Ocular Bandage Research Articles

Cell-free matrix derived from adipose mesenchymal stromal cells enhances corneal rehabilitation via delivery of nerve regenerative PGRN

Promotion of corneal dense network of nerve is a promising method to treat severe corneal injury, yet with limited effective drugs. In our previous work, decellularized matrix of adipose derived mesenchymal stromal cells (ADMSCs), named as DMA, presented excellent conjunctival repair capacity with proper suture resistance and immune modulatory characteristics. Thus, we intended to investigate their potential application in facilitating corneal repair after alkali burn. Owing to the transparent characteristic of DMA, DMA could be applied as novel ocular bandages with nutritious function. In this study we found that cornea treated with DMA showed accelerated recovery compared with those received amniotic membrane (AM) treatment by fluorescein staining, slip-lamp examination, OCT and corneal nerve immunostaining. Further, in order to find key components responsible for the faster recovery, high-throughput proteomic analyses were conducted and more than 2000 proteins, including associated signaling pathways, were identified in DMA. Intriguingly, progranulin (PGRN), one of enriched proteins identified in DMA, was firstly recognized for its neurotrophic role in alleviation of corneal damage. To sum up, DMA exhibited a potent clinical application with a cocktail of key therapeutic factors, in which PGRN was a crucial factor in promoting neurite outgrowth and re-establishing homeostasis of the cornea.

Eye protection following cataract surgery: a systematic review

ContexteOn note une grande variabilité en matière de modalités de protection oculaire postopératoire de la part des ophtalmologistes. Au nombre des modalités possibles, citons le couvre-œil rigide, le pansement oculaire, le bandage oculaire et la vision immédiate. Notre étude avait pour objectif d'examiner et de comparer les données sur les différents types de protection oculaire. MéthodesAprès avoir réalisé une revue systématique de la littérature, on a retenu les études comparatives originales qui avaient consigné les symptômes subjectifs (p. ex., sensation d'avoir un corps étranger dans l’œil, photophobie, larmoiement et douleur) et les résultats postopératoires (p. ex., le temps de rupture du film lacrymal, la meilleure acuité visuelle corrigée, etc.) après l'utilisation d'une méthode de protection oculaire. RésultatsLa revue a porté sur les données de 8 articles regroupant 598 yeux. Les études retenues examinaient le recours au bandage oculaire (n = 6), au pansement oculaire (n = 4), à la vision immédiate (n = 2) et au couvre-œil rigide (n = 1) en période postopératoire. Lors de 5 études, les patients qui ont eu un bandage oculaire ont spontanément signalé autant ou moins de symptômes – notamment la douleur (n = 3), la sensation d'avoir un corps étranger dans l’œil (n = 4), la photophobie (n = 3) et le larmoiement (n = 3) – que les patients qui ont reçu d'autres modalités de protection oculaire. Dans le cas du bandage oculaire, 3 études ont signalé un allongement du temps de rupture du film lacrymal, tandis que 1 étude a fait état d'améliorations de la cicatrisation cornéenne, comparativement à ce qui a été observé chez les sujets témoins. Deux études ont signalé un raccourcissement du temps de rupture du film lacrymal lors de l'utilisation d'un pansement oculaire, comparativement au bandage oculaire, tandis que dans une autre étude, le temps de rupture du film lacrymal était plus court lorsque les patients optaient pour une vision immédiate plutôt que pour un pansement oculaire. ConclusionsLes patients qui reçoivent un bandage oculaire après une chirurgie de la cataracte signalent nettement moins de symptômes, comparativement à ceux qui optent pour la vision immédiate. En effet, les patients préfèrent recevoir une forme de protection oculaire après l'intervention plutôt que d'opter pour la vision immédiate.

Good Visual Acuity Outcome from an Ocular Blast Injury with Proper Management in Dr. Soetomo General Hospital Surabaya, Indonesia

Introduction: Ocular blast injury related to fireworks most often causing corneal erosion (29%), conjunctival erosion (11%), and conjunctival foreign body (10%) with children are more often than adults (65.9%:34.1%), and males far more often than female (71.9%:28.1%). Knowing proper management is very important to achieve the best result. Case presentation: We describe an ocular blast injury that experienced broad erosion and multiple foreign bodies on the corneal and pericorneal surface in the left eye and visual acuity decreased. The foreign body was scattered, and the fluorescein test was positive. We did proper foreign body extraction, irrigation, and ocular bandage. It was treated with chloramphenicol 0.5% eye ointment and homatropine eye drop. In two months, the patient’s left eye had clear cornea with a small scar formation near the visual axis. The visual acuity was 6/7 and BCVA was 6/6 with S-0.5 C-0.5 A 50° correction. Conclusions: Patients with ocular blast injury limited to superficial cornea erosion and and conjunctival erosion have a reasonable probability of achieving the best visual acuity. Foreign body extraction, proper irrigation, and topical medication show promising results. Scar formation near the visual axis can disrupt visual acuity however can be corrected in this case it can be corrected with glasses. Furthermore, public promotion and regulation to control firework using are very important.

In-situ porcine corneal matrix hydrogel as ocular surface bandage

PurposeBioactive substrates can be used therapeutically to enhance wound healing. Here, we evaluated the effect of an in-situ thermoresponsive hydrogel from decellularized porcine cornea ECM, COMatrix (COrnea Matrix), for application as an ocular surface bandage for corneal epithelial defects. MethodsCOMatrix hydrogel was fabricated from decellularized porcine corneas. The effects of COMatrix hydrogel on attachment and proliferation of human corneal epithelial cells (HCECs) were evaluated in vitro. The effect of COMatrix on the expressions of the inflammatory genes, IL-1β, TNF-α, and IL-6 was assessed by RT-PCR. The in-situ application and also repairing effects of COMatrix hydrogel as an ocular bandage was studied in a murine model of corneal epithelial wound. The eyes were examined by optical coherence tomography (OCT) and slit-lamp microscopy in vivo and by histology and immunofluorescence post-mortem. ResultsIn vitro, COMatrix hydrogel significantly enhanced the attachment and proliferation of HCECs relative to control. HCECs exposed to COMatrix had less induced expression of TNF-α (P < 0.05). In vivo, COMatrix formed a uniform hydrogel that adhered to the murine ocular surface after in-situ curing. Corneal epithelial wound closure was significantly accelerated by COMatrix hydrogel compared to control (P < 0.01). There was significant increase in the expression of proliferation marker Ki-67 in wounded corneal epithelium by COMatrix hydrogel compared to control (P < 0.05). ConclusionsCOMatrix hydrogel is a naturally derived bioactive material with potential application as an ocular surface bandage to enhance epithelial wound healing.

Novel Cross-Linked Ocular Bandage Gel Improves Reepithelialization After Photorefractive Keratectomy: A Randomized, Masked Prospective Study

Purpose: To compare, in a masked manner, a novel cross-linked hyaluronic acid ocular bandage gel (OBG) versus standard-of-care bandage contact lens (BCL) plus artificial tears with respect to safety and effectiveness in healing epithelial defects created for photorefractive keratectomy (PRK). Methods: This was a randomized, reading center-masked, exploratory study. Forty-five patients (myopic without significant anisometropia) scheduled for bilateral PRK (9-mm epithelial defect) were randomized post-PRK to treatment with OBG 8 times daily for 3 days, followed by 4 times daily for 11 days (Group 1); OBG 4 times daily for 14 days (Group 2); or BCL and artificial tears (Control). A masked reading center used image analysis of digital slit lamp photos of the fluorescein-stained cornea to evaluate defect size during the 14-day postoperative follow-up period. Effectiveness endpoints were (1) time to complete closure of the corneal defect and (2) proportion of patients with complete healing on day 3 postoperatively, whose defect remained closed. Safety assessments included findings for adverse events and vision, Standard Patient Evaluation of Eye Dryness (SPEED™) Questionnaire, slit lamp, intraocular pressure, and fundus examinations. Results: The proportion of patients with complete healing at 3 days was 73.3%, 86.7%, and 66.7% of patients in Groups 1, 2, and Control, respectively. On day 2, the mean wound size was 6%-26% smaller in Groups 1 and 2 compared with Control. No safety concern arose. SPEED scores were not significantly different across groups. Conclusion: OBG offers a well-tolerated and effective therapy for quickly reepithelializing the cornea following trauma, disease, or surgery.

Surface modified electrospun poly(lactic acid) fibrous scaffold with cellulose nanofibrils and Ag nanoparticles for ocular cell proliferation and antimicrobial application.

Corneal and conjunctival infections are common ocular diseases, sometimes, causing severe and refractory drug-resistant bacteria infections. Fungal keratitis is a leading cause for blindness and traditional medical treatment is unsatisfactory. Thus, there is an urge to develop a new therapy to deal with these cases. In this study, we developed surface modified poly(lactic acid) (PLA) electrospun nanofibrous membranes (EFMs) with silver nanoparticles (AgNPs) and cellulose nanofibrils (CNF) as scaffolds for cell proliferation and antimicrobial application. The AgNPs with a very low content (below 0.1%) were easily anchored on the surface of PLA EFMs by CNF, which endowed the scaffold with hydrophilicity and antibacterial ability. The in-vitro cell co-culture experiments showed that the scaffold had great biocompatibility to ocular epithelial cells, especially the scaffolds coated by CNF, which significantly proliferated cells. Furthermore, the antibacterial activity could reach >95% inhibiting Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) due to the implantation of AgNPs, and the antifungal activity was also outstanding with most of the Fusarium spp. inhibited. Hence, the developed PLA EFMs with CNF and AgNPs are promising ocular bandages to promote cell proliferation and kill infectious pathogens, exhibiting potential applications in ocular wound healing in the future.

Bacterial nanocellulose compared to the amniotic membrane as a potential corneal bandage material

AbstractPurposeTo compare bacterial nanocellulose (BNC) patches produced by K.xylinus, against the amniotic membrane (AM) as a bandage material for ocular surface disorders. Based on previous structural characterizations of our BNC patches, and detailed cytocompatibility tests of BNC with human dermal fibroblasts; we hypothesise that BNC is viable as a bandage material for corneal surface disorders.MethodsWe tested the mechanical resistance of BNC (n = 6) and AM (n = 5) samples by using progressively weighted sutures to tear the samples. In order to test material stability, 6 samples of each type were maintained in culture media at physiological conditions for 30 days. Then any change in the morphology, nanostructure and light absorbance were analysed. Finally, in order to study the effects of corneal tissue on the samples, we sutured 3 of each type to ex‐vivo porcine corneas and cultured them in physiological conditions for 2 weeks. After which, morphology, fibre nanostructure and transparency were evaluated.ResultsBNC resisted tearing at the suture point until an average weight of 41g while AM resisted &lt;4.5 g. After 30 days in culture, both sample types lost some mass, BNC maintained transparency while AM became more opaque and had some crystal formations. After culture with a cornea; BNC presented no obvious nanostructure degradation, while AM did show some areas with more pores. Macroscopically, BNC samples remained more transparent than AM.ConclusionsBased on the results, BNC is more resistant mechanically to sutures, equally conformable to the dome shape of the eye, and more stable than AM. Overall these results support BNC as a promising new ocular bandage material.

Efficacy of an Ocular Bandage Contact Lens for the Treatment of Dry Eye After Complicated and Combined Cataract Surgery

Efficacy of an Ocular Bandage Contact Lens for the Treatment of Dry Eye After Complicated and Combined Cataract Surgery

Efficacy of an Ocular Bandage Contact Lens for the Treatment of Dry Eye After Cataract Surgery

Efficacy of an Ocular Bandage Contact Lens for the Treatment of Dry Eye After Cataract Surgery

Efficacy of an ocular bandage contact lens for the treatment of dry eye after phacoemulsification

BackgroundTo evaluate the safety and efficacy of a bandage contact lens for alleviating dry eye discomfort after phacoemulsification.MethodsIn this prospective, controlled study, 60 age-related cataract patients with mild Meibomian gland dysfunction (MGD) were randomized to treatment with an ocular bandage contact lens (BCL) (n = 30) or to an untreated control group (n = 30) after phacoemulsification and intraocular lens implantation. The Ocular Surface Disease Index (OSDI) questionnaire, evaluation of subjective symptoms and evaluation of the best-corrected visual acuity (BCVA) were conducted preoperatively and postoperatively on days 1, 7, 14, 30 and 90. The tear breakup time (TBUT), Schirmer test with anesthesia, and fluorescein staining scores were measured preoperatively and postoperatively on days 7, 14, 30 and 90.ResultsThere were no significant differences with respect to the BCVA between the groups at any time point. For the comparison of the OSDI, subjective evaluation scores, TBUT and fluorescein staining, statistically significant improvements were noted in the BCL group, especially on days 7 and 14 (P < 0.001, P < 0.001; P = 0.031, P = 0.009; P = 0.021, P = 0.028; and P = 0.03, P = 0.032, respectively). The Schirmer test results did not significantly change postoperatively.ConclusionsA BCL can improve tear film stability and lessen dry eye discomfort immediately after phacoemulsification.Trial registrationCurrent Controlled Trials ChiCTR-INR-16008863 (Date of registration: 20 July 2016).

Ability of a new crosslinked polymer ocular bandage gel to accelerate reepithelialization after photorefractive keratectomy

To evaluate the safety and performance of a crosslinked thiolated carboxymethyl hyaluronic acid liquid-gel (CMHA-S) ocular bandage gel in accelerating reepithelialization of corneal defects created for photorefractive keratectomy (PRK). Three community-based clinical research sites. Prospective case series. Patients scheduled for bilateral PRK had both eyes randomized immediately after PRK to Group 1 (ocular bandage gel 4 times a day for 14days and bandage contact lens), Group 2 (ocular bandage gel 4 times a day for 14days), or Group 3 (control; bandage contact lens and artificial tears 4 times a day for 14days). Patients received a 9.0mm epithelial defect for PRK and were followed through 28days postoperatively. Safety assessments included adverse events, vision, pain, slitlamp, intraocular pressure, and fundus examinations. The primary performance endpoint was time to corneal reepithelialization after PRK. The study comprised 39 patients. The ocular bandage gel was well tolerated. The time to reepithelialization was 3days for 54.5%, 80.0%, and 45.5% of patients in Group1, Group 2, and Group 3, respectively. Compared with measurements in the control group, the mean horizontal andvertical defect lengths in Group 2 (ocular bandage gelalone) were 36.9% and 29.0% smaller, respectively, by 1day. Crosslinked hyaluronic acid showed the ability to quickly reepithelialize the cornea and may promise a well-tolerated and effective therapy for ocular wound care after trauma, disease, or surgery.

An industry update: what is new in the field of therapeutic delivery this month?

The present industry update covers the period of 1-30 November 2016, with information sourced primarily from company press releases, regulatory and patent agencies, scientific literature and various news websites. There was positive news on the clinical trials front for both EyeNovia and Glaxo SmithKline, but this month also saw Innocol release disappointing Phase IIb results for its Cogenzia product. In regulatory news, it was announced that the US FDA indicated that EyeGate may use the 510(k) De Novo Path for their device, the Ocular Bandage Gel. Also this month, Glaxo SmithKline announced that it filed a regulatory submission with the FDA for its novel triple-combination therapy product, utilizing its Ellipta® inhaler.

Study of fluid ingress through clear corneal incisions following phacoemulsification with or without the use of a hydrogel ocular bandage: a prospective comparative randomised study.

To assess the use of a hydrogel ocular bandage (HOB) on clear corneal incisions in phacoemulsification cataract surgery and determine whether HOB reduces ocular surface contaminants ingress after routine surgery. In this prospective randomized controlled study, thirty eyes of patients undergoing uneventful phacoemulsification were recruited consecutively and randomly assigned to have a HOB applied to the corneal incision at the end of the surgery or not. At the end of the surgery, trypan blue (TRB) was instilled on the ocular surface, aqueous fluid was aspirated from the anterior chamber (AC) and its optical density was measured using ultraviolet spectrophotometry. The corneal incisions were examined postoperatively using anterior segment optical coherence tomography. Main outcome measures were concentration of TRB in the AC, corneal incision architecture, intraocular pressure (IOP) and Seidel test. All incisions were Seidel negative. The mean IOP in the immediate postoperative period was 18.1 ± 5.48 mmHg for the intervention group and 16.9 ± 5.7 mmHg for the control group (p > 0.05). No architectural differences of the incisions between the two groups were noted. The total mean length of the three-step corneal incisions in the two groups was 2261.2 ± 96.92 μm and 2263 ± 119.75 μm, respectively (p > 0.05). No trace of TRB was detected in any of the samples. Proper surgical wound construction without the use of a HOB is efficient in preventing the ingress of fluid through the main corneal incision postoperatively.

Surgical outcomes after application of a liquid adhesive ocular bandage to clear corneal incisions during cataract surgery

To compare the anatomic and refractive outcomes in eyes having phacoemulsification with 1 of 3 clear corneal incision (CCI) closure methods. Ambulatory surgical center, Makati, Philippines. Prospective randomized clinical trial. Patients having phacoemulsification cataract surgery had wound closure using no additional treatment (control), a single 10-0 nylon suture, or a liquid adhesive ocular bandage (Ocuseal). The main outcome measures were wound-edge closure rates, surgically induced astigmatism (SIA), foreign-body sensation, and intraocular pressure (IOP) 1, 3, 5, 7, and 14 days postoperatively. The study evaluated 90 eyes. There was a significant improvement in wound-edge closure rates in the suture group and the ocular bandage group compared with the control group (P<.001). A significant increase in SIA occurred in the sutured group but not in the control or ocular bandage groups (P<.001). The ocular bandage group had significantly less foreign-body sensation than the control and suture groups (P<.001). There were no significant differences in IOP between the groups (P=.515). The liquid adhesive ocular bandage resulted in improved wound-edge closure, reduced SIA, and diminished foreign-body sensation. Suturing was associated with improved wound-edge closure but increased SIA and foreign-body sensation. Unsutured incisions led to delayed wound-edge closure and increased foreign-body sensation.

Soft Contact Lenses for Controlled Ocular Delivery: 50 Years in the Making

The use of contact lenses as ocular bandages for drug delivery was envisioned nearly 50 years ago by Wichterle and co-workers. Despite the therapeutic advantages that can be obtained, this application has to face up to the poor affinity shown by commercially available contact lenses for most ophthalmic drugs, resulting in small amounts of drug being loaded and short time of therapeutic levels in the eye structures. Novel strategies that appeared in the beginning of 21st century, for example coating lenses with vitamin E, incorporation of drug nanocarriers or application of molecular imprinting technology, are becoming relevant tools for development of true drug/contact lens combination products that may be available for ocular therapy in the foreseeable future.

Optimisation of a standardised chemical burn animal model for use in corneal wound healing

AbstractPurpose The rabbit ocular surface has been used for many years as a reliable comparison for the study of human corneal injuries. This work aimed to create a standardised corneal epithelial injury using an alkali insult, which results in a type III healing response with wound healing. The ultimate aim is the use of this in vivo injury model to test novel ocular bandages and substrate treatments.Methods De‐epithelialisation first required in vitro optimisation for reproducibility before use in in vivo rabbit models. Corneas obtained from New Zealand White rabbits were de‐epithelialised with sodium hydroxide (NaOH) solution using a range of concentrations, durations and modes of application. The injury area, depth and severity were assessed using haematoxylin and eosin staining and transmission electron microscopy. The optimised in vitro model was applied to an in vivo pilot study in rabbits and tested for reproducibility using normal and fluorescein slit lamp images.Results In vitro optimisation revealed that higher NaOH concentrations and extended durations caused undesirable irreversible damage to the cornea. Lower concentrations and durations produced the injury required. The injury model was established in an in vivo pilot study using our optimal parameters and tested to see if a chemical burn with little variation in area or severity could be achieved. Following 48 hour treatment we were able to detect reliable wound healing using our refined model.Conclusion The in vitro optimisation showed us parameters that were sufficient to de‐epithelialise the cornea, creating an injury without causing stromal damage. The model is now in use in vivo, to test the biocompatibility and efficacy of various ocular surface substrate treatments.

Synthesis and properties of regenerated cellulose-based hydrogels with high strength and transparency for potential use as an ocular bandage

Cellulose is a biologically derived material with excellent wound-healing properties. The high strength of cellulose fibers and the ability to synthesize gels with high optical transparency make these materials suitable for ocular applications. In this study, cellulose materials derived from wood pulp, cotton, and bacterial sources were dissolved in lithium chloride/N,N-dimethylacetamide to form regenerated cellulose hydrogels. Material properties of the resulting hydrogels, including water content, optical transparency, and tensile and tear strengths, were evaluated. Synthesis parameters, including activation time, dissolution time, relative humidity, and cellulose concentration, were found to impact the material properties of the resulting hydrogels. Overnight activation time improves the optical transparency of the hydrogels from 77% to 97% at 550nm, whereas controlling cellulose concentration improves their tear strength by as much as 200%. On the basis of the measured transmittance and strength values of the regenerated hydrogels prepared via the optimized synthesis parameters, Avicel PH 101, Sigma-Aldrich microcrystalline cellulose 435236, and bacterial cellulose types were prioritized for future biocompatibility testing and potential clinical investigation.

Comparison of Bursting Pressure after Scleral Tunnel Incision Sealed with Sutures or an Adherent Ocular Bandage in Human Globes

To evaluate the efficiency of a hydrogel adherent ocular bandage for sealing of scleral tunnel incisions in human eye globes. A 4-mm scleral tunnel incision was made in each of 10 globes and bursting pressure was measured using the Seidel test to check for wound leakage. Globes were sealed using either two interrupted 10-0 nylon sutures (n = 5) or an adherent ocular bandage in the form of polyethylene glycol hydrogel (n = 5). Bursting pressure was then measured for a second time. Bursting pressure was significantly higher after wound sealing in both groups. There were no statistically significant differences in bursting pressure between the two groups before or after sealing. The adherent ocular bandage successfully protected the incision in ex vivo human globes immediately after surgery, with a sealing efficiency comparable to two nylon sutures, suggesting that it is a safe and effective alternative to conventional suturing.

42 The design of ocular bandage lenses: the influence of lens surface on local immunological response

42 The design of ocular bandage lenses: the influence of lens surface on local immunological response

The effect of stromal hydration on surgical outcomes for cataract patients who received a hydrogel ocular bandage.

Purpose:The purpose of this study was to examine the effect of stromal hydration on surgical outcomes for patients who received the new hydrogel ocular bandage (ReSure™ Adherent Ocular Bandage, Ocular Therapeutix, Inc, Bedford, MA, USA) following routine cataract surgery.Methods:This post-hoc, single-masked study was conducted with 310 patients who were scheduled to undergo unilateral clear corneal cataract surgery with phacoemulsification and intraocular lens implantation. Incisions were closed with stromal hydration (270 patients) or without stromal hydration (40 patients) based on physician standard of care. All patients received the hydrogel bandage at the conclusion of the procedure. Ocular assessments of stromal edema, flare, corneal staining, anterior chamber cells, best-corrected visual acuity, and intraocular pressure were made 24 hours after surgery.Results:Significantly more patients experienced stromal edema in the group with stromal hydration (26.3% versus 10.0%, respectively; P = 0.028). A higher percentage of patients experienced corneal staining when stromal hydration was performed (20.4% versus 2.5%; P = 0.004). The mean BCVA (best-corrected visual acuity) also was significantly different between the groups (logMAR of 0.164 with stromal hydration versus 0.095 without hydration; P = 0.007). No significant differences were observed between the study groups in terms of flare, anterior chamber cells, or intraocular pressure.Conclusion:Cataract surgery without stromal hydration provided better surgical outcomes than the traditional hydration procedure when used in conjunction with a new hydrogel bandage.