Healing Of Epithelial Defect Research Articles

Management of Ocular Surface Inflammation with Persistent Epithelial Defects Using a Sutureless Human Amniotic Membrane Dehydrated Matrix: A Prospective Study Utilizing a Digital Ocular Surface Assessment Tool.

To report the outcomes of using a sutureless human amniotic membrane dehydrated matrix (HAMDM) in the management of a range of ocular surface conditions utilizing a digital ocular surface disease assessment tool. Two UK NHS Trusts - Queen Victoria Hospital Foundation Trust (East Grinstead and Maidstone) and Tunbridge Wells Trust (Kent) - prospectively treated patients with ocular surface disease with sutureless HAMDM. The patient cohort was assessed for resolution of epithelial defects, ocular surface inflammation, and best-corrected visual acuity pre- and posttreatment. Measurements of ocular surface inflammation and epithelial defect size were assessed using AOS digital imaging software, a validated tool for objective grading of bulbar conjunctival redness and measurement of corneal epithelial defects. A total of 47 applications of sutureless HAMDM on 46 eyes of 46 patients (25 male, 21 female, age 9-94 years) were assessed across various etiologies for an average of 24.0±14.1 days. Patients with limbal stem-cell deficiency (n=17), persistent epithelial defects (n=16), neurotrophic corneal disease (n=7), filamentary keratitis (n=2), corneal erosion (n=1), corneal thinning (n=1), ocular surface inflammation (n=1), and traumatic corneal laceration (n=1) were included in the study. Across all patents, 63% of eyes showed complete healing of epithelial defects and 32.6% of eyes showed partial resolution. The average rate of healing (wound closure) was 0.36 mm2 per day across the overall patient cohort, and the rate of healing in cases with complete resolution of epithelial defects was 0.41 mm2 per day. Inflammation across all four quadrants of the ocular surface remained stable. Visual acuity across the patient cohort remained stable (61%) and improved in 26% of patients (0.06±0.51 logMAR). Sutureless HAMDM application can be accomplished in just a few minutes and effectively treat a range of ocular surface disease in a clinical, nonsurgical setting. The AOS imaging software offered a quantitative methodology for measuring epithelial defect size and inflammation state.

Topical Insulin Treatment for Neurotrophic Corneal Ulcer with Persistent Epithelial Defect

Background: Neurotrophic keratitis (NK) is a degenerative corneal disease caused by impairment of corneal sensory innervation. It is characterized by decreased or absent corneal sensation, leading to epithelial breakdown, impairment of healing, and ultimately to the development of corneal ulceration, melting, and perforation. We described a case of neurotrophic ulcer with persistent epithelial defect and its remarkable healing response to insulin eye drop treatment. Case Presentation: A 62-year-old male patient was referred to our hospital for the management of stage III NK in the left eye. The condition started 6 months ago; the patient developed a sudden onset of left eye diminution of vision, red eye, and tearing. The patient sought an ophthalmic consultation and was diagnosed with herpes simplex keratitis. On examination, visual acuity OS was hand motion (HM), severe conjunctival injection, deep corneal vascularization, corneal opacity with stromal infiltration, epithelial defect about 3.5 x 6 mm, stromal thinning, Descemet membrane folds and loss of corneal sensation by cotton wisp test. The patient was treated with topical insulin eye drops for 6 weeks and showed substantial ulcer healing and reepithelization of the epithelial defect. Conclusion: Insulin drops have been shown to substantially promote persistent epithelial defect healing in the case of neurotrophic ulcers. Therefore, topical insulin use can potentially help in the treatment of refractory neurotrophic keratitis. Further studies with large case numbers and long follow-ups should be the main focus of future research.

Blast Eye Injury After Mobile Phone Battery Explosion: A Case Report

Introduction : Injuries from mobile phone blasts have been on the rise in recent years. Mobile phone blasts cause serious ocular morbidity. We report a rare case of blast eye injury after mobile phone battery explosion.
 Case Illustration : A 16 years old woman presented with burning sensation on both the eyes, following a smartphone battery blast. Immediately, after disconnecting the phone from the charger, the battery exploded and the phone blew apart. Her presenting visual acuity was 1/300 and 1.0 in right eye and left eye. Examination revealed broad corneal haziness on right eye, charred lashes, circumciliary congestion, and multiple soot particles embedded over the cornea, conjunctiva, and the lid margins. The eyes were washed with copious ringer lactate and the debris was carefully removed. Topical preservative free lubricants, broad-spectrum antibacterial agent, corticosteroid, and cycloplegic agent were prescribed along with systemic nonsteroidal anti-inflammatory drug. The healing of epithelial defects started on the next day and was complete by the 14th day.
 Discussion : We describe an ocular blast injury due to mobile phone explosion. The mechanism of injury from battery blast could be a combination of mechanical (battery pieces), thermal, and chemical injuries. The vision can be saved if the ocular surface burns are treated promptly and properly.
 Conclusion : Mobile blast injury is emerging as a new mode of ocular trauma. Knowing proper management is very important to achieve the best result.

Potential Benefits of Integrin αvβ3 Antagonists in a Mouse Model of Experimental Dry Eye.

The purpose of this study was to extensively evaluate the efficacy of integrin αvβ3 antagonists for the treatment of experimental dry eye (EDE). Vitronectin, an αvβ3 ligand, was used to induce tumor necrosis factor-α gene expression in human THP-1 macrophages. To induce EDE, C57BL/6 mice were housed in a low-humidity controlled environment chamber and injected subcutaneously with scopolamine for 7 days. Subsequently, αvβ3 antagonists, including RGDfD, c(RGDfD), c(RGDiD), c(RGDfK), ATN-161, SB273005, and cilengitide, were administered topically to EDE animals under controlled environment chamber conditions. Corneal epithelial damage in EDE was assessed by fluorescein staining. The density of conjunctival goblet cells and secretion of tears was measured by period acid-Schiff staining and phenol red-impregnated cotton threads, respectively. Inflammation markers, including tumor necrosis factor-α, interleukin (IL)-1β, IL-6, IL-17A, and metalloproteinase (MMP)-9, in the pooled cornea and conjunctiva tissues were examined by real-time polymerase chain reaction. The inhibitory effects of αvβ3 antagonists on the vitronectin-induced tumor necrosis factor-α gene expression and integrin-mediated inflammatory signaling were validated in THP-1 macrophages. αvβ3 antagonists ameliorated the impairment of the corneal epithelial barrier with varying therapeutic efficacies, compared with vehicle-treated mice. c(RGDfD) and c(RGDiD) significantly protected against goblet cell loss, tear reduction, and proinflammatory gene expression in EDE. Topical applications of αvβ3 antagonists yield therapeutic benefits in EDE by promoting corneal epithelial defect healing and reducing inflammation. Antagonistic targeting αvβ3 may be a novel promising strategy to treat patients with dry eye disease.

MiRNA 24-3p-rich exosomes functionalized DEGMA-modified hyaluronic acid hydrogels for corneal epithelial healing.

The damage of corneal epithelium may lead to the formation of irreversible corneal opacities and even blindness. The migration rate of corneal epithelial cells directly affects corneal repair. Here, we explored ocu-microRNA 24-3p (miRNA 24-3p) that can promote rabbit corneal epithelial cells migration and cornea repair. Exosomes, an excellent transport carrier, were exacted from adipose derived mesenchymal stem cells for loading with miRNA 24-3p to prepare miRNA 24-3p-rich exosomes (Exos-miRNA 24-3p). It can accelerate corneal epithelial migration in vitro and in vivo. For application in cornea alkali burns, we further modified hyaluronic acid with di(ethylene glycol) monomethyl ether methacrylate (DEGMA) to obtain a thermosensitive hydrogel, also reported a thermosensitive DEGMA-modified hyaluronic acid hydrogel (THH) for the controlled release of Exos-miRNA 24-3p. It formed a highly uniform and clear thin layer on the ocular surface to resist clearance from blinking and extended the drug-ocular-epithelium contact time. The use of THH-3/Exos-miRNA 24-3p for 28 days after alkali burn injury accelerated corneal epithelial defect healing and epithelial maturation. It also reduced corneal stromal fibrosis and macrophage activation. MiRNA 24-3p-rich exosomes functionalized DEGMA-modified hyaluronic acid hydrogel as a multilevel delivery strategy has a potential use for cell-free therapy of corneal epithelial regeneration.

Clinical Profile and Treatment Outcomes of Patients With Acremonium Species Positive Keratitis Managed in a Tertiary Eye Care Center.

To report the clinical profile and treatment outcomes of patients with culture-positive Acremonium keratitis. This is a retrospective observational study. Medical records of all patients treated in a tertiary eye hospital for culture positive infective keratitis from March 2016 to February 2021 were screened, of which those positive for Acremonium species on fungal culture were reviewed. Demographic details, clinical presentation, clinical course, treatment given, total follow-up duration, time taken for ulcer to heal, scar size, and final visual acuity in the last follow-up were recorded. Fifty three cases of fungal keratitis caused by Acremonium species were identified, 22 females and 31 males, with average age of 46.39±18.64 years. The mean duration of symptoms being 54.47±50 days. Only five patients had a history of trauma with vegetative matter. Clinical presentation of patients showed a large number of variations, with 2 patients presenting as peripheral ulcerative keratitis and 1 with epithelial plaque. The mean visual acuity of patients at presentation was 2.43±0.46 logMAR units. Thirty-three of 53 patients presented with perforated corneal ulcer and underwent penetrating keratoplasty; 20 patients were medically managed on topical voriconazole 1%, natamycin 5%, and oral voriconazole. The mean duration of healing of epithelial defect was 95±60.62 days (range 60-165 days). Acremonium keratitis has a long and indolent course. A prolonged combination therapy of natamycin and voriconazole seems to be effective in the management. A delay in the diagnosis of Acremonium keratitis often leads to clinical worsening requiring keratoplasty.

A Study Protocol for Assessing the Effect of Diode Green Photocoagulation with Rose Bengal in Progressive Infectious Keratitis

Background: Infectious keratitis manifested as corneal ulcer can result in formation of pus in corneal tissue. The incidence has increased in recent years due to overuse of steroids. Infectious keratitis is the most common cause of blindness in India. Rose Bengal proves to be a promising option to treat this condition. Rose Bengal is topical ophthalmic dye which is mildly toxic. It is absorbed by damaged epithelial cells, mucus and fibrous cells. This stain is available in the form of 1% solution or impregnated filter strips. This study aims to assess the duration of resolution of corneal ulcer after Rose Bengal photodynamic therapy.
 Methodology: This will be an experimental study carried out at ophthalmology department of AVBRH, Wardha. Total 55 cases will be enrolled and examined on daily basis for one week. Pachymetry and specular microscopy will be done before Rose Bengal Photodynamic Therapy and at the end of three months of treatment.
 Results: Resistant infectious keratitis is expected to show complete healing of epithelial defect after receiving photodynamic therapy with green diode laser.

Use of Nicergoline as Adjunctive Treatment of Neurotrophic Keratitis in Routine Clinical Practice: A Case Series

ABSTRACT Purpose To describe the effectiveness and safety of nicergoline in patients with epithelial corneal defect or corneal ulcer due to neurotrophic keratitis (NK). Methods A prospective case series review was performed in 14 patients with NK who started treatment with nicergoline as an off-label prescription from January to November 2020. Patients with a epithelial defect or corneal ulcer due to NK were treated with oral nicergoline. Results/Serial cases Complete corneal healing was observed in 10 (71.4%) of the 14 patients after 25.6 ± 26.60 days (range 7–90) with nicergoline. In three (21.5%) patients wound healing was not achieved, and one patient (7.1%) was lost to follow-up. The mean time between diagnosis and the starting of nicergoline was 10.92 ± 8.85 days (0–28). No adverse effects of nicergoline were observed. Conclusion Nicergoline as an adjunctive treatment for NK showed a potential use in the healing of epithelial defect in real-life clinical practice.

Comparison of exosomes derived from induced pluripotent stem cells and mesenchymal stem cells as therapeutic nanoparticles for treatment of corneal epithelial defects.

Induced pluripotent stem cells and mesenchymal stem cells are pluripotent stem cells that represent promising therapies for treating various tissue injuries and wound healing. Exosomes are nanosized extracellular vesicles that have been identified as important mediators of therapeutic functions, which are performed via cell communication. In this study, we compared the efficacy of induced pluripotent stem cells-derived exosomes (iPSCs-Exos) and mesenchymal stem cells-derived exosomes (MSCs-Exos) in treating corneal epithelial defects. The characteristics of the two types of exosomes were not significantly different. Compared to MSCs-Exos, iPSCs-Exos had a better in vitro effect on the proliferation, migration, cell cycle promotion and apoptosis inhibition of human corneal epithelial cells. iPSCs/MSCs-Exos promoted cell regeneration by upregulating cyclin A and CDK2 to drive HCECs to enter the S phase from the G0/G1 phase. In vivo results from a corneal epithelial defect model showed that both iPSCs-Exos and MSCs-Exos accelerated corneal epithelium defect healing while the effects of iPSCs-Exos were much stronger than those of MSCs-Exos. This study demonstrated that iPSCs-Exos had a better therapeutic effect on corneal epithelial defect healing. Thus, a novel potential nanotherapeutic strategy for treating corneal epithelial defects and even more ocular surface disease could be undertaken by using iPSCs-Exos dissolved in eye drops.

Efficacy of fixation of the amniotic membrane on a symblepharon ring with continuous suturing in acute ocular chemical burn patients

To describe a modified non-traumatic amniotic membrane transplantation (AMT) technique and evaluating its efficiency for the ocular surface injury after chemical burn were aimed. Twenty eyes of 20 patients (F: 6, M: 14) with acute chemical burn for whom modified non-traumatic AMT was utilized were evaluated retrospectively. In this technique, amniotic membrane (AM) was fixated onto a symblepharon ring with continuous suturing. The healing time of the corneal epithelial defect due to ocular surface chemical injury and melting duration of AM were evaluated. Development of infection or symblepharon, recurrence or persistence of epithelial defect, corneal perforation and the ring falling out with AM were evaluated as complications. Mean age of the patients was 24.7 ± 11.7years old (14months-40years). Mean duration of applying the non-traumatic AMT after contact with the chemical agent was 8.4 ± 6.2days (2-21days). The mean duration of the epithelial defect healing was 27.8 ± 8.8days (11-40days) in the grade II, III, and IV (n = 12) cases, while in the grade V and VI (n = 8) cases, a persistent epithelial defect developed, and the mean duration of the epithelial defect healing was 83 ± 23.1days (42-120days) (p = 0.0002). The mean melting duration of the AM was 22.7 ± 10days (10-42days). By using this modified AMT technique, AM can be utilized efficiently, easily, and non-traumatically in every center for the treatment of the ocular surface injury due to chemical burn.

Evaluation of early postoperative ocular pain after photorefractive keratectomy and corneal crosslinking

To evaluate and compare early postoperative pain after photorefractive keratectomy (PRK) and corneal crosslinking (CXL). Khatam-al-Anbia Eye Hospital, Mashhad, Iran. Prospective case series. The PRK group included patients with simple refractive errors whereas the CXL group included patients with clinical keratoconus. The groups were compared regarding the level of pain based on the visual analogue scale (VAS), verbal rating scale (VRS), and Wong-Baker FACES pain rating scale immediately after surgery, 6hours postoperatively, and 1, 3, and 7days postoperatively. The epithelial defect size was measured at 6hours after surgery and 1day and 3days after surgery in both groups. The study comprised 68 patients (34 patients in the PRK group and 34 patients in the CXL group). The epithelial defect size was significantly smaller in the CXL group than in the PRK group (P<.001); however, the amount of pain was significantly higher after CXL than after PRK based on VAS and VRS (P=.04 and P=.019, respectively). In the FACES scaling system, the pain score was also higher in the CXL group than in the PRK group. However, the difference was not statistically significant. No intraoperative or postoperative complications were observed during follow-up. The epithelial defect healing rate was statistically significantly faster in the CXL group than in the PRK group. However, the level of pain was greater in the CXL group, suggesting that postsurgical pain might be influenced by other factors than the epithelial defect.

In Vivo-Like Culture Conditions in a Bioreactor Facilitate Improved Tissue Quality in Corneal Storage.

The cornea is the most-transplanted tissue worldwide. However, the availability and quality of grafts are limited due to the current methods of corneal storage. In this study, a dynamic bioreactor system is employed to enable the control of intraocular pressure and the culture at the air-liquid interface. Thereby, in vivo-like storage conditions are achieved. Different media combinations for endothelium and epithelium are tested in standard and dynamic conditions to enhance the viability of the tissue. In contrast to culture conditions used in eye banks, the combination of the bioreactor and biochrom medium 1 allows to preserve the corneal endothelium and the epithelium. Assessment of transparency, swelling, and the trans-epithelial-electrical-resistance (TEER) strengthens the impact of the in vivo-like tissue culture. For example, compared to corneas stored under static conditions, significantly lower optical densities and significantly higher TEER values were measured (p-value <0.05). Furthermore, healing of epithelial defects is enabled in the bioreactor, characterized by re-epithelialization and initiated stromal regeneration. Based on the obtained results, an easy-to-use 3D-printed bioreactor composed of only two parts was derived to translate the technology from the laboratory to the eye banks. This optimized bioreactor facilitates noninvasive microscopic monitoring. The improved storage conditions ameliorate the quality of corneal grafts and the storage time in the eye banks to increase availability and reduce re-grafting.

Growth Factor Concentration in Keratocyte Supernatant after Incubation with Human Serum In Vitro

Application of serum eye drops is an alternative treatment option for therapy-resistant corneal epithelial defects. In case of persisting epithelial defects, cytokines, which are secreted from stromal keratocytes, may play a role in epithelial wound healing. Our aim was to analyze fibroblast growth factor basic (FGFb), hepatocyte growth factor (HGF), keratinocyte growth factor (KGF) and transforming growth factor β1 (TGF-β1) concentration in the supernatant of keratocytes, after incubation with human serum (HS). Serum eye drops of 10 patients were prepared using the standards of the LIONS Eye Bank Saar-Lor-Lux, Trier/Westpfalz, and were stored at - 80 °C. Primary human keratocytes were isolated from human corneoscleral rings using collagenase A (1 mg/ml) (n = 1) and were cultured in DMEM/Ham's culture medium with 10% fetal bovine serum (FBS). Thereafter, keratocyte cultures were incubated in 15 or 30% HS (in DMEM/F14 without FBS) and FGFb, HGF, KGF and TGF-β1 concentration was determined with an enzyme-linked immunoabsorbent assay (ELISA) from the supernatant of the culture after 24 hours. We used 15 or 30% HS without keratocytes (under the same storage conditions) as controls. HGF concentration was, for both HS concentrations, significantly higher in the supernatant of keratocytes, than in HS controls (without keratocytes) following 24 hours (p < 0.01). FGFb concentration was significantly increased in 30% HS with keratocytes compared to 30% HS without keratocytes after 24 hours (p < 0.01). TGF-β1 and KGF concentrations remained unchanged through keratocytes. HGF and FGFb concentrations increase in the supernatant of keratocytes, 24 hours after incubation with human serum. These concentration changes may play a role in wound healing of epithelial defects.

Corneal Polishing After Pterygium Excision With Motorized Diamond Burr: A Randomized Control Trial.

To evaluate outcomes of motorized diamond burr polishing versus manual polishing after pterygium excision. Dr. Rajendra Prasad Center for Ophthalmic Sciences, New Delhi. A randomized, interventional observer-masked controlled trial. Forty consecutive eyes underwent pterygium excision with fibrin, glue-assisted conjunctival autograft. In group 1 (20 eyes), polishing of the corneal bed was done using a crescent blade, and in group 2 (20 eyes), using a motorized diamond burr. There was no difference in the 2 groups with respect to mean age (P=0.08), gender (P=0.3), preoperative uncorrected visual acuity (UCVA) (P=0.45), best spectacle-corrected visual acuity (BCVA) (P=0.52), spherical equivalent (P=0.5), mean astigmatism (P=0.7), tear function tests like tear break-up time, tear film meniscus height, Schirmer I and II (P=0.6, 0.5, 0.7, 0.9 respectively), pterygium dimension (P=0.4), and conjunctival autograft size (P=0.24). Mean intraoperative surgical time was significantly more in group 1 (16.9 ± 2.85 min) as compared with 12.25 ± 1.88 min in group 2 (P=0.0001). Postoperatively, there was a statistically significant reduction in astigmatism and improvement in UCVA, BCVA, spherical equivalent in all eyes. No difference was found in mean epithelial defect healing time, UCVA, BCVA, astigmatism, tear film break-up time, Schirmer I and II, and tear meniscus height at 6 months between 2 groups; however, significantly better UCVA was found in group 2 at 3 months (P=0.04). Surgically induced astigmatism (SIA) was significantly more in group 2 as compared with group 1 at 6 months (P=0.0006). Motorized diamond burr polishing of the corneoscleral bed during primary pterygium excision in comparison with manual polishing requires significantly lesser surgical time with better UCVA, decreased astigmatism, and greater SIA at 6 months, which indicates greater astigmatic correction.

Comparison of umbilical cord serum and amniotic membrane transplantation in acute ocular chemical burns

PurposeTo compare the efficacy of umbilical cord serum (UCS) with amniotic membrane transplantation (AMT) in cases of acute ocular chemical burns.MethodsIn a retrospective, interventional, comparative case series, 55 eyes with...

Examination of the process underlying healing of epithelial defects by using different wound dressings

Scar contracture occurring during recovery of epithelial defects after the oral and maxillofacial surgery including palatoplasty is known to cause various functional disorders, such as facial deformities, disturbance of maxillary development, speech disorders, and dysphasia. Various types of wound-healing dressings have been used to assist recovery of epithelial defects. However, conventional dressings result in scar contracture around the epithelial defect after the oral and maxillofacial surgery.

Autologous Serum Eye Drops for Post-Chemical Injuries and Corneal Epithelial Defects

Aim: To evaluate success rate (efficacy, safety) in treatment of post-chemical injuries and corneal defects using autologous serum eye drops.Material and Methods: Authors reviewed 93 patients (116 eyes) hospitalized in Clinic of ophthalmology from 2010 to 2013, who had post-causoma corneal defects that were nonresponsive to conventional treatment and were treated with serum therapy. Authors correlated time of epithelialization of defects with rate of epithelial healing.Results: Authors investigated 93 patients (52 males, 41 females; aged 18 - 74) for treatment of corneal defects. Application of autologous serum therapy 56 (48.28%) of 116 eyes was healed in an average time of 4 weeks. Among 116 eyes, epithelial defects healed in 4 (3.45%) within 1 week, in additional 17 (14.65%) in 1-2 weeks, totalling 31 (26.72%) within 3 weeks. Five eyes (4.31%) completely healed at 5 week; three eyes (2.59%) had subsequent healing of epithelial defect at 6 week; 56 eyes completely healed within one month, and the remaining eight eyes healed within 1.5 month.Conclusion: Using serum therapy, it was managed to reduce time of healing from eleven weeks, which were necessary just couple years ago (before 2010) to four (maximum six) weeks to complete healing which are necessary today.

Autologous Serum Eye Drops for Post-Chemical Injuries and Corneal Epithelial Defects

Aim: To evaluate success rate (efficacy, safety) in treatment of post-chemical injuries and corneal defects using autologous serum eye drops.Material and Methods: Authors reviewed 93 patients (116 eyes) hospitalized in Clinic of ophthalmology from 2010 to 2013, who had post-causoma corneal defects that were nonresponsive to conventional treatment and were treated with serum therapy. Authors correlated time of epithelialization of defects with rate of epithelial healing.Results: Authors investigated 93 patients (52 males, 41 females; aged 18 - 74) for treatment of corneal defects. Application of autologous serum therapy 56 (48.28%) of 116 eyes was healed in an average time of 4 weeks. Among 116 eyes, epithelial defects healed in 4 (3.45%) within 1 week, in additional 17 (14.65%) in 1-2 weeks, totalling 31 (26.72%) within 3 weeks. Five eyes (4.31%) completely healed at 5 week; three eyes (2.59%) had subsequent healing of epithelial defect at 6 week; 56 eyes completely healed within one month, and the remaining eight eyes healed within 1.5 month.Conclusion: Using serum therapy, it was managed to reduce time of healing from eleven weeks, which were necessary just couple years ago (before 2010) to four (maximum six) weeks to complete healing which are necessary today.

Effectiveness of topical autologous serum treatment in neurotrophic keratopathy

ObjectiveTo evaluate the effectiveness of 20% autologous serum as a treatment for neurotrophic keratopathy. Material and methodsA longitudinal, observational and descriptive study was performed on 19 patients (22 eyes) with neurotrophic keratopathy in different stages of Mackie's classification. The following variables were evaluated on the first visit, and then 4 months later: best corrected visual acuity (BCVA), subjective patient symptomatology (faces scale), Schirmer's test without anesthesia (mm), tear film break-up time (BUT) (sg) and healing of the epithelial defect (weeks). The Wilcoxon signed-rank test was used for the statistical analysis of the data. ResultsA symptomatic improvement was observed in 100% of the cases, and a 71% improvement in best corrected visual acuity (P<.05). There was also a statistically significant improvement in the Schirmer's test and BUT (P<.05). Healing of epithelial defect occurred in 71% of the cases within 6 weeks, and in 91% of the cases within 12 weeks of treatment. The remaining 9% of the cases that did not heal had a grade 3 neurotrophic keratopathy. ConclusionsThe use of 20% autologous topical serum represents an effective treatment for grades 1 and 2 neurotrophic keratopathy, but is an insufficient treatment for a grade 3 keratopathy. In cases where there is a significant loss of tissue, the application of a higher concentration of autologous serum, or platelet-rich derivatives, or plasma rich in growth factors, may be more effective than the application of 20% autologous serum, due to their greater effect on cell proliferation.

Efectividad del tratamiento con suero autólogo tópico en la queratopatía neurotrófica

ObjectiveTo evaluate the effectiveness of 20% autologous serum as a treatment for neurotrophic keratopathy. Material and methodsA longitudinal, observational and descriptive study was performed on 19 patients (22 eyes) with neurotrophic keratopathy in different stages of Mackie's classification. The following variables were evaluated on the first visit, and then 4 months later: best corrected visual acuity (BCVA), subjective patient symptomatology (faces scale), Schirmer's test without anesthesia (mm), tear film break-up time (BUT) (sg) and healing of the epithelial defect (weeks). The Wilcoxon signed-rank test was used for the statistical analysis of the data. ResultsA symptomatic improvement was observed in 100% of the cases, and a 71% improvement in best corrected visual acuity (P<.05). There was also a statistically significant improvement in the Schirmer's test and BUT (P<.05). Healing of epithelial defect occurred in 71% of the cases within 6 weeks, and in 91% of the cases within 12 weeks of treatment. The remaining 9% of the cases that did not heal had a grade 3 neurotrophic keratopathy. ConclusionsThe use of 20% autologous topical serum represents an effective treatment for grades 1 and 2 neurotrophic keratopathy, but is an insufficient treatment for a grade 3 keratopathy. In cases where there is a significant loss of tissue, the application of a higher concentration of autologous serum, or platelet-rich derivatives, or plasma rich in growth factors, may be more effective than the application of 20% autologous serum, due to their greater effect on cell proliferation.