Ocular Surface Disorders Research Articles

Comparative Evaluation of Surgical Techniques for Pterygium Management: An In Vitro Study

ABSTRACT Background: Pterygium is a common ocular surface disorder characterized by the growth of fibrovascular tissue onto the cornea, leading to discomfort and visual impairment. Various surgical techniques, including conjunctival autografting, amniotic membrane transplantation, and bare sclera excision, are employed in the management of pterygium. Materials and Methods: Cultured human conjunctival epithelial cells were subjected to simulated pterygium conditions, mimicking the fibrovascular proliferation observed in vivo. Subsequently, different surgical techniques, including conjunctival autografting, amniotic membrane transplantation, and bare sclera excision, were simulated in vitro. Cell viability, proliferation, migration, and inflammatory cytokine expression were assessed using various assays, including MTT assay, scratch assay, and enzyme-linked immunosorbent assay (ELISA). Untreated cells served as controls for comparison. Results: Conjunctival autografting demonstrated superior outcomes in terms of cell viability and proliferation compared to amniotic membrane transplantation and bare sclera excision. Autografted cells exhibited a significantly higher percentage of viable cells and enhanced proliferative capacity compared to cells subjected to other surgical techniques (P < 0.05). Additionally, conjunctival autografting promoted faster cell migration into the defect area, resulting in more rapid wound closure compared to other techniques. Furthermore, reduced expression of inflammatory cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), was observed in cells treated with conjunctival autografts compared to other groups. Conclusion: In vitro findings suggest that conjunctival autografting may offer superior outcomes in the management of pterygium compared to amniotic membrane transplantation and bare sclera excision.

Assessment of Wavefront Aberrations in Children with Myopia Against the Background of Ocular Surface Disorders in Combination with Computer Vision Syndrome Digital and Eye Strain

Purpose: to assess the state of the wavefront in children with myopia, who have various manifestations of digital eye strain and symptoms of ocular surface disorders, and to evaluate the diagnostic significance of wavefront criteria for assessing the state of the ocular surface.Patients and methods. The study involved 76 children (152 eyes) with myopia aged 8 to 18 years who used gadgets and computers for more than 2 hours a day. All patients used glasses as a method of optical correction and were constantly worn. The patients were divided into 2 groups: 1st with symptoms of ocular surface disorder, 2nd — comparison group. Subjective signs were studied using the online questionnaire “State of the ocular surface”. Using the “Keratograph 5M Oculus” the following parameters were assessed: non­invasive tear film breakup time (NTBR), including the first tear film breakup time, average tear film breakup time, breakup time gradient and maximum tear film breakup zone, the same device was used to perform infrared meibography and study of the lipid layer of the tear film. All patients underwent wavefront aberrometry in a darkened room without cycloplegia.Results. It was found that in the group of patients with the presence of subjective phenomena of disturbance of the state of the ocular surface, identified using the online questionnaire “State of the ocular surface”, rotor aberrations were statistically significantly higher than in the comparison group. At the same time, the indicators of higher­order corneal aberrations have comparable values. Correlation analysis between indicators of the state of the ocular surface and parameters of the wavefront in the group of children with disturbances of the state of the ocular surface showed that a higher level of corneal aberrations corresponds to a higher number of points on the questionnaire of disturbances of the ocular surface and the state of visual comfort, in turn, when comparing data on non­invasive tear film breakup time, a negative correlation was established, which means that with a higher number of points on the questionnaire, and therefore, with a more significant degree of impairment of the ocular surface, the tear film breakup time was shorter.Conclusion. The structure of the wavefront in children with myopia against the background of a disorder of the ocular surface in combination with CVS and digital eye strain is significantly different from the structure of the wavefront in the comparison group.

TGF-β-Based Therapies for Treating Ocular Surface Disorders.

The cornea is continuously exposed to injuries, ranging from minor scratches to deep traumas. An effective healing mechanism is crucial for the cornea to restore its structure and function following major and minor insults. Transforming Growth Factor-Beta (TGF-β), a versatile signaling molecule that coordinates various cell responses, has a central role in corneal wound healing. Upon corneal injury, TGF-β is rapidly released into the extracellular environment, triggering cell migration and proliferation, the differentiation of keratocytes into myofibroblasts, and the initiation of the repair process. TGF-β-mediated processes are essential for wound closure; however, excessive levels of TGF-β can lead to fibrosis and scarring, causing impaired vision. Three primary isoforms of TGF-β exist-TGF-β1, TGF-β2, and TGF-β3. Although TGF-β isoforms share many structural and functional similarities, they present distinct roles in corneal regeneration, which adds an additional layer of complexity to understand the role of TGF-β in corneal wound healing. Further, aberrant TGF-β activity has been linked to various corneal pathologies, such as scarring and Peter's Anomaly. Thus, understanding the molecular and cellular mechanisms by which TGF-β1-3 regulate corneal wound healing will enable the development of potential therapeutic interventions targeting the key molecule in this process. Herein, we summarize the multifaceted roles of TGF-β in corneal wound healing, dissecting its mechanisms of action and interactions with other molecules, and outline its role in corneal pathogenesis.

Unravelling the molecular tapestry of pterygium: insights into genes for diagnostic and therapeutic innovations.

Pterygium, an ocular surface disorder, manifests as a wing-shaped extension from the corneoscleral limbus onto the cornea, impacting vision and causing inflammation. With a global prevalence of 12%, varying by region, the condition is linked to UV exposure, age, gender, and socioeconomic factors. This review focuses on key genes associated with pterygium, shedding light on potential therapeutic targets. Matrix metalloproteinases (MMPs), especially MMP2 and MMP9, contribute to ECM remodelling and angiogenesis in pterygium. Vascular endothelial growth factor (VEGF) plays a crucial role in angiogenesis and is elevated in pterygium tissues. B-cell lymphoma-2, S100 proteins, DNA repair genes (hOGG1, XRCC1), CYP monooxygenases, p53, and p16 are implicated in pterygium development. A protein-protein interaction network analysis highlighted 28 edges between the aforementioned proteins, except for VEGF, indicating a high level of interaction. Gene ontology, microRNA and pathway analyses revealed the involvement of processes such as base excision repair, IL-17 and p53 signalling, ECM disassembly, oxidative stress, hypoxia, metallopeptidase activity and others that are essential for pterygium development. In addition, miR-29, miR-125, miR-126, miR-143, miR-200, miR-429, and miR-451a microRNAs were predicted, which were shown to have a role in pterygium development and disease severity. Identification of these molecular mechanisms provides insights for potential diagnostic and therapeutic strategies for pterygium.

Impact of inflammasomes on the ocular surface.

The ocular surface is prone to inflammation due to exposure to environmental irritants and pathogens. Inflammasomes are intracellular, multiprotein complexes that communicate potentially dangerous signals to the immune system. The identification of inflammasomes in various inflammatory ocular surface conditions can aid in the development of therapeutics to treat these chronic inflammatory conditions. Several inflammasomes have been associated with ocular surface disorders including dry eye disease, keratitis, and allergies. Mechanisms for activation of these inflammasomes with regards to specific disorders have been explored in models to aid in the development of targeted treatments. Research efforts continue to characterize the types of inflammasomes and activators of these in inflammatory ocular surface conditions. Various therapies targeting specific inflammasome types or pyroptosis are being tested preclinically to assess effects on decreasing the associated chronic inflammation.

Extensive Contact Lens Wear Modulates Expression of miRNA-320 and miRNA-423-5p in the Human Corneal Epithelium: Possible Biomarkers of Corneal Health and Environmental Impact.

The identification of new biomarkers of ocular diseases is nowadays of outmost importance both for early diagnosis and treatment. Epigenetics is a rapidly growing emerging area of research and its involvement in the pathophysiology of ocular disease and regulatory mechanisms is of undisputable importance for diagnostic purposes. Environmental changes may impact the ocular surface, and the knowledge of induced epigenetic changes might help to elucidate the mechanisms of ocular surface disorders. In this pilot study, we investigated the impact of extensive contact lens (CL) wearing on human corneal epithelium epigenetics. We performed ex vivo analysis of the expression of the miR-320 and miR-423-5p involved in the processes of cellular apoptosis and chronic inflammation. The human corneal epithelium was harvested from healthy patients before the photorefractive keratectomy (PRK). The patients were divided into two age- and sex-matched groups accordingly to CL wearing history with no CL wearers used as a control. The epithelium was stored frozen in dry ice at -80 °C and forwarded for miRNA extraction; afterwards, miRNA levels were detected using real-time PCR. Both miRNAs were highly expressed in CL wearers (p < 0.001), suggesting epigenetic modifications occurring in chronic ocular surface stress. These preliminary results show the relationships between selected miRNA expression and the chronic ocular surface stress associated with extensive CL use. MicroRNAs might be considered as biomarkers for the diagnosis of ocular surface conditions and the impact of environmental factors on ocular surface epigenetic. Furthermore, they might be considered as new therapeutic targets in ocular surface diseases.

Application of a practical amniotic membrane ring made on-site for restoration of ocular surface health in dry eye disease

Purpose: Dry eye disease (DED) is one of the most common ocular surface disorders worldwide. Despite different underlying pathogenic processes, DED is characterized by ocular surface inflammation, which in turn induces further damage to the corneal epithelium and its underlying structures. Amniotic membrane transplants are known to have potent anti-inflammatory effects and also have the ability to enhance epithelial healing. In this study, we aimed to evaluate the clinical efficacy of amniotic membrane ring (AMR) application in treating refractory dry eye disease.Methods: A retrospective analysis of 22 patients treated with contact lens-like amniotic membrane rings was performed. This amniotic membrane ring was formed using an aspiration catheter covered by a large piece of amniotic membrane graft. The amniotic membrane was sutured to the catheter using eight sutures. In this way, a customized amniotic membrane ring was prepared for each patient. Patients’ demographics, symptoms, use of medications, conjunctival inflammation, corneal staining, and visual acuity were compared before and after treatment. In addition, the amniotic membrane retention duration, the amniotic membrane's effect on ocular surface healing, follow-up time, and complications were evaluated.Results: Twenty-eight eyes of 22 patients (18 females and 4 males) aged 53.32 ± 13.36 (6-73) years were included. The AMR retention duration ranged from 5 to 16 days, with a mean of 11 ± 3.09 days, at which time the amniotic membrane had dissolved or been removed inadvertently by the patient. Discomfort with the ring was seen in 1 of 28 eyes (3.6 %). The patients reported symptomatic relief for a period of 3.64 ± 1.25 months. Symptomatic relief was accompanied by a reduction of OSDI scores (from 63.39 ± 17.24 to 33.19 ± 12.45) (p<0.001), use of topical medications (from 4.21 ± 1.03 to 2.42 ± 0.50) (p<0.001), conjunctival hyperemia (from 1.57 ± 1.19 to 0.35 ± 0.48) (p<0.001), corneal staining (from 2.89 ± 1.16 to 0.57 ± 0.74) (p<0.001), and improvement in visual acuity (from 0.23 ± 0.16 to 0.16 ± 0.25 logMAR) (p=0.001).Conclusions: Amniotic membrane ring treatment might be used to treat refractory dry eye disease. This technique has an economic advantage over other commercially available amniotic bandage tissues and can be easily removed and replaced during a follow-up examination.

Ocular surface changes in moderate-to-severe acne vulgaris.

To investigate ocular surface disorders and tear function changes in patients with acne vulgaris and explore the potential relationship between acne vulgaris and dry eye. This cross-sectional study included right eyes of 53 patients with acne vulgaris and 54 healthy controls. The participants completed the Ocular Surface Disease Index (OSDI) questionnaire. The following ocular surface-related parameters were measured: tear meniscus height (TMH), noninvasive tear breakup time (NIBUT), Schirmer I test (SIT), lipid layer thickness (LLT) score of the tear film, meibum score, meibomian gland orifice obstruction score, the ratio of meibomian gland loss, conjunctival hyperemia score, and corneal fluorescein staining (CFS) score. The stability of the tear film decreased in acne vulgaris patients. In the acne group, the TMH and NIBUT were lower, whereas the OSDI, meibum score, meibomian gland orifice obstruction score, ratio of meibomian gland loss, and conjunctival hyperemia score were higher compared with controls (P<0.05). There were no significant differences in the CFS score, SIT, or LLT score between the groups (P>0.05). In two dry eye groups, the TMH, NIBUT, and LLT score were lower in the acne with dry eye (acne-DE) group, and the meibum score, meibomian gland orifice obstruction score, ratio of meibomian gland loss and conjunctival hyperemia score in the acne-DE group were higher (P<0.05). There were no significant differences between OSDI, SIT, and CFS score (P>0.05). Patients with moderate-to-severe acne vulgaris are more likely to experience dry eye than those without acne vulgaris. Reduced tear film stability and meibomian gland structure dysfunction are more pronounced in patients with moderate-to-severe acne and dry eye.

Disrupted mitochondrial transcription factor A expression promotes mitochondrial dysfunction and enhances ocular surface inflammation by activating the absent in melanoma 2 inflammasome

PurposeSevere dry eye disease causes ocular surface damage, which is highly associated with mitochondrial dysfunction. Mitochondrial transcription factor A (TFAM) is essential for packaging mitochondrial DNA (mtDNA) and is crucial for maintaining mitochondrial function. Herein, we aimed to explore the effect of a decreased TFAM expression on ocular surface damage. MethodsFemale C57BL/6 mice were induced ocular surface injury by topical administrating benzalkonium chloride (BAC). Immortalized human corneal epithelial cells (HCECs) were stimulated by tert-butyl hydroperoxide (t-BHP) to create oxidative stress damage. HCECs with TFAM knockdown were established. RNA sequencing was employed to analyze the whole-genome expression. Mitochondrial changes were measured by transmission electron microscopy, Seahorse metabolic flux analysis, mitochondrial membrane potential, and mtDNA copy number. TFAM expression and inflammatory cytokines were determined using RT-qPCR, immunohistochemistry, immunofluorescence, and immunoblotting. ResultsIn both the corneas of BAC-treated mice and t-BHP-induced HCECs, we observed impaired TFAM expression, accompanied by mitochondrial structure and function defects. TFAM downregulation in HCECs suppressed mitochondrial respiratory capacity, reduced mtDNA content, induced mtDNA leakage into the cytoplasm, and led to inflammation. RNA sequencing revealed the absent in melanoma 2 (AIM2) inflammasome was activated in the corneas of BAC-treated mice. The AIM2 inflammasome activation was confirmed in TFAM knockdown HCECs. TFAM knockdown in t-BHP-stimulated HCECs aggravated mitochondrial dysfunction and the AIM2 inflammasome activation, thereby further triggering the secretion of inflammatory factors such as interleukin (IL) -1β and IL-18. ConclusionsTFAM reduction impaired mitochondrial function, activated AIM2 inflammasome and promoted ocular surface inflammation, revealing an underlying molecular mechanism for ocular surface disorders.

Trichiasis in cicatricial ocular surface disease: a multi-center comparison of electroepilation versus eyelash resection outcomes

ABSTRACT Purpose To evaluate the outcomes of trichiasis (excluding entropion) management in non-trachomatous cicatricial ocular surface diseases. Methods This is a multicenter, retrospective study of 59 patients with trichiasis who were managed using two different techniques: electroepilation using radiofrequency (RF) cautery and eyelash resection. The assessed outcomes were residual trichiasis at 6 weeks, 6, and 12 months of follow-up and the number of procedures needed. Results 41 patients (90 eyelids) underwent electroepilation, and 18 (41 eyelids) were managed with eyelash resection. All patients belonged to either Indian or Japanese ethnicity. Most patients in both groups had Stevens-Johnson Syndrome (63.4% vs. 88.9%). The mean age (43.2 vs. 46 years), disease duration (122 vs. 192.4 months), median trichiasis grade (2 vs. 2), and involvement of upper eyelids (53/90 vs. 23/41) were similar in the two groups. At six weeks, 48.9% of eyelids that underwent electroepilation had no trichiasis, and recurrences were managed with repeat electroepilation (6 eyelids) and mucous membrane grafting (10 eyelids), and 35 eyelids opted for manual epilation, giving 67.8% success at a mean follow-up of 20 months. The eyelash resection group had 75.6% success at 6 months, and recurrences were managed using lid splitting and eyelash resection, resulting in 100% success at a mean follow-up of 79 months. More interventions were needed in the electroepilation group compared to eyelash resection. Conclusion Eyelash resection of the trichiatic eyelashes achieves a better success rate than electroepilation in cicatricial ocular surface disorders. Following electroepilation, one needs multiple interventions to resolve trichiasis.

Nanohydroxyapatite Coating Attenuates Fibrotic and Immune Responses to Promote Keratoprosthesis Biointegration in Advanced Ocular Surface Disorders.

Keratoprosthesis (KPro) implantation is frequently the only recourse for patients with severe corneal disease. However, problems arise due to inadequate biointegration of the KPro, particularly the PMMA optical cylinder, such as tissue detachment, tissue melting, or eye-threatening infection in the interface. Here, using the AuroKPro as a model prosthesis, a surface functionalization approach─coating the optical cylinder with nanohydroxyapatite (nHAp)─was trialed in rabbit eyes with and without a proceeding chemical injury. In chemically injured eyes, which simulated total limbal epithelial stem cell deficiency, clear benefits were conferred by the coating. The total modified Hackett-McDonald score and area of tissue apposition differences 12 weeks after implantation were 5.0 and 22.5%, respectively. Mechanical push-in tests revealed that 31.8% greater work was required to detach the tissues. These differences were less marked in uninjured eyes, which showed total score and tissue apposition differences of 2.5 and 11.5%, respectively, and a work difference of 23.5%. The improved biointegration could be contributed by the attenuated expression of fibronectin (p = 0.036), collagen 3A1 (p = 0.033), and α-smooth muscle actin (p = 0.045)─proteins typically upregulated during nonadherent fibrous capsule envelopment of bioinert material─adjacent to the optical cylinders. The coating also appeared to induce a less immunogenic milieu in the ocular surface tissue, evidenced by the markedly lower expression of tear proteins associated with immune and stimulus responses. Collectively, the level of these tear proteins in eyes with coated prostheses was 1.1 ± 13.0% of naïve eyes: substantially lower than with noncoated KPros (246.5 ± 79.3% of naïve, p = 0.038). Together, our results indicated that nHAp coating may reduce the risk of prosthesis failure in severely injured eyes, which are representative of the cohort of KPro patients.

Visual outcome and postoperative complications of cataract surgery in patients with ocular surface disorders.

To determine the visual outcome and postoperative complications of cataract surgery in patients with ocular surface disorders (OSDs). Tertiary eyecare center in North India. Retrospective observational study. Patients with various OSDs with stabilized ocular surfaces who underwent cataract surgery during this period and had a minimum postoperative follow-up of 6 weeks were included. The primary outcome measures were postoperative corrected distance visual acuity (CDVA) at 6 weeks, best CDVA achieved, and postoperative complications. The study included 20 men and 24 women. A total of 55 eyes were evaluated: Stevens-Johnson syndrome (SJS) 35 eyes, ocular cicatricial pemphigoid (OCP) 4 eyes, 8 eyes with dry eye disease (DED), 6 eyes with chemical injury and 2 eyes with vernal keratoconjunctivitis (VKC). The mean duration of OSD was 33.9 ± 52.17 months. The median preoperative CDVA was 2.0 (interquartile range [IQR], 1.45 to 2.0). The median CDVA ever achieved was 0.50 (IQR, 0.18 to 1.45) at 2 months and the median CDVA at 6 weeks was 0.6 (IQR, 0.3 to 1.5). Maximum improvement in CDVA was noted in patients with DED and SJS and the least in OCP. Phacoemulsification was performed in 47.27% eyes with intraoperative complications noted in 9% eyes. Postoperative surface complications occurred in 12 (21.82%) eyes. Other postoperative complications occurred in 9 (16%) eyes. Cataract surgery outcome can be visually rewarding in patients with OSDs provided ocular surface integrity is adequately maintained preoperatively and postoperatively.

A case–control study of tear film functions in patients with unilateral pterygium at a Tertiary Care Center in Marathwada

Context: Pterygium is a very common ocular surface disorder. Tear film dysfunctions have been reported in subjects with pterygium. Aim: We aim to study the correlation between pterygium and dry eye disease in patients with unilateral pterygium. Settings and Design: A case–control study of patients with unilateral pterygium was undertaken after ethical clearance from the institutional ethics committee. Subjects and Methods: Eighty-seven patients with unilateral pterygium were included in the study. Tear film break-up time (TBUT), Rose Bengal staining (RBS), and Schirmer’s test 1 were performed in both eyes of the patients. Test results were compared with contralateral normal eye of the same patient. Statistical Analysis Used: Data were analyzed using t-test and Chi-square test. P &lt;0.05 was considered statistically significant. Results: The tear film function parameters, namely Schirmer 1, TBUT, and RBS in the study group, were statistically different as compared to the control group. The mean of TBUT was 8.19 ± 1.87 s in pterygium eyes and 11.83 ± 1.69 s in contralateral normal eyes. The mean of Schirmer’s 1 was 10.65 ± 3.69 mm in pterygium eyes and 16.37 ± 4.82 mm in contralateral eyes with no pterygium. Conclusion: There was a statistically significant difference in the values of tear film function between eyes with pterygium and contralateral normal eyes.

Dual benefits of scleral lenses in collateral cases of Stevens-Johnson syndrome and Keratoconus-A case series

Scleral lenses (SL) are larger diameter lenses that rest over the scleral, unlike the corneal lenses. These lenses are fitted to not touch the cornea by creating a space that will be filled with sterile isotonic fluid. Indications of SL include corneal ectatic conditions such as keratoconus (KC), pellucid marginal degeneration,and ocular surface disorders such as dry eye (DE), Stevens-Johnson syndrome (SJS), and graft-versus-host disease. Corneal ectasia in SJS has been rarely reported but still exists, which causes severe DE, photophobia, and blurred vision. In such a scenario, SL is an ideal treatment option as they provide constant lubrication to the ocular surface and better visual acuity. This report witnessed the effectiveness of SL in SJS associated with KC – a rare combination.

Loss of function of the meibomian glands among HIV and AIDS individuals undergoing antiretroviral therapy

Background: Meibomian gland dysfunction (MGD) is one of the most encountered diseases in the clinical practice but appears to be underappreciated as it does not cause blindness. Meibomian gland dysfunction is a multifactorial and complex disorder of the ocular surface.Aim: This study aims to evaluate the characteristics of the meibomian glands in individuals living with HIV and AIDS undergoing antiretroviral therapy.Setting: The study was conducted at the antiretroviral (ARV) clinic, Mankweng Hospital.Methods: This was a prospective study conducted with 37 HIV and AIDS participants and 20 healthy controls. All participants were assessed using the Ocular Surface Diseases Index (OSDI) score and, tear break-up time and lid margin regularity (using the slit-lamp biomicroscopy). The loss of the meibomian glands was evaluated using the Marx’s line. For this study, this line represented a clinical parameter of meibomian function.Results: The OSDI score was significantly higher in the HIV and AIDS group than that of the control participants (39.95 ± 18.65 and 13.00 ± 9.09, respectively, P 0.05). The tear breakup time (TBUT) for the HIV and AIDS study group was lower than that of the control group (7.95 ± 3.54 and 9.90 ± 3.70, respectively, P 0.05). The HIV and AIDS participants showed greater meibomian gland loss relative to the healthy controls (9.30 ± 4.97 and 5.70 ± 2.1, P 0.05).Conclusion: The loss of eyelid meibomian glands is common in people living with HIV and AIDS in comparison with healthy controls.Contribution: Although there is a decrease in sight-threatening complications in the era of ARVs, ocular surface disorders (OSD) are still commonly found, which may reduce the quality of life of HIV and AIDS individuals.

Modified sutureless and glue-free method versus conventional sutures for conjunctival autograft fixation in primary pterygium surgery: a systematic review and meta-analysis

BackgroundPterygium is a common ocular surface disorder that requires surgical intervention for treatment. Conjunctival autografts are preferred over simple excision due to lower recurrence rates. This systematic review and meta-analysis...

A Novel Technique of Aseptic Manufacture of Autologous Serum Eye Drops (ASEDs) and Sterility Analysis of the Bottled Ophtioles.

To introduce a novel technique of the aseptic manufacture of autologous serum eye drops (ASEDs) with a prefiltered closed system and to analyze the sterility of the produced ophtioles between 2018 and 2022. This is a prospective single-center study conducted at the Department of Ophthalmology at a Swiss University Hospital between 2018 and 2022. For regulatory reasons, closed systems for manufacturing ASEDs are strongly recommended. We attached an upstream sterile filter (Sterivex PES0.22 µm Burlington, USA) to a commercially available closed system (COL System Modena, Italy) for manufacturing ASEDs. The goal of this novel approach was to reduce the microbiological contamination of the donated autologous blood. Using the presented manufacturing method, we are able to produce, on average, 56 ophtioles per batch, containing either 1.45 mL or 2.5 mL of autologous serum per ophtiole. For each batch of ASEDs, we performed a microbiological analysis by automated blood culture testing (BACTEC). This system examines the presence of bacteria and fungi. We analyzed all manufactured batches between 2018 and 2022. None of the 2297 batches and the resulting 129 060 ophtioles showed bacterial or mycotic contamination. During the analyzed period, two batches were discarded: one due to fibrin-lipid aggregations, further microbiological and histological work-up excluded any contamination; another due to false-positive HIV in serological testing. Overall, the contamination rate was 0%, and the batch discharge rate was 0.09%. The combination of upstream sterile filtration with a commercial closed system for manufacturing ASEDs proved to be effective in ensuring sterility without any contamination over the past 4 years. This is becoming crucial, as the demand for autologous blood products for treating ocular surface disorders, such as refractory dry eyes or nonhealing defects of the corneal epithelium, is on the rise.

Marine Natural Products Rescuing the Eye: A Narrative Review.

Different degrees of visual impairment lead to a decrease in patient wellbeing, which has an adverse effect on many facets of social and professional life. Eye disorders can affect several parts of the eye, most notably the retina and the cornea, and the impacted areas might share a common form of cellular damage or dysfunction (such as inflammation, oxidative stress and neuronal degeneration). Considering that marine organisms inhabit a broad variety of marine habitats, they display a great degree of chemical diversity. As a result, molecules with a marine origin are receiving more and more attention in the hopes of developing novel therapeutic approaches. For instance, fucoxanthin has been demonstrated to be effective in protecting the retina against photo-induced damage, while largazole, astaxanthin and spirulina have all shown antioxidant, anti-inflammatory and antiapoptotic activities that can be useful for the management of several ocular diseases, such as age-related macular degeneration and ocular surface disorders. The aim of this review is to analyze the scientific literature relating to the therapeutic effects on the eye of the main natural marine products, focusing on their mechanism of action and potential clinical uses for the management of ocular diseases.

Diabetic Ocular Surface Has Defects in Oxygen Uptake Revealed by Optic Fiber Microsensor.

Diabetes mellitus causes diabetic keratopathy (DK). This and other ocular surface disorders are underdiagnosed and problematic for affected patients as well as recipients of diabetic donor corneas. Thus, it is important to find noninvasive means to facilitate determination of the potentially vision-threatening DK. It has been reported that diabetic corneas uptake significantly less oxygen (O2) than healthy controls. However, an integral assessment of the ocular surface is missing. Using an optic-fiber O2 micro-sensor (optrode) we demonstrated recently that the healthy ocular surface displays a unique spatiotemporal map of O2 consumption. We hypothesize that diabetes impairs the spatiotemporal profile of O2 uptake at the ocular surface. Using streptozotocin (STZ)-induced diabetic mice, we found diminished O2 uptake and loss of the unique pattern across the ocular surface. A diabetic cornea consumes significantly less O2 at the bulbar conjunctiva and limbus, but not the central and peripheral cornea, compared to controls. Further, we show that, contrary to the healthy cornea, the diabetic cornea does not increase the O2 consumption at the limbus in the evening as the normal control. Altogether, our measurements reveal a previously unknown impairment in O2 uptake at the diabetic cornea, making it a potential tool to diagnose ocular surface abnormalities and suggesting a new etiology mechanism.

The effect of polyethylene cover intervention on ocular surface disorder of intensive care unit patients: a systematic review and meta-analysis

BackgroundPolyethylene covers have been proven to be effective in protecting the eyes in patients with decreased or disappeared blink reflexes, but their advantages compared to other conventional methods are still unclear. This systematic review and meta-analysis study aimed to elucidate the impact of polyethylene covers in the prevention of ocular surface disease (OSD) in patients admitted to the intensive care unit (ICU).MethodsWe searched the Scopus, PubMed, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases to identify randomized controlled trial studies. This study followed the PRISMA guidelines and used the Cochrane Collaboration tool to assess the risk of bias.ResultsThe findings were expressed as risk ratio (RR) with 95% confidence intervals. The incidence of OSD in the polyethylene cover group was lower than that in the eye drops group (RR = 0.27; 95% CI (0.07, 1.09), P = 0.07) and adhesive tape group (RR = 0.11, 95%CI (0.04, 0.31), P < 0:0001) but the polyethylene cover group showed no significant difference compared to the eye gel group (RR = 0.79, 95%CI (0.18, 3.51), P = 0.76) and the eye ointment group (RR = 0.85; 95% CI (0.36, 1.99), P = 0.71).ConclusionThis study showed that polyethylene covers, eye gels, and eye ointments had an equal effect on preventing OSD in ICU patients, and eye drops and adhesive tapes were relatively less effective. However, other intervention methods had not been compared due to the small number of articles. Hence, further studies should assess the available methods to choose the best practical method.