Peripheral Ulcers Research Articles

Analysis of the interplay between proximal lower limb and foot joint structures as a mechanical predictor of neuropathic ulceration

BackgroundDiabetes-related foot ulcers are a leading cause of morbidity and mortality globally, in which the most significant contributing factor is peripheral neuropathy. The purpose of this research was to evaluate the influence of diabetic peripheral neuropathy and ulceration on lower limb and foot joint kinematics during gait. Research questionAre there any significant alterations lower limb and foot joint kinematics during gait in the presence of active and history of diabetic neuropathic ulceration? MethodsA prospective, cross-sectional study was conducted, recruiting eighty adult participants who were equally divided into four groups, namely, the diabetes (DM), diabetic peripheral neuropathy (DPN), active diabetic neuropathic ulceration (DNU) and history of diabetic neuropathic ulceration (DHNU) groups. Three-dimensional gait analysis was performed, and participants were instructed to walk barefoot over a 10-m walkway at self-selected speed. The acquired pelvic, hip, knee, ankle and foot joint segmental kinematic data was compared between individuals with and without active neuropathic ulceration. ResultsMean scores between the four independent groups was performed using the Kruskal-Wallis test. Participants within the DNU and DHNU groups demonstrated significantly reduced knee flexion, ankle dorsiflexion and first metatarsal dorsiflexion kinematics with resultant increased anterior pelvic tilt, hip flexion and midtarsal kinematics (all values p<0.01) when compared to participants within the DM and DPN groups. SignificanceThrough the integration of a more individualised, biomechanical approach, the findings in this study may provide improved preventative and management strategies of ulceration amongst the diabetic population.

Prevalence and incidence of peripheral neuropathy, peripheral artery disease, foot disease, and lower extremity amputation in people with diabetes in Ireland; a systematic review protocol.

Introduction Internationally, the prevalence of diabetes is increasing, and with this comes an increase in diabetes related complications. Diabetic foot disease is the most common lower extremity complication in people with diabetes causing 2% of the global disease burden. It, is associated with major morbidity, mortality, and costs to health services. Despite this burden, the incidence and prevalence of diabetic foot disease is unknown in Ireland. This paper presents a protocol for a systematic review to examine the incidence and prevalence of diabetic foot disease in the Irish population. Methods A systematic review will be performed using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Pubmed, EMBASE, and Lenus, the Irish Health Research repository, will be searched for publications in any language and without restrictions to date. Title, abstract, and full text screening will be carried out independently by two investigators. Publications reporting on the incidence or prevalence of peripheral neuropathy, peripheral artery disease, ulceration, or amputation in people with diabetes in Ireland, from a defined geographical catchment area of Ireland, will be included. Joanna Briggs Institute (JBI) Critical Appraisal tool will be used to assess included studies methodological quality. Results will be reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Conclusion The results of this systematic review can be used to inform appropriate stakeholders on the incidence and prevalence of diabetic foot disease in Irish populations, enabling decision making around appropriate use of resources to help prevent, and improve management of this disease. Systematic review registration CRD42023472904

A Knitted and MXenzyme-Integrated Dressing for Geriatrics Diagnosis and Ulcer Healing.

Integrated diagnostic and therapeutic dressings are desirable to relieve diabetic patients who often suffer from diabetic foot ulcers (DFUs) and peripheral vascular diseases (PVDs). However, it is highly difficult to monitor the pulse waves with fidelity under wet environments and connect the waveforms to diseases through a small strain sensor. Additionally, immobilizing MXenzyme to regulate spatially heterogeneous levels of reactive oxygen species (ROS) and applying active intervention to enhance ulcer healing on a single structure remain a complex task. To address these issues, we designed a multiscale wearable dressing comprising a knitted all-textile sensing array for quantitatively investigating the pulse wave toward PVD diagnosis. MXenzyme was loaded onto the dressing to provide multiple enzyme mimics for anti-inflammatory activities and deliver electrical stimulation to promote wound growth. In mice, we demonstrate that high and uniform expression of the vascular endothelial growth factor (VEGF) is observed only in the group undergoing dual mediation with electrical stimulation and MXenzyme. This observation indicates that the engineered wound dressing has the capability to accelerate healing in DFU. In human patient evaluations, the engineered dressing distinguishes vascular compliance and pulse period, enabling the diagnosis of arteriosclerosis and return blockage, two typical PVDs. The designed and engineered multiscale dressing achieves the purpose of integrating diagnostic peripheral vessel health monitoring and ulcer healing therapeutics for satisfying the practical clinical requirements of geriatric patients.

Effects of Rheopheresis in dialysis patients with peripheral artery disease and diabetic foot ulcers: A multicentric Italian study.

Peripheral artery disease (PAD) in hemodialysis (HD) patients has a significant social impact due to its prevalence, poor response to standard therapy and dismal prognosis. Rheopheresis is indicated by guidelines for PAD treatment. Twenty-five HD patients affected by PAD stage IV Lerichè-Fontaine and ischemic ulcer 1C or 2C according to the University of Texas Wound Classification System (UTWCS), without amelioration after traditional medical therapy and/or revascularization, were selected and underwent 12 Rheopheresis sessions in 10 weeks. Improvements in pain symptoms using Numerical Rating Scale (NRS), healing ulcers and laboratory hemorheological parameters have been evaluated. A clinically and statistically significant mean value reduction and of relative percentage differences between estimated marginal means (Δ), calculated at each visits, of NRS was observed, with a maximum value (-48.5%) between the first and last visit. At the end of the treatment period 14.3% of ulcers were completely healed, 46.4% downgraded, 53.6% were stable. Overall, no ulcers upgraded. A statistically significant reduction of the Δ, between the first and last visit, for fibrinogen (-16%) was also observed. Rheopheresis reduced overall painful symptoms; data suggest that it could heal or improve ulcers and hemorheological laboratory parameters in HD patients with PAD and ischemic ulcers resistant to standard therapies.

Vascular complications in extremities of physically restrained intensive care unit patients: A prospective, observational study.

Physical restraint is used to prevent agitation, to continue treatments and to ensure safety in intensive care patients. Physical restraint has negative effects on physical and psychological health, and physical restraint should not be used unless necessary. The purpose of this study was to evaluate the development of vascular complications in extremities of physically restrained patients hospitalized in the intensive care unit (ICU) and the associated factors. A prospective, observational study. The study was conducted between September 1, 2022, and March 31, 2023 in eight ICUs of a hospital located in the inner regions of Türkiye. The development of vascular complications (discolouration, distemperature, variations in capillary refill time, fluctuations in peripheral pulse, skin ulceration and oedema in the area of physical restraint) rate in patients hospitalized in the ICUs who were physically restrained. Independent sample t test, Mann-Whitney U test and Pearson-χ2 test were used to analyse the data. During the study, 2409 patients were admitted to ICUs. Physical restraint was applied to 209 of these patients. Of the 209 patients, 112 patients who met the inclusion criteria were included in the study. The physical restraint site of the patients was evaluated an average of 230.12 times and physical restraint was terminated in 9.8% of the patients (n = 112) because of vascular complications that developed in the physical restraint site. The rate of vascular complications at the site of physical restraint was higher in patients with endotracheal tubes (p < .05), lower GCS scores (p < .05) and higher INR values (p < .05). Patients with skin ulceration at the restraint site received more massages and cream applications (%95CL = 1. 1.692-34.734, OR = 7.667, p = .032). It was determined that more massage was applied to patients with changes in skin temperature at the restraint site (%95Cl = 1.062-11.599, OR = 3.510, p = .032). Vascular complications may develop at the restraint site in patients hospitalized in the ICU. This may be more common in ICU patients with endotracheal tube, lower GCS score and higher INR values. Nurses should closely monitor ICUs patients with endotracheal tube, lower GCS score and higher INR values, and implement care interventions to prevent the development of vascular complications.

The most common contact lens-related complications: A brief review of the literature

Introducion and purpose Millions of people use contact lenses every day. Their primary and most common use is correcting refractive errors. Despite their beneficial purpose, contact lens use has many complications. It is estimated that 5 to 50% of patients may develop at least a single complication. The state of knowledge Contact lens-related complications are multifactorial. One of the main reasons for contact lens discontinuation is contact lens discomfort. Patients most often report dryness, burning, and irritated eyes. Other disorders can be briefly divided into conjunctival and corneal complications. The most common conjunctival and allergic complication of contact lens use is giant papillary conjunctivitis. Other significant conditions involving the conjunctiva can also be superior limbic keratoconjunctivitis or allergic or toxic conjunctivitis. Corneal complications, on the other hand, seemed to be much more severe. These include superficial punctate keratitis, peripheral corneal ulceration, and contact lens-related keratitis. Also, abrasion can occur due to improper eye hygiene or mechanical damage during lens replacement. It should also be remembered that prolonged use of lenses can lead to hypoxia and corneal edema. Summary This paper briefly outlines the possible complications of contact lens use. It is important to remember that despite their appropriate use, sometimes significant complications can occur. Noteworthy, corneal, or conjunctival complications require discontinuation of the lenses and appropriate treatment.

Advanced Mass Spectrometry-Based Biomarker Identification for Metabolomics of Diabetes Mellitus and Its Complications.

Over the years, there has been notable progress in understanding the pathogenesis and treatment modalities of diabetes and its complications, including the application of metabolomics in the study of diabetes, capturing attention from researchers worldwide. Advanced mass spectrometry, including gas chromatography-tandem mass spectrometry (GC-MS/MS), liquid chromatography-tandem mass spectrometry (LC-MS/MS), and ultra-performance liquid chromatography coupled to electrospray ionization quadrupole time-of-flight mass spectrometry (UPLC-ESI-Q-TOF-MS), etc., has significantly broadened the spectrum of detectable metabolites, even at lower concentrations. Advanced mass spectrometry has emerged as a powerful tool in diabetes research, particularly in the context of metabolomics. By leveraging the precision and sensitivity of advanced mass spectrometry techniques, researchers have unlocked a wealth of information within the metabolome. This technology has enabled the identification and quantification of potential biomarkers associated with diabetes and its complications, providing new ideas and methods for clinical diagnostics and metabolic studies. Moreover, it offers a less invasive, or even non-invasive, means of tracking disease progression, evaluating treatment efficacy, and understanding the underlying metabolic alterations in diabetes. This paper summarizes advanced mass spectrometry for the application of metabolomics in diabetes mellitus, gestational diabetes mellitus, diabetic peripheral neuropathy, diabetic retinopathy, diabetic nephropathy, diabetic encephalopathy, diabetic cardiomyopathy, and diabetic foot ulcers and organizes some of the potential biomarkers of the different complications with the aim of providing ideas and methods for subsequent in-depth metabolic research and searching for new ways of treating the disease.

Small-diameter acellular porcine corneal stroma for peripheral corneal ulceration treatment.

To evaluate the clinical efficacy of small-diameter acellular porcine corneal stroma (SAPS) for the treatment of peripheral corneal ulceration (PCU). This retrospective clinical study included 18 patients (18 eyes) with PCU between April 2018 and December 2020. All patients had PCU and underwent lamellar keratoplasty with SAPS. Observation indicators included preoperative and postoperative best-corrected visual acuity (BCVA) and transparency of SAPS. The infection control rate in the surgical eye-lesion area was also calculated. Eighteen patients underwent lamellar keratoplasty with SAPS to treat PCU. None of the patients experienced rejection after 6mo (18/18) and 12mo (16/16) of follow-up. The BCVA (0.47±0.30) at the 6mo follow-up after operation was significantly improved compared with the baseline (0.99±0.80), and the difference was statistically significant (Z=-3.415, P<0.05). The BCVA at the 12mo follow-up after operation was not statistically significant compared to the 6mo (Z=0, P=1). With time, the SAPS graft gradually became transparent. At the 6mo (18/18) and 12mo (16/16) follow-up, none of the patients had recurrent corneal infection. SAPS is clinically effective in the treatment of PCU, improving the patient's BCVA and reducing the incidence of rejection after keratoplasty.

Physiological Changes in the Cornea When Wearing Rigid Gas Permeable Contact Lenses

Rigid gas permeable (RGP) contact lenses are made of materials with excellent oxygen permeability and wettability, so they not only improve oxygen permeability compared to existing lenses, but also provide correction of refractive errors and improved vision in irregular corneas such as keratoconus. However, the hard material of the lens along with hypoxia and hypercapnia of the cornea caused by wearing RGP contact lenses cause various physiological changes in the cornea. Physiological changes in the cornea that may occur when wearing RGP contact lenses include mucin balls, decreased corneal epithelial thickness and increased size, decreased epithelial barrier function, corneal erosion and staining, decreased keratocyte density, decreased corneal sensitivity, and stromal opacities, contact lens‐induced peripheral ulcers, endothelial blebs, increased endothelial polymegethism, and changes in corneal shape. It is necessary to know the performance of the RGP contact lenses being prescribed, be aware of the physiological changes in the cornea caused by wearing RGP contact lenses, and provide the correct lens prescription along with appropriate education to the patient.

Single-cell analysis of age-related changes in leukocytes of diabetic mouse hindpaws

Complications associated with Type 1 and Type 2 diabetes, such as diabetic peripheral neuropathy and diabetic foot ulcers, are a growing health-care concern. In addition, this concern increases as diabetic patients age due to their increased susceptibility to complications. To address this growing problem, it is important to understand fluctuations in physiology which lead to pathological changes associated with the metabolic disturbances of diabetes. Our study explores dysregulation of immune cell populations in the hindpaws of healthy and diabetic mice at 12 and 21 weeks of age using single-cell RNA sequencing to provide insight into immune disruptions occurring in the distal limb during chronic diabetes. In 21-week-old Leprdb/db mice, increases were seen in mast cells/basophils, dermal γδ T cells, heterogeneous T cells, and Type 2 innate lymphoid cells. In addition, macrophages represented the largest cluster of immune cells and showed the greatest increase in genes associated with immune-specific pathways. Sub-clustering of macrophages revealed a bias toward angiogenic Lyve1+MHCIIlo macrophages in the hindpaws of 21-week-old diabetic mice, which corresponded to an increase in Lyve1+ macrophages in the hindpaws of 21-week-old diabetic mice on histology. Our results show that in Type 2 diabetes, the immunological function and phenotype of multiple immune cell types shift not only with metabolic disturbance, but also with duration of disease, which may explain the increased susceptibility to pathologies of the distal limb in patients with more chronic diabetes.

Prevalence and risk factors for diabetic foot complications among people living with diabetes in Harare, Zimbabwe: a cross-sectional study

BackgroundDiabetic foot disease (DF) is a common diabetes-related complication; however, the prevalence and associated risk factors for DF are not well characterised among people living with diabetes (PLWD) in Zimbabwe. This may suggest the unavailability of adequate strategies to diagnose and treat DF in the country. This study aimed to determine the prevalence of DF and associated risk factors for PLWD in Harare, Zimbabwe.MethodsThis was a cross-sectional study, employing a quantitative approach. In total, 352 PLWD were recruited from 16 primary care clinics in Harare. Sociodemographic and clinical data were collected via face-to-face interviews and clinical records reviews. The DF screening included an evaluation for peripheral neuropathy, ankle-brachial index (ABI), ulceration, and amputation. Self-administered questionnaires were used to assess knowledge, attitudes, and practices (KAPs), and KAP was scored using Bloom’s cut-off. Chi-Square goodness-of-fit tests were performed, and regression analyses were used for association analysis. The threshold for significance was p < 0.05.ResultsThis group included 82 men and 279 women, with a combined mean age of 57.9 ± 14 years. Twenty one (~ 26%) men and 41 (15%) women had type 1 diabetes. The diabetes type distribution significantly differed by gender (p < 0.001). Oral hypoglycaemics (71%) were most commonly administered for management. DF was observed in 53% (95% CI = 50–56) of PLWD. Other DF symptoms observed were abnormal ABI (53%), peripheral neuropathy (53%), foot ulceration (17%) and amputation (3%). Peripheral neuropathy increased the risk of ulceration (OR = 1.7; 95% CI = 1.1–2.6; p = 0.019), while insulin use was protective against amputation (OR = 0.1; 95% CI = 0.1–0.9; p = 0.049). Most (87%) of the participants demonstrated good DF knowledge and the importance of adhering to medication to prevent DF. However, 96% did not know that smoking was a risk factor for DF. Nearly two-thirds (63%) demonstrated poor attitudes and practices. Poor attitudes and practices were not predictors of DF ulceration risk (p > 0.05).ConclusionThis study showed that there was a high prevalence of DF (53%) in PLWD in Zimbabwe, and insulin use was protective against DF. There is an urgent need for policy revisions to include foot screening in routine primary care and increasing insulin use for PLWD to prevent complications such as DF as an integral part of primary care.

Can acupuncture increase microcirculation in peripheral artery disease and diabetic foot syndrome? - a pilot study.

Globally, diabetes mellitus (DM) and peripheral artery disease (PAD) have an increasing incidence and a high prevalence and are both associated with high morbidity and complication rates, e.g., as chronic non-healing peripheral ulcers. Impaired macro- and microcirculation and peripheral neuropathy lead to an increased risk of foot ulcers and infections. These complications are difficult to treat, have a high risk of becoming chronic and often lead to lower limb amputation. The aim of this planned study was to investigate the potential effects of acupuncture on improving microcirculation in patients with Diabetic Foot Syndrome (DFS) and PAD. In 18 patients with chronic non-healing peripheral ulcers and diagnosed DM or PAD, data on 8 microcirculatory parameters were collected simultaneously on intact skin close to the wound margin. Microcirculation was assessed using an O2C device combining laser Doppler shift and white light spectroscopy (LEA Medizintechnik GmbH, Giessen, Germany). Unilateral and bilateral acupuncture was performed on the connecting line between acupuncture points Stomach 14 and Stomach 15. After unilateral acupuncture (ipsilateral to the wound side), a statistically significant improvement in 7 out of 8 microcirculatory parameters was demonstrated compared to baseline measurements before acupuncture. After bilateral acupuncture, there was an additional improvement and statistical significance in all parameters in both DFS and PAD patients. These results show an improvement in the microcirculation and peripheral blood flow at the edges of the wound. As impaired micro- and macrocirculation is considered to be a critical prognostic factor for the healing of a peripheral lesion, the intervention could have a positive impact on the healing of (chronic) peripheral wounds.

Peripheral Ulcerative Keratitis: A Serious Corneal Inflammation

Abstract&#x0D; Introduction : Peripheral ulcerative keratitis (PUK) is a rare, but severe sight-threatening inflammatory condition that affects the cornea. PUK is characterized by peripheral corneal ulceration, stromal thinning, and neovascularization that can lead to corneal perforation and vision loss. Although PUK can occur in individuals without underlying systemic disease, it is most commonly associated with autoimmune disorders.&#x0D; Case Illustration : A 53-year-old woman presented to the ophthalmology clinic with complaints of redness, foreign body sensation, and blurred vision in her both eye for the past three days. On examination, slit-lamp biomicroscopy revealed a peripheral corneal ulcer. She had a history of rheumatoid arthritis for the past 2 months and was being treated with methotrexate and metylprednisolone. Laboratory investigations revealed elevated Anti-CCP IgG, which confirmed the presence of rheumatoid arthritis.&#x0D; Discussion : PUK is most commonly associated with autoimmune disorders, particularly rheumatoid arthritis, but may also occur in individuals with infectious, degenerative or traumatic corneal injuries. Immune- mediated inflammation, complement activation, and tissue destruction are thought to be involved in the pathogenesis of PUK. The diagnosis of PUK requires a thorough ophthalmic examination, including slit-lamp biomicroscopy, and laboratory investigations for underlying autoimmune disorders.&#x0D; Conclusion : PUK is a rare but serious ocular disease that requires prompt diagnosis and management to prevent severe complications such as corneal perforation and vision loss. Although PUK can occur in individuals without underlying systemic disease, it is most commonly associated with autoimmune disorders, particularly rheumatoid arthritis.

Devastating Mooren Ulcer Halt by Timely Aggressive Treatment - A Case Report

Introduction : Mooren ulcer is a progressive and painful peripheral ulcerative keratitis of unknown cause. Study aims to show effective aggressive treatment for Mooren ulcer.&#x0D; Case Illustration : A 43-year-old man was admitted with a marked clinical worsening of the white tissue covering the cornea, accompanied by pain, redness, and blurry vision of the left eye. Initial examination showed visual acuity of 6/21cc. Peripheral corneal ulcer was found from 6 to 2 clock hours with superficial vascularization and epithelial defect. Patient underwent ancillary examinations with unremarkable findings. Patient was diagnosed with Mooren Ulcer and treated with artificial tears and steroid topical. Patient had no significant improvement; therefore conjunctival resection with immunosuppressive therapy were performed. At follow up, no pain was reported, vision improved to 6/15cc, and the ocular surface inflammation resolved.&#x0D; Discussion : Mooren ulcer is usually misdiagnosed since the clinical signs are similar to other differential diagnoses. The examination must be performed carefully to rule out autoimmune and corneal infection. Treatment goals are to halt the destructive process and promote reepithelization. The stepwise aggressive approach of Mooren Ulcer treatments is crucial. It starts directly with topical steroid to control the progression of inflammation. However, when used alone, topical steroid usually cannot prevent the rapid progression so conjunctival resection is needed to remove the source of collagenase production by cutting the perilimbal blood vessels’ access to the area of the ulcer. Combination with an immunosuppressant will effectively maintain a stable condition.&#x0D; Conclusion : Early diagnosis and aggressive treatment for Mooren ulcer are needed to prevent the rapid progression.

Prevalence and incidence of peripheral neuropathy, peripheral artery disease, foot disease, and lower extremity amputation in people with diabetes in Ireland; a systematic review protocol.

Introduction Internationally, the prevalence of diabetes is increasing, and with this comes an increase in diabetes related complications. Diabetic foot disease is the most common lower extremity complication in people with diabetes, and is associated with major morbidity, mortality, and costs to health services. Despite this burden, the incidence and prevalence of diabetic foot disease is unknown in Ireland. This paper presents a protocol for a systematic review to examine the incidence and prevalence of diabetic foot disease in the Irish population. Methods A systematic review will be performed using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Pubmed, EMBASE, and Lenus, the Irish Health Research repository, will be searched for publications in any language and without restrictions to date. Title, abstract, and full text screening will be carried out independently by two investigators. Publications reporting on the incidence or prevalence of peripheral neuropathy, peripheral artery disease, ulceration, or amputation in people with diabetes in Ireland, from a defined geographical catchment area of Ireland, will be included. Joanna Briggs Institute (JBI) Critical Appraisal tool will be used to assess included studies methodological quality. Results will be reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Conclusion The results of this systematic review can be used to inform appropriate stakeholders on the incidence and prevalence of diabetic foot disease in Irish populations, enabling decision making around appropriate use of resources to help prevent, and improve management of this disease. Systematic review registration CRD42023472904

Contact lens‐related complications

The use of contact lens is very popular and its global market is growing. They have numerous applications, some well‐established and others still not consensual but which have been gaining more and more approval, namely refractive errors, dry eye management, post refractive surgery rehabilitation, persistent epithelial defects, cosmetic approaches and drug delivery systems. Unfortunately, there are some complications caused by their use, some of them sight threatening. The purpose of this presentation is to review these problems and to provide a better understanding of them.The major mechanisms implicated are numerous: trauma, decreased corneal oxygenation, reduced corneal and conjunctival lubrication, allergic and inflammatory responses and infection. However, depending on the complication we are talking about, there are other factors involved, such as contact lens‐related factors (material, design, fit and wearing schedule) and environmental factors (ocular surface condition, external environment, occupational factors, medications and compliance).The symptomatology experienced by patients ranges from hypoesthesia and mild conjunctival hyperemia to photophobia, contact lens intolerance and even decreased visual acuity.Many complications have been described. The most important (most common or most serious) are contact lens discomfort (CLD), dry eye, corneal deepithelialization (CD), sterile infiltrates (SI), corneal neovascularization (CNV), infectious keratitis (IK) and giant papillary conjunctivitis (GPC). Superior epithelial arcuate lesion, contact lens‐related peripheral ulcer, corneal distortion, hypoesthesia, ptosis, pinguecula, corneal edema, allergy aggravation, herpes reactivation and endothelial changes have also been described.CLD is an episodic or persistent adverse ocular sensation related to lens wear with a variable incidence in the literature, ranging from 23% to 94% in different series, being less common with soft lenses. Dry eye plays its role acting as a risk factor for CLD and/or as a consequence of contact lens use. CD manifests as punctate epithelial keratopathy, epithelial abrasions, foreign body tracks, corneal dellen, microcysts, vacuoles, mucin balls and dimple veiling. GPC is one of the most common adverse effects of contact lenses and the papillary reaction of the upper tarsal conjunctiva is the main feature of this entity. CNV is the formation of new vessels basically found in capillaries and venules of the pericorneal plexus, which may progress to the corneal stroma. They are much more associated with soft contact lenses, especially in extended wearers. Of note, contact lens use is one of the most common causes of CNV usually highlighted. SI are the result of an immunological reaction, often do not contain overlying epithelial defect or anterior chamber reaction and may manifest as stromal deep opacities. IK may be caused by bacteria, viruses, fungus or parasites and prompt immediate care and close revaluations to anticipate disastrous outcomes.Conservative measures play a role in almost all complications and their prevention, such as patient education, lubrication, contact lens exchange when applicable and modification of environmental factors. Addressing and learning how to prevent or quickly diagnose all these complications is crucial to prevent serious consequences.

Периферические язвы роговицы в ассоциации с ревматической патологией

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

Effect of Ankle Brachial Index (ABI) and Compression Therapy on Diabetic Foot Ulcer Healing.

Knowing the effect of compression therapy on the value of the Ankle Brachial Index in the healing process of Diabetic Foot Ulcer. This study used a quasi-experimental method with pretest-posttest with control group design with purposive sampling and non-equivalent control groups for eight weeks of treatment. Patients diagnosed with Diabetic Foot Ulcer have and have Peripheral Artery Disease, patient characteristics are homogenized, age >18 years, wound care every three days, Ankle Brachial Index values between 0.6-1.3 mmHg, research three clinics in Indonesia in February 2021. The population with Diabetic Foot Ulcer was screened by inclusion criteria with Ankle Brachial Index and Bates-Jensen Wound Assessment Tool instruments, a total of n=140; in the study, thirteen samples were excluded, the intervention group was given Compression Therapy n= 68, and the control group was compression stockings for eight weeks n=59, the data were statistically analyzed non-parametric test using Wilcoxon and Mann-Whitney U. Statistical analysis showed that the mean difference in paired group means was 26.4%. Meanwhile, in the mean analysis, the difference in the post-test healing of diabetic foot ulcers was 2.83%; p=0.000 and improvement of peripheral microcirculation was 33.02%; p=0.000 in the eighth week. Thus, compression therapy intervention in diabetic foot ulcer patients can improve peripheral microcirculation and increase Diabetic Foot Ulcers healing compared to the control group. Compression therapy tailored to the patient's needs and according to standard operating procedures can improve peripheral microcirculation, so that blood flow in the legs becomes normal; it can speed up the healing process of Diabetic Foot Ulcers.

Therapeutic Potential for Beta-3 Adrenoreceptor Agonists in Peripheral Arterial Disease and Diabetic Foot Ulcers.

Annually, peripheral arterial disease is estimated to cost over USD 21 billion and diabetic foot disease an estimated at USD 9-13 billion. Mirabegron is a TGA-approved beta-3 adrenoreceptor agonist, shown to be safe and effective in the treatment of overactive bladder syndrome by stimulating bladder smooth muscle relaxation. In this review, we discuss the potential use of beta-3 adrenoreceptor agonists as therapeutic agents repurposed for peripheral arterial disease and diabetic foot ulcers. The development of both conditions is underpinned by the upregulation of oxidative stress pathways and consequential inflammation and hypoxia. In oxidative stress, there is an imbalance of reactive oxygen species and nitric oxide. Endothelial nitric oxide synthase becomes uncoupled in disease states, producing superoxide and worsening oxidative stress. Agonist stimulation of the beta-3 adrenoreceptor recouples and activates endothelial nitric oxide synthase, increasing the production of nitric oxide. This reduces circulating reactive oxygen species, thus decreasing redox modification and dysregulation of cellular proteins, causing downstream smooth muscle relaxation, improved endothelial function and increased angiogenesis. These mechanisms lead to endothelial repair in peripheral arterial disease and an enhanced perfusion in hypoxic tissue, which will likely improve the healing of chronic ulcers.

Outcome of conjunctival flap surgery in case of non-healing corneal ulcer in a multi-specialty eye hospital of Northern Bangladesh

Background: This retrospective study evaluates the outcomes of conjunctival flap surgery for non-healing corneal ulcers at a tertiary eye hospital that were resistant to medical treatment. Methods: The study included 47 eyes of 47 patients with deep corneal ulcers who underwent conjunctival flap surgery in a multi-specialty eye hospital between April 2020 and January 2022. The follow-up period was 12 months. Primary outcome measures included the restoration of ocular surface integrity, while secondary outcomes assessed improvements in visual acuity and postoperative complications. Results: Among the 47 patients, 30 (63.82%) were male, and 17 (36.17%) were female, with a mean age of 52.13±14.91 years. The mean ulcer diameter was 4.52±2.02 mm, and the mean ulcer depth was 65±22.20% of the corneal thickness. An anatomic cure was achieved in 34 (72.34%) of the 47 eyes. Three eyes that failed to respond to conjunctival flap surgery required evisceration. Postoperative visual acuity improved in 15 eyes with peripheral ulcers. Common postoperative complications included flap retraction, flap necrosis, granuloma formation, and perforation. Conclusions: Conjunctival flap surgery is an effective treatment for non-healing corneal ulcers, providing ocular surface integrity and supporting corneal healing. It can potentially eliminate the need for emergency penetrating keratoplasty or prepare the eye for future optical keratoplasty.