Corneal Ulcer Research Articles

Evaluation of the Use of Highly Concentrated Autologous Platelet-Rich Plasma and Platelet-Rich Fibrin Membrane to Improve the Outcome in the Management of Severe Dry Eye Disease, Corneal Neurotrophic Ulcer and Corneal Burn.

The aim of this study was to evaluate the use of highly concentrated platelet-rich plasma (PRP) subconjunctival injections, in combination with eye drops (eye PRP, or E-PRP), in treating dry eye disease (DED) and the use of platelet-rich fibrin (PRF) membrane in treating corneal burns and neurotrophiculcers for the restoration of the homeostasis of the tear film and the morphology and function of the cornea. We studied 16 patients (n=32 eyes) with severe DED. The disease was graded as severe according to the Oxford Grading Scale.There were 12 males (75%) and four females (25%) with a mean age of 56 years; these patients were treated with monotherapy, which involved a single subconjunctival injection of 0.2-0.3 mL of PRP prepared from autologous blood, followed by application of autologous PRP eye drops four times a day for 15 days between September 2019 and December 2020 in the same geographic area. All patients gave written informed consent before undergoing the outlined treatment protocol. We evaluated best corrected visual acuity (BCVA), Schirmer test score, tear film breakup time (TBUT) and corneal staining with fluorescein (Oxford Grading Scale) before and after six to eight weeks of treatment. Subjective normalization was defined by a decrease in the Ocular Surface Disease Index (OSDI) score to 10 or less, an objective normalization of the TBUT to five to six seconds, improvement in the Schirmer test score and Oxford grading and the BCVA gain of at least one line in the vision chart (Snellen chart). Furthermore, we report on the results from different variants of platelet concentrate-based treatments in five cases of corneal diseases: neurotrophic ulcers and corneal burns due to different causes (e.g., chemical burns) using E-PRP and PRF membrane with regard to normalization of morphology and function. The OSDI score decreased to normalization in 75% of the patients (p=6.545× 10-15). TBUT was restored significantly in 20 of 32 eyes from 2.78±0.55 to 5.43±0.71 (p=1.612× 10-24). The Schirmer test score showed an improvement from 4.46±0.67 to 10.28±1.18 (p=3.411 ×10-29), and BCVA improved by 43.75%, from 0.15±0.19 to 0.09±0.16 (logMAR, p=0.2331). Oxford grading changed to Scale I in 75% and Scale 0 in 25% of the patients. No complications or adverse reactions occurred in the five cases of corneal injuries. We observed a restoration of the morphology and function of the cornea with PRP injections or PRF+PRP application in 7-12 days, depending on the severity of the initial finding. PRP treatment is a new approach in ophthalmology with impressive results. Although patients show good compliance and acceptance of the treatment protocol, studies with larger sample sizes are needed to confirm and optimize its use.

A facile method to construct ZIF-8 MOFs on contact lens for high antibiotics loading and self-defensive release

Eye trauma, ophthalmic surgery and contact lens (CL) wearing cause corneal infection and bacterial biofilms formation, which further lead to corneal ulcer and perforation. In view of the low bioavailability of antibiotic eye drops and the clinical problems that cause bacterial resistance, we used pH sensitive zeolitic imidazolate framework-8 metal–organic frameworks (ZIF-8 MOFs) to load broad-spectrum antibacterial drugs levofloxacin (LEVO). After the surface modification by hyaluronic acid (HA), the nanomaterial surface was negatively charged. A simple amination treatment was used to endow CL surface with amino groups to combine the negatively charged nano drug loading system through electrostatic forces. The bacteriostatic ring of ZIF-8@LEVO@HA-PEI modified CL (ZLHP-CL) was 34 mm, which could be owing to the high drug loading capacity of ZIF-8 (0.65 mg/cm2). The bactericidal function was further confirmed by shake flask method and live/dead bacterial staining assay against S. aureus, S. epidermidis and E. coli. It is worth mentioning that ZLHP-CL showed significant pH sensitivity to the bacterial infection, which released drug rapidly at pH 5.5 and hardly released drug at pH 7.4. In the bacterial biofilm’s formation experiment, it was found that ZLHP-CL obviously inhibited bacterial adhesion and biofilms formation. Furthermore, it was proved in infectious keratitis animal that ZLHP-CL could kill the bacteria and reduce the inflammation reaction, which showed advantages in corneal tissue repair and light transmittance maintenance. In this work, based on nanotechnology, a facile CL drug loading technology is developed, which can be used to sustained release of various drugs for ophthalmic diseases treatment.

P20 A Rare Case of Hereditary Mucoepithelial Dysplasia With Long Term Follow Up

Abstract This 28-year old woman initially presented at 2 years of age with patchy alopecia, perianal erythema and widespread rough skin. Prior to her first birthday she was diagnosed with bilateral corneal ulceration and was treated initially with soft contact lenses. She had no features of ichthyosis or hyperkeratosis and teeth, nails and eyelashes were normal. The hair loss progressed with involvement of the eyebrows. On examination, there was widespread keratosis pilaris, perianal and vulval erythema and angular cheilitis. Light microscopy of the cut hair was essentially normal. A clinical diagnosis of hereditary mucoepithelial dysplasia was made at that time. She recently underwent genetic testing which has confirmed the diagnosis. She is now registered blind and wears a wig. Her IQ is normal. Hereditary mucoepithelial dysplasia (HMD; OMIM 158310) is a rare autosomal dominant genodermatosis characterised by chronic mucosal lesions associated with keratitis, non-scarring alopecia, keratosis pilaris and psoriasiform perineal intertrigo. A novel causative heterozygous pathogenic variant c.1580G>T (p.Arg527Leu) was identified in our patient in the sterol regulatory element-binding factor 1 (SREBF1) gene. This is involved in promoting the transcription of lipogenes that are associated with epidermal cholesterol and fatty acid biosynthesis. HMD is allelic with autosomal dominant IFAP showing considerable phenotypic overlap and should be considered in patient with congenital hypotrichosis.

Ocular complaints and diagnoses in spaceflight.

The NASA human system risk board (HSRB) has long focused on trauma and acute medical illness as a key contributor to high level in-flight medical risk. However, ocular issues, trauma, and complaints during spaceflight are poorly characterized. In a retrospective case series, the NASA data from the life sciences data archieve (LSDA) and the lifetime surveillance of astronaught health (LSAH) was queried for eye related complaints and conditions in spaceflight across international space station (ISS) missions and space shuttle (STS) missions. The ISS dataset included missions from the year 2000 to 2020, and the STS dataset included missions from 1981 to 2011. Data were reviewed and segmented into categories of ocular complaints. 135 STS missions and 63 ISS missions were included in this analysis. Ocular events were only noted across 83 STS missions (61.5%) and 41 ISS missions (65.1%). Overall, the most common ocular complaints were eye irritation (n = 80, 33.1%), ocular foreign body or foreign body sensation (n = 55, 22.7%), dry eye syndromes (n = 38, 15.7%), epiphora or excessive tearing (n = 19, 7.85%). Of all ocular complaints or diagnoses, 9 (3.72%) were considered higher severity (keratitis, corneal ulcer, chemical exposure, and corneal abrasion). However, seemingly none required evacuation from mission. Improved depiction of ocular symptoms and diagnoses, and a more standard classification system and process to describe ocular symptoms, diagnoses, and treatments in space is crucial to provide more effective and comprehensive treatments.

Oftalmopatias em 574 cães da raça Shih tzu atendidos em um Hospital Veterinário: estudo retrospectivo

Abstract Brachycephalic breeds, including Shih Tzus, are predisposed to developing ophthalmic conditions due to facial conformation. This study investigated the primary ophthalmic diseases in Shih Tzus treated at the Governador Laudo Natel’s Veterinary Hospital of São Paulo State University Júlio de Mesquita Filho, Jaboticabal-São Paulo, Brazil, between 2014 and 2022. We selected 574 cases, totaling 1,724 diagnoses. Regarding sex, 50% (287/574) were female, and 50% (287/574) were male. Anatomically, diagnoses in group 1 (lacrimal system, eyelids, and adnexa) were the most common, comprising 55% (945/1,724), followed by group 2 (anterior segment) at 40% (683/1,724), group 4 (eyeball) at 4% (73/1,724), and group 3 (posterior segment) at 1% (23/1,724). The mean age at diagnosis was 5.2 years. Adult dogs were the most represented age group at 55% (317/574), followed by young dogs at 25% (145/574) and elderly dogs at 20% (112/574). Elderly dogs had more diagnoses of glaucoma and cataracts compared to young and adult dogs. In young dogs, the most diagnosed conditions were ulcerative keratitis and distichiasis, while in adults and elderly dogs, the predominant conditions were keratoconjunctivitis sicca and ulcerative keratitis.

Amniotic membrane transplantation for neurotrophic corneal ulcers.

To evaluate the clinical results of cryopreserved amniotic membrane transplantation as a treatment option for refractory neurotrophic corneal ulcers. This prospective study included 11 eyes of 11 patients who underwent amniotic membrane transplantation for the treatment of refractory neurotrophic corneal ulcers at Hospital de Clínicas da Universidade Federal do Paraná, in the city of Curitiba, from May 2015 to July 2021. Patients underwent different surgical techniques in which the amniotic membrane was applied with the epithelium facing upward to promote corneal re-epithelialization. The median age of the patients was 60 years (range, 34-82 years), and 64% were men. The predominant etiology of corneal ulcers was herpes zoster (45% of cases). Approximately one-third of the patients (27%) were chronically using hypotensive eye drops, and more than half (54%) had previously undergone penetrating corneal transplantation. At the time of amniotic membrane transplantation, 18% of the eyes had corneal melting, 9% had corneal perforation, and the others had corneal ulceration without other associated complications (73%). The time between clinical diagnosis and surgical treatment ranged from 9 days to 2 years. The corrected visual acuity was worse than 20/400 in 90% of the patients preoperatively, with improvement in 36% after 3 months of the procedure, worsening in 18% and remaining stable in 36%. Of the patients, 81% complained of preoperative pain, and 66% of them reported total symptom relief after the surgical procedure. In one month, 54.6% of the patients presented a closure of epithelial defect, and half of the total group evolved with corneal thinning. The failure rate was 45.5% of the cases. Cryopreserved amniotic membrane transplantation can be considered a good alternative for treating refractory neurotrophic corneal ulcers, as it resulted in significant improvement in pain (66%) and complete epithelial closure (60%) in many patients at 1 month postoperatively. Notably, the high failure rate highlights the need for further studies to identify patientand ulcer-related factors that may influence the outcomes of this procedure.

The Clinical and Microbiological Characteristics of Fungal Keratitis in COVID-19 Period

Abstract Context: In India, the incidence of fungal keratitis ranges from 44% to 47%, due to its tropical environment and huge at-risk agricultural population. The emergence of COVID-19 has influenced the medical management of fungal keratitis. Aim: The aim of this study was to assess the clinical and microbiological characteristics of fungal corneal ulcers during COVID-19 period. Settings and Design: This was a cross-sectional study of 1-year duration. Subjects and Methods: Fifty-two KOH mount-positive and fungal culture-positive patients were included in the study. Ophthalmic examination, including best-corrected visual acuity, slit-lamp examination, fluorescent staining was done, Anterior segment optical coherence tomography (ASOCT). Corneal scraping was sent for 10% KOH mount and fungal cultures with Sabouraud’s dextrose agar for growth. Statistical Analysis Used: The Statistical Package for the Social Sciences (Version 20) was used for statistical analysis. Results: Fifty-two KOH mount and fungal culture-positive patients were included, with a mean age of 50.88 years. 53.8% were farmers. 55.6% had a history of trauma with organic matter. The common signs noted were an irregular, dry looking, central corneal ulcer measuring 2-5mm extending 20-50% deep, mid stromal infiltration, satellite lesions and surrounding stromal oedema. Eleven presented with perforation. The best-corrected visual acuity was hand movements (32.7%). The KOH mount positive among the screened patients was 46.7%, of which 52 were culture positive. Aspergillus fumigatus (61.5%) was the predominant cause of mycotic keratitis. Conclusion: Mycotic keratitis was mostly caused by filamentous fungus and was most frequently observed among farmers. COVID-19 has increased the cases of perforated corneal ulcers, and ASOCT was the noninvasive, feasible tool to assess the cornea.

Ocular Traumas among Artisans Received at the University Teaching Hospital in the Suru-Lere Zone of Cotonou, Benin

Introduction: Authors investigated the epidemiological, clinical, therapeutic, and evolutionary aspects of ocular traumas among artisans received at the Suru-Lere University Teaching Hospital (CHUZ-SL) in Cotonou, Benin. Method: A retrospective study was conducted over a 5-year period at the Suru-Léré University Teaching Hospital by exhaustive recruitment of 715 patients consulting for ocular trauma during the period. Included in the study were the records of artisan patients received for ocular trauma during their activities. Results: In total, 89 cases of ocular traumas among artisans were collected, representing a frequency of 12.45%. The mean age of the patients was 30.60 ± 10.47 years. Male artisans were the most numerous (97.8%) with a sex ratio of 43.5. The most exposed professions were welders, accounting for 36%, followed by carpenters at 15.7%. The average consultation delay was from 24 hours to one week (61.8%). The right eye was the most affected, accounting for 51.7%. In the majority of cases, it was a trauma due to the projection of a superficial foreign body (84.30%). Predominant initial lesions were bulbar hyperemia (53.93%) and corneal ulcer (34.5%). Most patients underwent medical and surgical treatment (62.9%). Sequelae included corneal opacities (75.4%). Conclusion: Ocular traumas among artisans are quite frequent and can be prevented by the use of personal protective equipment.

Corneal epithelial cell markers in congenital aniridia

Congenital aniridia is a rare panocular disease in which almost all structures of the eye are affected. The observed corneal abnormalities are called aniridia‐associated keratopathy (AAK). AAK is characterized by progressive limbal stem cell deficiency (LSCD), epithelial thinning and erosions, corneal ulceration, vascularization, inflammation and pannus formation. Although in some aspects AAK resembles other types of LSCD, through its specific genetic origin, alterations in corneal epithelial cell gene expression differ from other types of corneal diseases. Primary limbal epithelial cells of aniridia subjects lack expression of KRT3 and KRT12 mRNA and protein, and DSG1, ADH7, FABP5, CRABP2, SPINK7 and ALDH1A1 mRNA expression is decreased in these cells. However, miRNA 138‐5p expression is upregulated. This epithelial behaviour can also be mimicked using an siRNA based aniridia primary limbal epithelial cell model.

Facial Onset Sensory and Motor Neuronopathy with Neurotrophic Keratitis: A Case Report

Facial-onset sensory and motor neuronopathy (FOSMN) is a rare, progressive neurodegenerative disorder characterized by sensory loss and motor deficits, primarily affecting the face and upper extremities. The condition begins with sensory impairments in the trigeminal nerve distribution, extending to involve the scalp, neck, upper limbs, and trunk. Symptoms include facial weakness, bulbar disturbances (dysphonia, dysarthria, dysphagia, and sialorrhea), and lower motor neuron signs (weakness, atrophy, fasciculation, and cramps) in the limbs. A hallmark of FOSMN is the diminished or absent corneal reflex, indicating trigeminal nerve involvement and leading to potential complications like neurotrophic keratitis (NK), which can cause corneal ulceration and blindness. The etiology of FOSMN remains uncertain, with theories proposing autoimmune or neurodegenerative origins. Diagnosis is challenging due to the overlap with other ocular surface disorders, necessitating careful examination and differential diagnosis. Management focuses on symptomatic relief, including eye protection to prevent corneal complications. Awareness and early detection of ocular symptoms in FOSMN are crucial for preventing severe outcomes like NK and blindness.

Experience of using autologous cornea for deep and penetrating keratoplasty in dogs and cats

This paper presents a generalized experience in the treatment of deep corneal ulcers, descemetoceles and perforated corneal ulcers in which keratoplasty was used using autologous cornea. Deep corneal ulcers are characterized by an acute inflammatory process and the risk of developing many complications leading to loss of vision. Conservative treatment of such pathologies takes a long time and is not always successful. Keratoplasty for corneal transplantation is considered an effective method. The outcome of the operation depends on the transplanted material and postoperative treatment tactics. The work conducted a study on the effectiveness of using autologous cornea in 32 animals with subsequent inclusion of a regenerative drug in the treatment regimen. The authors describe the clinical picture, the surgical technique, and provide the results of dynamic observation of animals. Based on the results of clinical observations, it was established that the use of autologous cornea for deep corneal ulcers can be an effective treatment method. In none of the 32 cases examined, rejection was recorded, while the morphofunctional characteristics of the cornea were preserved. Drug maintenance therapy, including a regenerative drug, showed good results in the postoperative period. The use of a regenerative drug accelerated the healing process and made it possible to maintain the transparency of the cornea and its curvature.

Analysis of the potential of the homeopathic eye drops Marine Cineraria 4CH to induce cell migration

The ocular surface comprises diverse components that collaborate to maintain homeostasis, and any change can be termed an ocular surface disorder. One frequently observed change is the development of corneal ulcers, a primary contributor to visual impairment. Cineraria maritima is a botanical species renowned for its therapeutic application in managing diagnosed cataracts and other eye-related ailments. This study evaluated the effect of the homeopathic eye drops containing Cineraria maritima using cell viability assessments, a scratch experiment, and the quantification of IL-8 levels. The in vitro tests revealed the absence of any cytotoxic effects associated with the eye drops, thus demonstrating their safety for use. Furthermore, these eye drops exhibited the capacity to enhance the percentage of scratch closure. The treated group had an average closed area percentage of 57%, while the control group exhibited only 41% area closure, indicating the potential efficacy of eye drops in managing ocular disorders. Finally, IL-8 levels were measured following the induction of an inflammatory response by LPS and subsequent treatment with the eye drops. The outcomes indicate a decrease in the levels of this cytokine in the treated group. Such findings assure the safety and effectiveness of Cineraria maritima 4CH homeopathic eye drops, suggesting a potential avenue for their application to treat corneal ulcers.

Challenging course of endophthalmitis with corneal ulcer following cataract surgery: successful management and visual rehabilitation

Challenging course of endophthalmitis with corneal ulcer following cataract surgery: successful management and visual rehabilitation

Actual aspects of treatment and prevention of infectious bovine keratoconjunctivitis

Infectious bovine keratoconjunctivitis is a bacterial eye disease. The disease is characterized by inflammation of the conjunctiva, corneal ulceration and excessive lacrimation. Although this disease does not lead to the death of animals, its economic importance is enormous, since it leads to a decrease in livestock weight gain and a reduction in dairy productivity. The main etiological role in IBK belongs to Moraxella spp. (including in associations with Staphylococcus spp., Streptococcus spp., Pseudomonas aeruginosa, E. coli, Proteus). The use of traditional treatment methods, such as the use of antibacterial chemicals, for Moraxella infection may be ineffective due to the factors of resistance and immunity of these bacteria. The development of a vaccine can be expensive and time-consuming, due to the external localization of the infection; it will be difficult to achieve a protective effect. New strategies for the treatment and prevention of bacterial infection open up prospects for the use of bacteriophages. Due to the growing antibiotic resistance of circulating bacterial pathogens and to increase the effectiveness of therapeutic and preventive measures in IBK, the development of phage therapy is relevant. Fundamental studies of biological properties and exploratory studies of virulent active bacteriophages to zoopathogenic Moraxelles are an urgent problem.

Bowman's layer transplantation—A new hope for regaining of correct ocular surface

Aims/Purpose: To present a novel surgical technique of selective Bowman's layer transplantation as well as results of the surgery in patients with neurotrophic corneal ulcers.Methods: 3 eyes from 3 patients with neurotrophic corneal ulcers who underwent corneal grafting with Bowman's layer. Pre‐ and postoperative analyses of the anterior segment of the eye were based on optical coherence tomography and slit lamp assessment.Results: Postoperatively a gradual corneal stroma restoration and fast corneal epithelialisation were noticed.Conclusions: Based on our observations, stiff and firm structure of Bowman's layer is supposed to strengthen corneal surface and maintain its shape. It acts also as an anti‐pathogen and anti‐toxin corneal barrier. Application of this acellular corneal layer transplantation to cover trophic corneal ulcers is an interesting, modern and crucial method of neurotrophic keratitis treatment.Reference1. Hsu HY, Modi D. Etiologies, quantitative hypoesthesia, and clinical outcomes of neurotrophic keratopathy. Eye Contact Lens 2015;41(5):314–7.2. Sacchetti M, Lambiase A. Diagnosis and management of neurotrophic keratitis. Clin Ophthalmol 2014;8:571–9.3. Mantelli F, Mauris J, Argüeso P. The ocular surface epithelial barrier and other mechanisms of mucosal protection: from allergy to infectious diseases. Curr Opin Allergy Clin Immunol. 2013 Oct;13(5): 563–8.4. Wilson SE. Bowman's layer in the cornea‐ structure and function and regeneration. Exp Eye Res 2020 Jun;195:108033.5. Lagali N, Germundsson J, Fagerholm P. The Role of Bowman's Layer in Corneal Regeneration after Phototherapeutic Keratectomy: A Prospective Study Using In Vivo Confocal Microscopy. Invest Ophthalmol Vis Sc. 2009 Sep;50(9):4192–8.

Graves Eye Disease Medical and Surgical Management: A Review

Graves’ disease (GD) is the most frequent cause of hyperthyroidism, where iodine levels are abundant. One of the extrathyroidal symptoms is Graves’ ophthalmopathy (GO) which presents with ophthalmic symptoms that can range from minor (e.g., dry eye) to sight-threatening (e.g., corneal ulceration and compressive optic neuropathy) features. About 79% of Graves’ disease cases can be attributed to genetic predispositions, while the remaining 21% are due to environmental factors. Acute stress, active or passive smoking, and past radioactive iodine therapy have all been linked to the development or aggravation of thyroid eye disease (TED). The devastating effects of GO or TED might include diplopia, ocular hypertension, optic nerve degeneration, and glaucoma. A low basal serum Thyroid Stimulating hormone (TSH) level has the highest sensitivity and specificity for diagnosing hyperthyroidism. Moreover, the appearance of Thyroid Stimulating hormone receptors (TSHR) autoantibodies (TRAbs) is presumed to be highly specific for the diagnosis of Graves’ disease. Imaging studies of the orbit that use ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI), for example, can confirm the diagnosis of TED. In order to treat Graves’s eye disease optimally, a multidisciplinary approach must be applied involving primary care physicians, ophthalmologists, internists and endocrinologists. Therefore, it is essential to restore the euthyroid state and this can be obtained by either antithyroid medications, radioactive iodine or surgical thyroidectomy. Treatment of GO ranges from supportive treatment (lubricants and moisturizer drops), to medical intervention, preferably corticosteroid, and variable surgical interventions. Key words: Graves’ disease, Medical and surgical management

Non infectious ocular surface inflammation: Paediatric GVHD

Although ocular findings and treatment for GVHD are described in adult patients, the literature describing this condition in paediatric patients is relatively few. In children, detection of symptoms and diagnosis of ophthalmic findings are more difficult than in adults, as history taking, clinical examination and diagnostic tests such as fluorescein staining or Schirmer tests are difficult to perform due to limited cooperation. Also patients cannot specify their complaints and symptoms especially in younger age group. Follow‐up and frequent ophthalmic evaluation are important in diagnosis and management of children who had bone marrow transplantation. Even though ophthalmic findings are common in children, usually milder than adults but timely diagnosis and management are very important to decrease secondary eye complications such as corneal ulcers and vision loss and also to improve quality of life.Graft‐versus‐host disease (GVHD) is a major complication of bone marrow transplantation that is performed for haematological malignancies and diseases and seen in 50–70% of cases. It is a complex clinical disease with many organ and system involvement. Acute form is seen in the first 3 months after transplantation, systemic manifestation mainly include hepatitis and skin involvement and chronic form is mostly seen after acute GVHD. Ocular manifestations can be classified as acute and chronic and also as anterior and posterior. Most common ocular finding is dry eye with corneal involvement and seen in 40–90% of patients with chronic GVHD. Corneal vascularization, keratitis and even perforation can be seen. Conservative treatment with topical steroids, autologous serum, lubricant eye drops and ointments should be integrated with topical cyclosporine‐A that might be an effective and safe treatment option in dry eye related to chronic GVHD.

Периферические язвы роговицы в ассоциации с ревматической патологией

Background: peripheral ulcerative keratitis (PUK) is a polyetiological disease. The pathogenesis of PUK is attributed to a combination of factors, including the anatomy of the peripheral cornea, the activation of autoimmune reactions, and the corneal destruction caused by autoan- tibodies and matrix metalloproteinases. Aim: to describe the clinical symptoms of PUK, its association with rheumatic diseases (RD), its course, and the efficacy of treatment options. Patients and Methods: а total of 32 patients (9 men and 23 women, mean age 59.3±9.4 years) with PUK associated with RD were under surveillance. The diagnosis was established based on the results of eye examinations, tear production test, and multidisciplinary examination. Treatment was performed in an outpatient or inpatient setting based on the severity of corneal lesions. Results: the most common association between PUK and RD was established with rheumatoid arthritis (56.2%). Clinical hallmarks of PUK included mild infiltration and perifocal corneal edema, accompanied by the appearance of an oval or sickle-shaped epithelial and stromal defect 2–4 mm from the limbus. Additionally, rapid corneal lysis and perforation (18.7%) and association with perilimbal vasculitis and scleritis (31.2%) were observed. Bilateral corneal lesions were observed in 56.2%. Tear production, as measured by Schirmer's test, was 6±2 mm, while tear film stability was 2±1 mm. Conservative management was found to be effective in 59.4% (outpatient treatment in 40.6% and inpatient treatment in 18.7%). Surgical interventions were performed for emergent indications, including tectonic keratoplasty (21.9%) and deep anterior lamellar keratoplasty (15.6%). Conclusion: PUK represents a severe clinical manifestation of visual disorders in RD. Treatment for PUK involves local and systemic steroids in the acute period, basic immunosup-pressive therapy, and, when necessary, keratoplasty. Systemic rheumatological therapy, regular use of tear substitutes and reparative preparations are prescribed to prevent recurrences. KEYWORDS: keratitis, corneal ulcer, limbus, autoimmune diseases, rheumatoid arthritis, keratoplasty. FOR CITATION: Drozdova E.A. Peripheral corneal ulcers in association with rheumatic diseases. Russian Journal of Clinical Ophthalmology. 2024;24(2):88–93 (in Russ.). DOI: 10.32364/2311-7729-2024-24-2-8.

Cornea on fire: PACK‐CXL in the treatment of infectious keratitis

Infectious keratitis is a severe eye condition that can cause permanent vision loss if not treated promptly. The current standard of care for this condition involves the use of broad‐spectrum topical antibiotic drops. However, researchers have explored photoactivated chromophore for collagen cross‐linking (PACK‐CXL) as a potential treatment option for infectious keratitis. Studies have shown that PACK‐CXL can improve the healing process in bacterial keratitis and prevent corneal melting caused by bacterial enzymatic degradation.When activated by UV light, riboflavin, the photosensitizer used in PACK‐CXL, induces changes in collagen properties, leading to a hardening and strengthening effect on the corneal stroma. However, individuals with corneal ulcers may experience greater penetration of UV light due to the compromised integrity of the cornea, which could cause endothelial cell loss and impair corneal function.The purpose of this presentation is to provide a summary of the evidence on the comparative effectiveness and safety of PACK‐CXL with or without standard therapy versus standard therapy alone for the treatment of bacterial keratitis. The latest randomized controlled trials (RCTs) will be reviewed, and their findings regarding the efficacy and safety of PACK‐CXL in treating infectious keratitis will be discussed, as well as a comparison with standard antibiotic therapy alone. Ultimately, this talk aims to inform evidence‐based recommendations for the treatment of infectious keratitis and provide clinicians with the most up‐to‐date information to make informed treatment decisions.

Blood‐derived trophic factors for the treatment of ocular surface diseases

The use of blood‐derived products (Eye Drop of Human Origin—EDHO; in Italian: Emocomponents for Not Transfusional Use, EUNT) for the treatment of various ocular surface diseases has become increasingly utilized in ophthalmic practice over the years. In particular, they are recommended as a third line option, when conventional tear substitutes, or active drugs, such as corticosteroids or Cyclosporine A, result unsuccessful in controlling either signs and, perhaps most importantly, subjective symptoms of discomfort and pain. The rationale for their use is based on the stimulation of cell proliferation and migration through the supply of metabolically active substances, in particular growth factors, and definitely mimicking the function of natural tears.EDHO have been used for the treatment of various ocular surface diseases, including dry eye, persistent corneal epithelial defect, corneal ulcer, neurotrophic keratitis, ocular surface burn, recurrent corneal erosion and limbal stem cell deficiency. However, the therapeutic potential of these products is still to be fully explored, as randomized clinical trials and internationally recognized harmonized guidelines are still needed to provide better evidence, improve quality of the final products and lead to a more widespread use of these therapies in daily clinical practice. The autologous source is still quite popular, although allogeneic sources appear to be a promising innovation. These might offer the solution of obtaining in advance products tailored for each patient and ocular surface disease, at scalable concentrations based on the severity of the disease and clinical parameters. There remain many unanswered questions regarding what might be considered optimal treatment, sketched as “The 5 Ws (and 2 H) for blood based eye drops”, to quote a review from our group (doi: 10.3390/jcm8091478). This presentation will discuss: 1. who is the patient to be treated, in terms of disease type, severity, and stage?; 2. Why is an EDHO needed, in terms of a target indication?; 3. When is it appropriate to prescribe an EDHO therapy?; 4. Where are EDHO be dispensed, and is a national/regional program a feasible solution to optimize resources?; 5. What is the EDHO of choice, which source and preparation are targeted for a given patient? And further: 1. how is EDHO standardized in terms of processing to ensure an optimal dilution, solvent, dispenser, storage time?; 2. How is EDHO delivered to the ocular surface, in terms of form, dose‐size modulation, length of treatment?An interdisciplinary work with transfusional medicine specialists is imperative to share information and competences, to achieve a better clinical management.