal ulcers. The anatomic integrity of the eyeball must be preserved through urgent surgical intervention to avoid potentially fatal consequences such as endophthalmitis, subsequent glaucoma, perforation, or corneal scarring. Case Presentation: A-11-year-old male child was taken to Community Eye Hospital, East Java due to a corneal ulcer. He complained of pain and redness right after he played with bamboo two weeks ago. The patient had been previously treated in other hospitals; however, there was a worsening of symptoms rather than improvement. Clinical examination of oculus sinister revealed a conjunctival injection, episcleral injection, corpus alienum (bamboo) sized 50 mm, an ulcer in the central cornea sized 3 x 2 mm irregular, shallow anterior chamber, impending perforation in the central cornea with a diameter of 2 mm. Thus, there had shown impending perforation, and the patient had to undergo surgery, of amniotic graft and antibiotic injection immediately to avoid perforation. Conclusions: A perforation, an ophthalmological emergency requiring surgery, can result from corneal ulceration, a medical emergency. The primary objectives of the procedure are to restore the eye’s anatomical integrity and to reduce problems as much as feasible.

Первичная отсроченная хирургическая помощь пациенту с боевым ранением глаза

Currently, injuries to the visual organ are one of the most important causes of blindness and disability due to the complicated course of the post-traumatic process and an unfavorable functional outcome, in the vast majority of cases of the able-bodied population. The timeliness of providing highly specialized ophthalmic surgical care is a fundamental factor that allows for the medical and social rehabilitation of patients with various visual organ injuries in the shortest possible time. In turn, the prolongation of the terms of primary surgical treatment dictates slightly different approaches to the conservative and surgical treatment of such patients. Objective. To evaluate the effectiveness of primary delayed simultaneous surgical care for a patient with a penetrating comminuted battle wound of the eye. Material and metods. Patient K., 35 years old, was admitted to the ophthalmological department of the State Medical Institution «OOKB» of Orenburg with complaints of decreased visual acuity of the left eye with the diagnosis: OS – Multiple military trauma. Consequences of penetrating eye injury. Corneal scar. Traumatic cataract. Partial hemophthalmos. Local retinal detachment. Intraocular foreign bodies. From anamnesis: a month ago, during military operations, he received a shrapnel wound to the head. An open penetrating comminuted fracture of the left temporal bone was performed in a military hospital. I did not receive surgical ophthalmological care. Ophthalmological status: Vis OD = 1,0: OS = movement of the shadow at the face. The IOP of both eyes is normal. OS – conjunctiva is injected, a metallic foreign body is embedded in the sclera at the meridian of 7 hours, 5 mm from the limb, the cornea is transparent, the corneal scar, the anterior chamber is shallow, the moisture is transparent, the iris is edematous, the pupil in the center is deformed, tightened for 7 hours, the pupil reaction is slowed down, inhomogeneous opacities in the lens. The reflex is dim, the details of the fundus and vitreous are not ophthalmoscoped. Preparatory measures were carried out before the surgical intervention: antibacterial and anti-inflammatory therapy. At the first stage, phacoemulsification of traumatic cataract with posterior continuous capsulorexis was performed in the conditions of medical mydriasis. The second stage was a standard three-port vitrectomy of 25 G with the removal of organized vitreous blood clots and the removal of the posterior hyaloid membrane. During the revision, a parietal foreign body with local retinal detachment is visualized in the middle outer part. A 23 G tweezers were used to remove the foreign body, which required the replacement of one of the ports. Delimitative endolasercoagulation was performed. The foreign body was removed through the posterior capsulorexis: brought to the iris in the anterior chamber of the eye, then evacuated through a tunnel incision of 2.75 mm. Then a perfluoroorganic compound (PFOS) was introduced, the retina was attached, additional retinal endolasercoagulation was performed. At the third stage, a simultaneous replacement of PFOS with silicone oil was carried out. The Miol-soft intraocular lens was implanted. At the last stage, the embedded foreign body of the sclera was removed, the conjunctival wound was sutured. On the fifth day after surgical treatment, the patient was discharged for outpatient follow-up with the functions of vis OS = 0.2 sph (+) 4.0 = 0.4 with recommendations. Conclusions. As a result of simultaneous high-tech vitreoretinal surgical treatment against the background of anti-inflammatory and antibacterial therapy, high functional results were achieved. Keywords: injury, penetrating wound of the eye, foreign body of the eye, local retinal detachment

Клинический случай комбинированного лечения тяжелой контузии глаза сопровождающаяся циклодиализом

Background. Eye injuries are still one of the main causes of vision loss and disability today. Injuries of the organ of vision are more likely to affect people of working age, which actualizes the significance of this pathology. Case presentation. A 32-year-old man experienced a retinal detachment in his left eye, complicated by traumatic cyclodialysis, choroid detachment, vitreous hemorrhage, aphakia, and corneal scar. His corrected distance visual acuity was 0.005 and intraocular pressure less 10.0 mmHg. We performed posterior trepanation of the sclera, anterior chamber reconstruction, corneal suture repositioning, threeport 25G-vitrectomy with removal of hemophthalmus, endolaser coagulation of the retina followed by tamponade of the vitreal cavity with silicone oil. 2 months later we performed trepanation of the sclera with drainage of the supraciliary fluid and the introduction of a blunt cannula into the supraciliary space of platelet-rich plasma – autologous conditioned plasma (ACP). Anterior segment optical coherence tomography and ultrasonic biomicroscopy revealed reattachment of the ciliary body to the sclera spur. In the end his corrected distance visual acuity was 0.4 and intraocular pressure 20 mmHg. Conclusions. The use of autologous conditioned plasma in the surgical treatment of cyclodialysis is an effective and safe method of treatment and allows achieve reattachment of the ciliary body to the sclera spur. The long-term effectiveness of the method can be assessed by increasing the observation period and the number of interventions. Keywords: cyclodialysis; trauma; autologous conditioned plasma

Scleral Lens Applications Focused on Korean Patients with Various Corneal Disorders.

We aimed to report on the clinical outcomes of scleral lens applications in Korean patients with various corneal disorders. This retrospective review was conducted for 62 eyes of 47 patients who had been fitted with scleral lenses for various corneal disorders. The patients were referred for inadequate spectacle-corrected visual acuity and rigid gas permeable (RGP) or soft contact lens intolerance. Uncorrected visual acuity, habitually corrected visual acuity, best lens-corrected visual acuity, topographic indices, keratometry indices, and lens parameters were evaluated. Twenty-six eyes of 19 patients with keratoconus were enrolled. Other conditions included corneal scar (13 eyes of 12 patients), phlyctenules (three eyes), laceration (four eyes), chemical burn (one eye), keratitis (one eye), Peters' anomaly (one eye), fibrous dysplasia (one eye), ocular graft-versus-host disease (two eyes of one patient), irregular astigmatism (18 eyes of 12 patients), and corneal transplant status (five eyes of four patients). The mean topographic values of the eyes include flat keratometric value (43.0 ± 6.1 diopters [D]), steep keratometric value (48.0 ± 7.4 D), and astigmatism (4.9 ± 3.6 D). Of the eyes fitted with scleral lenses, best lens-corrected visual acuity (0.10 ± 0.22 logarithm of the minimum angle of resolution [logMAR]) was significantly better than the habitually corrected visual acuity (0.59 ± 0.62 logMAR, p < 0.001). Scleral contact lenses are a good alternative for patients with corneal abnormalities and those who are intolerable to RGP contact lenses, resulting in both successful visual outcomes and patient satisfaction, especially concerning keratoconus, corneal scar, and corneal transplant status.

Etiologies, periocular manifestations and surgeries for congenital and childhood acquired facial nerve palsy

To report periocular surgeries performed for patients with congenital and childhood acquired facial nerve palsy (FNP). A retrospective case series of pediatric patients who presented with FNP over the last 34years, was conducted at two tertiary eye hospitals in Riyadh. Data were collected from electronic charts, hospital records and external photos. Main outcome measures were visual acuity, lagophthalmos, eyelid abnormalities, Bell's phenomena, exposure keratopathy, and corneal scar; in these cases, periocular surgeries were required. Among the 90recruited subjects; the mean age of onset was 4.8±5.4years old (range, 0.01 to 17.76years). Traumatic and congenital causes of FNP were the most common, representing over 80% of the cases. Seventy-one patients developed lagophthalmos, 26 with severe exposure that resulted in scarring. Thirty-six (40%) cases had associated strabismus. Lower lid retraction was the most common eyelid abnormality noted in 23cases, followed by entropion in 16 and ectropion in 6cases. Temporary tarsorrhaphy was performed in three patients (3.3%), while 18patients (20%) needed permanent tarsorrhaphy. Gold weight implants were placed in 17patients (18.9%). Lower lid retraction repair was performed in twelve patients (13.3%). Five patients (5.6%) underwent lower eyelid entropion repair, and three patients (3.3%) underwent lower eyelid ectropion repair. Lagophthalmos is the most common finding in children presenting with FNP and needs to be managed early to prevent permanent visual loss. Compared to adults, children may present with a different spectrum of eyelid abnormalities, with lower lid retraction and entropion being the most common eyelid malpositions.

Results of corneal collagen cross-linking in patients with corneal ectasia after laser refractive surgery—A prospective study

PurposeTo evaluate the safety and efficacy of epithelium-off (epi‑off) corneal cross-linking (CXL) in patients with post-LASIK corneal ectasia (PLE) SettingPrivate clinical practice DesignProspective clinical trial Methods82 eyes of adult patients post-LASIK, ages 21–67, with a topography pattern consistent with corneal ectasia, corrected distance visual acuity (CDVA) worse than 20/20, and minimum corneal pachymetry > 400 µm underwent epi‑off CXL. Exclusion criteria were patients with corneas that were thinner than 400 μm or demonstrated central corneal scarring, history of herpetic eye disease, pregnancy or nursing. Follow up examinations of spherical equivalent, uncorrected distance visual acuity (UDVA), CDVA, steep keratometry (KSteep) and minimum pachymetry occurred on different but highly overlapping subsets of the operated eyes yearly until 5 years post-CXL. ResultsOver the 5 years of follow up, spherical equivalent did not significantly change while UCVA and CDVA stabilized or improved to a non-significant degree. KSteep and minimum pachymetry continued to be decreased to a statistically significant degree (p < 0.05 at 5 years). ConclusionsCXL in PLE patients is safe and efficacious: it halts progression of PLE and may improve visual function. KSteep and minimum pachymetry decrease post-CXL. Patients with PLE should be encouraged to stop progression of the disease by undergoing epi‑off CXL once progression is established.

Clinical demographic characteristics and ocular Co-morbidities associated with Secondary lipid keratopathy at a tertiary care center

ObjectiveTo describe the demographics and clinical profile of Secondary Lipid Keratopathy in patients presenting to a multi-tier ophthalmology hospital network in India. MethodsThis cross-sectional hospital-based study included 3,082,727 new patients presenting between August 2010 and December 2021. Patients with a clinical diagnosis of Secondary Lipid Keratopathy in at least one eye were included as cases. The data were collected using an electronic medical record system. ResultsOverall, 389 (0.01%) patients were diagnosed with Secondary Lipid Keratopathy. Majority were males (53.5%) and had a unilateral affliction (82.8%). The most common age group at presentation was during the sixth decade of life with 76 (19.5%) patients. The overall prevalence was higher in patients from a lower socio-economic status (0.02%) presenting from the rural geography (0.01%) and in individuals related to agriculture work/ manual labor (0.02%). Of the 456 eyes, mild or no visual impairment (<20/70) was noted in 194 (42.5%) eyes followed by moderate visual impairment (>20/70 to 20/200) in 81 (17.8%) eyes. At presentation, the mean visual acuity was 0.96 ± 1.07 log MAR units. The most associated corneal condition was non-HSV corneal scar (36.8%), followed by spheroidal degeneration (19.7%) and HSV keratitis in (18.6%). ConclusionSecondary lipid keratopathy more commonly affected males presenting during the sixth decade of life. Most (42.5%) of the eyes had mild or no visual impairment. Corneal scar (non-HSV) was the most associated corneal condition in both unilateral and bilateral cases. HSV keratitis was the commonest corneal condition in those between 20 and 40 years, followed by those above 40 years.