Corneal Trauma Research Articles

Hyaluronic acid as a means to correct entropion in animals

Entropion, or inversion of the edge of the eyelid, is a frequent multifactorial disease in which the ciliated edge of the eyelid is wrapped inside, which leads to permanent corneal trauma and eye irritation. Currently, subcutaneous fillers based on hyaluronic acid are used to correct entropion due to the fact that it does not have organ- and speciesspecificity and, therefore, carries a minimal risk of allergic reactions. The advantage of subcutaneous fillers based on HA is that the injection can be reversed with the development of complications with the help of drugs based on hyaluronidase. The assessment was carried out by the amount of periocular moistening, alopecia and/or hyperemia of the eyelids with manual rotation of the eyelids outward during the examination. All patients underwent a complete ophthalmological examination with a slit lamp and indirect ophthalmoscopy, a Schirmer test and intraocular pressure. The injection methods used included linear threading, a series of single-point injections, or a combination of them. The criteria for evaluating the effectiveness of the use of hyaluronic acid as a means for correcting entropion in animals were local reactions to skin filler, inflammatory processes in the eye area associated with a relapse of entropion, as well as the duration of the period before repeated administration of the drug. The technique of subcutaneous injection of the GC filler is a simple, reliable, effective, safe, prolonged procedure that requires a minimum amount of time, which allows you to immediately alleviate the patient's condition from mild to moderate severity as a result of entropion in cats and dogs. This procedure is especially preferable for age-related patients and patients with high anesthetic risk.

Creation of a proof-of-concept 3D printed corneal trauma simulation model.

Creation of a proof-of-concept 3D printed corneal trauma simulation model.

Incidence and Risk Factors for Retinal Detachment Following Cataract Surgery at a Tertiary Center in Jeddah, Saudi Arabia.

Introduction The incidence of retinal detachment in the general population is 0.08%, it has been reported to reach 0.7% or higher following cataract surgery. One of the most important risk factors for retinal detachment is posterior capsular rupture during cataract surgery. Additional risk factors include high myopia, history of ocular trauma, young age, male sex, and diabetes. In this study, we aimed to investigate the incidence and risk factors of retinal detachment following cataract surgery in patients treated at our hospital. Materials and methods This retrospective cohort study was conducted at King Abdulaziz University Hospital (KAUH), a tertiary center in Jeddah, Saudi Arabia. The medical records of 365 patients (365 eyes) who underwent cataract surgery from 2017 to 2021 were reviewed. Results The average age of the 365 patients was 63 years, and 47.7% (n=174) of patients were male. The incidence of retinal detachment was 3.3% (n=12). The risk of RD was 2.8 times higher for the right eye than for the left eye. The incidence of RD was significantly more in eyes with intraoperative posterior capsular rupture, zonular dehiscence, corneal trauma, and surgery combined with anterior vitrectomy than in other eyes. The most common complication of cataract surgery is corneal edema, which was observed in 22.7% of the eyes; our analysis revealed a significant relationship between corneal edema and the duration of surgery. Conclusion In our study, we highlighted the higher incidence of retinal detachment compared to those in other studies; most cases occurred one month postoperatively.

Face mask use and effects on the ocular surface health: A comprehensive review.

In the COVID-19 period, face masks increased exponentially. Several studies suggest that the rise in ocular discomfort symptoms during the pandemic is mostly part of dry eye disease and that these are due to the effect of face masks, resulting in the newly described term MADE, for "mask-associated dry eye". The most commonly proposed mechanism states that wearing a face mask creates an unnatural upward airflow towards the ocular surface during expiration, although the increased temperature, humidity and levels of carbon dioxide of the exhaled air, stress, increased use of video display terminals, as well as changes in the ocular microbiota may contribute. Evidence supports that the use of face masks causes an increase in dry eye disease symptoms, a decreased tear break-up time, corneal epithelial trauma, periocular temperature changes and inflammatory markers secretion. Given that the use of masks may be frequent in some settings in the near future, it is important to establish its effects and consequences on the ocular surface.

Functional Profile of a Customized Wound Parameter in Femtosecond Laser-Assisted Corneal Incision for Cataract Surgery.

To evaluate the performance of optimized parameters of femtosecond laser for cataract surgery corneal incisions regarding opening, patency and surgically induced astigmatism (SIA). Patients scheduled for femtosecond laser-assisted cataract surgery between May 2018 and December 2018 were enrolled. Inclusion criteria were a healthy preoperative cornea and uneventful FLACS. Exclusion criteria were preoperative corneal astigmatism over 1.0 D, previous corneal trauma or pathologies. Clinical data were obtained from the electronic medical records. Surgical planning was based on Scheimpflug tomography images for keratometric data. At postoperative day 60, new keratometric evaluation was performed, obtained using the same device. 101 eyes (61 patients) matched the criteria for SIA analysis. Overall mean SIA was 0.44 ± 0.33 D (0-1.55 D). Axis and size did not have any statistically significant effects on SIA. The overall centroid of the SIA was 0.11. For the opening analysis, was included 156 eyes (79 patients). Successful opening in 87.7% of cases (137 eyes). Temporal incisions had the highest success rate (98.36%). These femtosecond laser parameters showed high opening rates with low opening times. These optimized parameters led to a low incidence of SIA and high predictability regardless of incision site and size. The association between incision opening and SIA was not statistically significant. There was, however, an association between incision opening success and site.

The levels of hypoxia- and angiogenesis-related regulators and matrix metalloproteinase 9 activity in tear fluid of patients with non-penetrating ocular traumas

This article was focused on the evaluation of protein biomarkers related to thrombosis, hypoxia, angiogenesis, and tissue remodeling in tear fluid of patients with non-penetrating corneal trauma. 32 patients with non-penetrating corneal injures were enrolled in the study, the control group consisted of 15 healthy patients. Samples of tear fluid were collected from the patients and control volunteers with the use of a disposable end micropipette. Protein levels of D-dimer, hypoxia-inducible factor 1α (HIF-1α), angiostatins, and matrix metalloproteinase 9 (MMP-9) in tear fluids were determined by western blot analysis. Proteolytic activity values of MMP-9 were measured by gelatin zymography. Results of western blot and zymography assay were calculated by densitometry analysis and expressed as arbitrary units. Significant increase of D-dimer and HIF-1α levels in tear fluid of patients with injured cornea by 7.3 (p<0.05) and 56 (p<0.001) folds, respectively was shown, compared with control, indicating thrombotic events and hypoxia condition to be involved in pathogenesis of ocular trauma. Dramatically elevated levels/activity of MMP-9 enzyme (by 105 folds vs. control, p<0.001) suggests intense tissue remodeling and degradation of extracellular matrix in the damaged cornea. Up-regulation of angiostatin level, products of proteolytical cleavage of plasminogen, in tear fluid collected from patients with traumatic eye in comparison with healthy volunteers (by 7.3 folds, p<0.05), could represent an adaptive mechanism, which counteracts excessive hypoxia-induced neovascularization of injured cornea. It is summarized that there was a strong association between elevation of D-dimer, HIF-1α, angiostatins, and MMP-9 levels suggesting thrombosis- and hypoxia-mediated mechanisms triggering wound healing of injured cornea. The findings of this study are novel and provide a basis for further investigations of the reparation mechanisms during non-penetrating ocular trauma. Studied proteins of tear fluid can serve as relevant biomarkers of corneal wound healing and are appropriate for diagnostic and prognostic purposes.

Phenotypes of Granular Corneal Dystrophy Type 2 among Koreans in Their Twenties

Purpose: Granular corneal dystrophy type 2 (GCD2) is a hereditary disease that features granular and lattice stromal deposits in the cornea. There are homozygotes and heterozygotes and the opacities are exacerbated by corneal trauma or surgery, such as laser in situ keratomileusis (LASIK). As there is individual variability in GCD2 phenotypes, we investigated various corneal features of GCD2 patients in their twenties, the main age group for refractive surgery.Methods: From genetically confirmed GCD2 patients who had an R124H mutation of the transforming growth factor β induced (<i>TGFBI</i>) gene at age 20 to 29 years, we chose representative patients: one homozygote; one compound heterozygote; one simple heterozygote with a severe phenotype with many granular deposits; one common heterozygote; and four heterozygotes with normal corneas. The corneas of all patients were subject to slit-lamp examination and photographed.Results: The homozygote had confluent granular deposits covering the cornea. The compound heterozygote had granular and lattice deposits covering the center of the cornea. The patient with a severe phenotype had more than 30 granular deposits in one eye, but was a simple GCD2 heterozygote, verified by full-sequencing of the <i>TGFBI</i> gene. In the four patients with normal corneas, a single small lesion was subsequently detected during follow-up in two, at 3 weeks and 6 months, respectively. Both corneas were judged clear at chance examinations.Conclusions: Among Koreans in their twenties, GCD2 patients have various phenotypes, from clear corneas to severe confluent opacities. There are GCD2 heterozygotes with nearly clear corneas, so caution must be taken when choosing patients for refractive surgery.

Susceptibility of the Intact and Traumatized Feline Cornea to In Vitro Binding and Invasion by Acanthamoeba castellanii.

Acanthamoeba castellanii ( A. castellanii ) displays host specificity at the level of the ocular surface. This study determined the susceptibility of the intact and traumatized feline cornea to A. castellanii binding and invasion relative to other host species with established susceptibility and resistance to Acanthamoeba binding. Full-thickness buttons of fresh feline, porcine, and canine corneas were prepared. The corneal epithelium was confirmed intact by fluorescein staining or lightly scarified with a 25-G needle to simulate corneal trauma. Acanthamoeba castellanii was axenically cultivated. Corneal buttons were incubated with the parasite suspension or parasite-free medium for 18 hours at 35°C. Corneal buttons were rinsed, fixed, and processed for histopathology and immunohistochemistry using immunoperoxidase and immunofluorescence methods of amoeba detection. Numerous amoebae were bound to feline and porcine corneas incubated with parasites. In both intact and traumatized corneas, amoebae were detected at all levels in the corneal epithelium and within the anterior stroma. In traumatized corneal sections, amoebae were frequently present in regions of epithelial damage. Corneal architecture was well-preserved in sections incubated with parasite-free medium; however, epithelial cell sloughing, separation of epithelial layers, and epithelial detachment from the stroma were observed in corneas incubated with amoebae. Intact and traumatized canine corneas were relatively free of adherent amoebae, and corneal architecture was indistinguishable between sections incubated with the parasite suspension and parasite-free medium. The feline cornea is highly susceptible to in vitro binding and invasion by A. castellanii . Acanthamoeba binding to the feline cornea does not require a previous epithelial defect.

Incidence, Clinical Profile, and Management of Keratitis Caused by Uncommon Species of Pseudomonas at a Tertiary Eye Care Center.

The purpose of this study was to study the incidence, demographic features, clinical course, profiling, and management of uncommon species of Pseudomonas keratitis (other than Pseudomonas aeruginosa ) at a tertiary eye care center. Thirty cases of culture-proven uncommon species of Pseudomonas keratitis between January 2017 and December 2021 were retrospectively studied. The incidence, demographic and clinical profile, predisposing factors, microbial results, treatment, and visual outcomes were analyzed. We evaluated the risk factors for poor treatment outcomes. Among bacterial keratitis cases, uncommon species of Pseudomonas keratitis occurred at a rate of 2.2%. The mean age at presentation was 51.37 years, and the most common predisposing factor was corneal trauma (36.7%). The mean best corrected visual acuity (BCVA) [in log of minimum angle of resolution (logMAR)] at presentation was 1.99, and the mean ulcer size was 5.75 mm. On culture, 56.7% of the cases were identified as Pseudomonas putida , 26.7% as Pseudomonas stutzeri , 10% as Pseudomonas mendocina, and 3.3% each of Pseudomonas oryzihabitans and Pseudomonas alcaligenes . We recorded good treatment responses in 66.7% of cases with the medical therapy of a combination of broad-spectrum antibiotics, whereas 33.3% of cases required surgical intervention. The risk factors for poor clinical outcome were older age, ocular trauma, previous ocular surgeries, poor BCVA at presentation, large ulcer size, delayed treatment, hypopyon, and early complications such as perforation, limbal involvement, and total ulcer. Uncommon species of pseudomonas keratitis was more closely related to predisposing factors such as corneal trauma and other factors such as previous ocular surgeries, older age, large ulcers, longer duration of treatment, early surgical intervention in complicated cases, and poor visual outcome.

Research advances in human corneal endothelial cell regeneration

Human corneal endothelial cells (HCECs) are the prerequisite for maintaining corneal transparency, but HCECs remain arrested at the G1 phase after embryonic development and can not proliferate and regenerate. Thus, the density of HCECs decreases spontaneously with corneal development. Systemic factors, primary corneal disease, refractive factors, glaucoma, inflammation, and trauma all can cause a massive loss of HCECs, lead to corneal edema and turbidity, and ultimately induce blindness. Currently, keratoplasty is the only effective treatment, but the scarcity of donor corneas and the limitation of corneal preservation technology restrict the availability of keratoplasty. Therefore, the most appealing way to tackle the tissue shortage problem is corneal endothelial cell regeneration. In recent years, not only the endogenous regeneration of HCECs mediated by surgery, drugs and gene therapy but also the exogenous regeneration of HCECs mediated by cell therapy have made fruitful progress. Although a number of regeneration strategies have entered the clinical trial stage, the wide clinical application of corneal endothelial regeneration is still far away. This review elaborates the basic research, clinical application and limitation of current strategies of corneal endothelial cell regeneration.

Comparative evaluation of “in-the-bag” intraocular lens implantation with cionni ring versus pars plana lensectomy–vitrectomy with anterior chamber IOL implantation in subluxated lenses in pediatric eyes

Background: Subluxation of the crystalline lens has various surgical management options. In moderate zonular dialysis, the capsular bag may be preserved and used for intraocular lens (IOL) implantation using a capsular tension ring or Cionni ring or Capsular tension segment. It is technically demanding and associated with high incidence of complications such as IOL decentration, dislocation, and posterior capsular opacification (PCO). Advantages of the combined pars plana lensectomy–vitrectomy (PPL/PPV) with anterior chamber IOL (ACIOL) approach include a closed ocular surgical system, minimal corneal trauma, limited iris trauma, and good vitreous control. Therefore, in this study, we aim to study the outcomes of inthe-bag IOL implantation with Cionni ring versus PPL/PPV with ACIOL in subluxated lenses in children. Aims and Objectives: The aims of this study were to compare “in-the-bag” IOL implantation with Cionni ring versus PPL/PPV with ACIOL implantation in subluxated lenses in children. Materials and Methods: In this prospective, comparative, and interventional case series, 20 eyes (18 children, 8–18 years) with 90–210° subluxation were randomly allocated into two groups (ten eyes each). Group A underwent single eyelet Cionni Ring with in-the-bag PCIOL implantation and Group B underwent PPL/PPV with ACIOL. Outcome measures included best-corrected visual acuity (BCVA), endothelial cell count (ECC), intraocular pressure, fundus evaluation, and intraoperative/post-operative complications. Results: The etiology of subluxation included trauma (40%), Marfan’s syndrome (20%), myopia (20%), and others (20%). In Group A, intraoperative difficulties were encountered in capsulorrhexis, irrigationaspiration, and increased duration of surgery. Two eyes in Group B had intraoperative lens fragment drop in vitreous. At 3 months, no statistically significant difference in BCVA was noted. About 90% eyes in Group A and 80% eyes in Group B had final BCVA of ≥6/18. ECC and PCO were significantly higher in Group A at 3 months. Conclusion: Implantation of planned open-loop ACIOL is viable surgical alternative to Cionni ring with PCIOL implantation in large lens subluxation and good pre-operative ECC.

S1.5b The burden of mycotic keratitis in West Africa

S1.5 Mycotic keratitis, September 21, 2022, 11:00 AM - 12:30 PM BackgroundFungal infection of the cornea, known as mycotic keratitis, can cause permanent corneal scarring and perforation resulting in the loss of the eye. This paper reviews the prevalence and epidemiology of mycotic keratitis in different countries in West Africa to estimate its burden.MethodsAn exhaustive search of the literature was made on Google, PubMed, MEDfacts, Cochrane Library, and Web of knowledge using different sets of keywords, viz. mycotic keratitis, ocular fungal infection, West Arica, risk factor, prevention, etc.ResultsA study in Nigeria over a period of 4 years (1974-1977) dealt with 42 confirmed cases of mycotic keratitis with Fusarium solani as the predominant etiological agent (14 cases) followed by Penicillium citrinum (8 cases) and Aspergillus fumigates (5 cases), Candida spp (3 cases). The remaining 12 cases were that of Fusarium moniliforme, Aspergillus spp, Penicillium sp, and Cladosporium spp. The predisposing factors identified were trauma from palm tree leaves, thorns, kernels, or other plant objects, mechanical tools, and frying oil. A 10-year review (2003-2012) of 152 cases of corneal ulcers at the University of Calabar Teaching Hospital, Calabar, Nigeria revealed only 2 (2.9%) cases due to Aspergillus sp, many patients in this study were farmers. Other studies from Nigeria only mentioned the prevalence of keratitis without any mention of fungal etiology. Of the two studies from Ghana, the one conducted in 1999 showed the predominant agents Fusarium spp. (52.3%) and Aspergillus spp. (15.3%), in the other one conducted in 1999-2001, these agents were represented by 42.2% and 17.4% respectively. In another prospective study of suppurative corneal ulcers in 290 cases in Ghana (June 1999-May 2001), the etiological agents identified in culturally proven 77 (85.5%) cases of mycotic keratitis were Fusarium spp-46, A. flavus-9, A. fumigates-7, A. niger-1, A. nidulans-1, and Aspergillus sp-1 A Siera Leonian study of cases of suspected infectious ulcerative keratitis from January 2005 to January 2006) detected 35.6% of mycotic keratitis and 13.7% of mixed fungal and bacterial etiology. A study on the burden of serious fungal infections in Togo mentioned an annual incidence of 951 cases of mycotic keratitis but no details of fungal etiology were mentioned.ConclusionInvestigators have estimated the annual global incidence of fungal keratitis at over 1 million cases. Reports of cases reported from some countries represent only a tip of the true burden of mycotic keratitis in West Africa. There is a need for comprehensive surveys (involving collaboration between ophthalmologists and microbiologists) of mycotic keratitis in representative communities in collaboration with primary health centers and hospitals in different countries. It should be possible to produce a combined antifungal antibacterial preparation for widespread and immediate prophylactic first-aid use after corneal trauma, especially in rural areas.

Suture selection in repair of traumatic pediatric corneal injuries

10-0 nonabsorbable nylon suture has traditionally been used for corneal wound repair. These sutures require eventual removal to prevent complications such as suture abscess. Efficacy of nonabsorbable versus absorbable sutures has been primarily assessed in the context of penetrating keratoplasty or cataract surgery. Limited data exists discussing the suture selection for corneal injury in the context of pediatric ocular trauma.

Microbiological Profile and Clinical Characteristics of Bacterial Keratitis with Poor Visual Outcome

Purpose: To compare clinical characteristics between the poor visual outcome (PVO) and good visual outcome (GVO) groups in culture-proven bacterial keratitis.Methods: A total of 230 cases (44 and 186 eyes in the PVO and GVO groups, respectively) of culture-proven bacterial keratitis, treated between January 2007 and December 2020, were reviewed retrospectively. The PVO group included cases with the final best-corrected visual acuity (BCVA) of less than 0.1 and no improvement compared to the initial BCVA. The remaining cases were included in the GVO group. The microbiological profiles, epidemiology, predisposing factors, and clinical characteristics were compared between the PVO and GVO groups, and the risk factors for PVO were analyzed.Results: Staphylococcus spp. and Pseudomonas spp. were common isolates in both the PVO and GVO groups, with no significant differences in the distribution of isolates. There were no significant differences between the groups in terms of sex, seasonal distribution, corneal trauma, and prior topical steroid use, but contact lens wear was significantly less in the PVO group. Significant risk factors for PVO were age ≥60 years (Z = 4.22, two-proportion Z-test), central corneal lesions (Z = 3.80), epithelial defect size ≥5 mm<sup>2</sup> (Z = 3.74), prior ocular surgery (Z = 3.63), hypopyon (Z = 3.42), previous ocular surface disease (Z = 3.32), and diabetes (Z = 3.12).Conclusions: In patients with bacterial keratitis, PVO was associated with older age, severe initial corneal findings, previous ocular disease history, and diabetes, but not with the causative pathogen itself.

Experience of Using Corneal Epithelium Protector Gel for the Treatment of Corneal Erosion for a Patient after Radial Keratotomy

Currently, one of the actual problems of pharmacotherapy is the treatment of recurrent corneal erosions. Traumatic and postoperative damage to the cornea can disrupt the connection between the basement membrane and the epithelium. One type of such predisposing factors that disrupt the connection between the epithelium and the basement membrane is a previously performed anterior radial keratotomy. This article describes a clinical case using off-label “Protector of corneal epithelial SPHERO®oko gel” within the complex treatment of traumatic corneal erosion for a patient after radial keratotomy. A conservative treatment includes applying 5 % dexpanthenol gel, 0.05 % picloxidine solution, a tear substitute and Corneal Epithelium Protector (BIOMIR Service, Russia) 4 times a day until the erosion was closed and then again during 2 weeks. On the 14th day complete epithelization of the cornea was achieved. Within 2 weeks the condition remained stable. Protector of corneal epithelial showed its effectiveness in complex treatment of traumatic corneal erosion for a patient after radial keratotomy.

Acute intraocular pressure elevation after Nd:YAG laser-puncture of a post-traumatic iris cyst

A 55-year-old man with a previous history of penetrating corneal trauma presented with decreased vision in his right eye, especially in photopic conditions. The visual acuity was 20/40 in the right eye and 20/20 in the left eye. A rounded lesion with smooth, thin walls and low reflective content was observed in the anterior chamber (A and B), in contact with corneal endothelium, suggestive of an iris cyst from epithelial downgrowth.

Antibiotic prophylaxis for corneal abrasion.

Corneal abrasion is a common disorder frequently faced by ophthalmologists, emergency physicians, and primary care physicians. Ocular antibiotics are one of the management options for corneal abrasion. A comprehensive summary and synthesis of the evidence on antibiotic prophylaxis in traumatic corneal abrasion is thus far unavailable, therefore we conducted this review to evaluate the current evidence regarding this important issue. To assess the safety and efficacy of topical antibioticprophylaxis following corneal abrasion. Our objectives were 1) to investigate the incidence of infection with antibiotics versus placebo or alternative antibiotics in people with corneal abrasion; and 2) to investigate time to clinical cure, defined as complete healing (re-epithelialization) of the epithelium, with antibiotics versus placebo or alternative antibiotics in people with corneal abrasion. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register; 2021, Issue 4), Ovid MEDLINE, Embase.com, PubMed, the Latin American and Caribbean Health Sciences Literature database (LILACS), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 25 April 2021. We included randomized controlled trials (RCTs) comparing antibiotic with another antibiotic or placebo in children and adults with corneal abrasion due to any cause. We used standard Cochrane methodology and assessed the certainty of the body of evidence for the prespecified outcomes using the GRADE classification. Our search of the electronic databases yielded 8661 records. We screened 7690 titles and abstracts after removal of duplicates. We retrieved 32 full-text reports for further review. We included two studies that randomized a total of 527 eyes of 527 participants in the review. One study was conducted in Denmark, and one was conducted in India. The two studies did not examine most of our prespecified primary and secondary outcomes. The first study wasaparallel-group RCT comparing chloramphenicol ocular ointment with fusidic acidocular gels (frequency was not clearly reported). This studyenrolled 153 participants older than 5 yearsof age with corneal abrasion in Denmark with a one-day follow-up duration.No participants had secondary infection in the fusidic acid group, whereas three (4.1%) participants in the chloramphenicol group had a slight reaction (risk ratio [RR] 0.15, 95% confidence interval [CI] 0.01 to 2.79; 144 participants; very low certainty evidence). Thirty-one(44.3%) participants in the fusidic acid arm and 34 (46.6%) participants in the chloramphenicol arm were cured(defined as the area of abrasion zero and no infection) at day 1(RR0.94, 95% CI0.65 to 1.34; 144 participants; very low certainty evidence).Without providing specific data, the study reported that the degree of pain was not affected by the interventions received. The most common adverse events reported were itching and discomfort of the eye, which occurred in approximately one-third of participants in each group (low certainty evidence). A secondmulticenter, two-arm RCT conducted in India enrolled 374 participants older than 5 years of age with corneal abrasion who presented within 48 hours after injury. This studyinvestigated the effect of a three-day course of either ocular ointment combinations of chloramphenicol-clotrimazole or chloramphenicol-placebo(all three times daily). At day 3,169 (100%) participants in thechloramphenicol-clotrimazole armand203 (99%) out of 205 participants in the chloramphenicol-placebo armwere cured without any complication, defined ascomplete epithelialization of the cornea without evidence of infection (RR1.01, 95% CI0.99 to 1.03; 374 participants; very low certainty evidence). Fourparticipants assigned tothe chloramphenicol-placebo armexperienced mild adverse events: two participants (1%) had mild chemosis and irritation, and two (1%) had small single sterile corneal infiltrates (low certainty evidence). Given the low to very low certainty of the available evidence, any beneficial effects of antibiotic prophylaxis in preventing ocular infection or accelerating epithelial healing following a corneal abrasion remain unclear. Moreover, the current evidence is insufficient to support any antibiotic regimen being superior to another. There is a need for a well-designed RCT assessing the efficacy and safety of ocular antibiotics in the treatment of corneal abrasion with a particular focus on high-risk populations and formulation of interventions.

Extracellular Vesicles in Corneal Fibrosis/Scarring.

Communication between cells and the microenvironment is a complex, yet crucial, element in the development and progression of varied physiological and pathological processes. Accumulating evidence in different disease models highlights roles of extracellular vesicles (EVs), either in modulating cell signaling paracrine mechanism(s) or harnessing their therapeutic moiety. Of interest, the human cornea functions as a refractive and transparent barrier that protects the intraocular elements from the external environment. Corneal trauma at the ocular surface may lead to diminished corneal clarity and detrimental effects on visual acuity. The aberrant activation of corneal stromal cells, which leads to myofibroblast differentiation and a disorganized extracellular matrix is a central biological process that may result in corneal fibrosis/scarring. In recent years, understanding the pathological and therapeutic EV mechanism(s) of action in the context of corneal biology has been a topic of increasing interest. In this review, we describe the clinical relevance of corneal fibrosis/scarring and how corneal stromal cells contribute to wound repair and their generation of the stromal haze. Furthermore, we will delve into EV characterization, their subtypes, and the pathological and therapeutic roles they play in corneal scarring/fibrosis.

Toxic non-inflammatory fungal keratitis.

Purpose:To report a new entity called “toxic non-inflammatory fungal keratitis.”Methods:Eyes manifesting infective keratitis with a history of prior administration of topical steroids were included in the study. The details pertaining to the type of injury, duration of injury, and primary treatment for corneal trauma were meticulously documented. The corneal tissues were scraped from the patients and were analyzed for fungal filaments by using a 10% KOH mount under a compound microscope. Moreover, these scraped materials were plated on blood agar and Sabouraud dextrose agar plates.Results:The corneal ulcers displayed a disproportionately reduced intensity of pain and improved visual acuity. Further, 10% KOH revealed profuse fungal filaments with few inflammatory cells in all the patients. The anterior chamber cells and flare were either reduced or entirely absent. There was no evidence of lid edema and surrounding corneal edema in any of the patients. The mean healing period was 28.8 days (standard deviation (SD): 10.05). The KOH mount revealed the presence of confluent fungal hyphae with a few inflammatory cell infiltrates. The Aspergillus species and Fusarium species were found in 47% and 40% of the cases, respectively.Conclusion:Toxic non-inflammatory fungal keratitis following steroid therapy needs to be considered in fungal ulcers with disproportionately less pain and good visual acuity. The fungal ulcers with altered clinical signs of classical inflammation need to be assessed for topical steroid misuse.

Manifestation of Corneal Wound Gap during Cataract Surgery: A Case Report

Significance: Intraoperative AS-OCT showed great advantages in the treatment of the patient with traumatic cataract and corneal perforation, and could be used to real-time monitor the changes of corneal wound and the IOL position. Purpose: To report the change of corneal wound in a patient with traumatic cataract and corneal perforation during the anterior segment-OCT-assisted (ASOCT- assisted) cataract surgery. Case Presentation: A 48-year-old male patient, whose right eye was injured by a steel wire two months ago, presented with traumatic cataract and corneal perforation. When he was referred to our hospital, the corneal epithelium and part of anterior stroma at the laceration had healed. Therefore, the corneal laceration was not sutured, and AS-OCT was conducted to monitor the corneal laceration and assess the IOL position during cataract surgery. The laceration maintained closed, and no liquid leakage through corneal laceration was found throughout the surgical operation. IOL was placed into the capsular bag, and the visual acuity of the affected eye recovered to 3/10 postoperatively. Conclusions: Intraoperative AS-OCT could be used to real-time monitor the changes of corneal wound and the IOL position, and showed a significant advantage in the treatment of the eye with traumatic cataract and corneal perforation