Persistent Corneal Research Articles

Optic Canal Analysis in Syndromic Craniosynostosis: Volumetric and Surface Area Validation Study Using Different Measurement Modalities.

In syndromic craniosynostosis (SC), unlike persistent corneal irritation due to severe exophthalmos and increased intracranial pressure, optic canal (OC) stenosis has been scarcely reported to cause visual impairment. This study aimed to validate the OC volumetric and surface area measurement among SC patients. Sixteen computed tomography scan of SC patients (8 months-6 years old) were imported to Materialise Interactive Medical Image Control System (MIMICS) and Materialise 3-matics software. Three-dimensional (3D) OC models were fabricated, and linear measurements were obtained. Mathematical formulas were used for calculation of OC volume and surface area from the 3D model. The same measurements were obtained from the software and used as ground truth. Data normality was investigated before statistical analyses were performed. Wilcoxon test was used to validate differences of OC volume and surface area between 3D model and software. The mean values for OC surface area for 3D model and MIMICS software were 103.19 mm2 and 31.27 mm2, respectively, whereas the mean for OC volume for 3D model and MIMICS software were 184.37 mm2 and 147.07 mm2, respectively. Significant difference was found between OC volume (P = 0.0681) and surface area (P = 0.0002) between 3D model and software. Optic canal in SC is not a perfect conical frustum thus making 3D model measurement and mathematical formula for surface area and volume estimation not ideal. Computer software remains the best modality to gauge dimensional parameter and is useful to elucidates the relationship of OC and eye function as well as aiding intervention in SC patients.

The Need for Improved Therapeutic Approaches to Protect the Cornea Against Chemotoxic Injuries.

Cornea, a highly specialized transparent tissue, is the major refractive element of the eye. The cornea is highly susceptible to chemotoxic injury through topical exposure to vapors, microparticles, and aqueous drops, as well as through systemically absorbed chemicals that access the cornea via tear film, aqueous humor, and limbal vasculature. Corneal injury activates a carefully orchestrated series of repair processes capable of resolving minor lesions over time, but it often fails to overcome the menace of moderate, severe, and chronic injuries and secondary pathophysiologies that permanently impair vision. The most serious complications of chemical injuries—persistent corneal edema, neovascularization, scarring/haze, limbal stem cell deficiency, and corneal melting—often manifest over months to years, suggesting that a better understanding of endogenous regenerative mechanisms of corneal repair can lead to the development of improved treatments that may attenuate or prevent corneal defects and protect vision.

Décollement descemétique post-phakoémulsification : à propos de 9 cas

Descemet's membrane detachment (DMD) is a rare but potentially serious complication of cataract surgery. Although there are no consensual guidelines regarding the diagnosis or treatment of DMD, incorrect treatment may result in irreversible corneal changes with visual sequellae. The purpose of our study is to describe the diagnosis and treatment of DMD. We report a series of 9 cases of DMD, their diagnosis, treatment and outcomes. We tested the HELP protocol retrospectively against our 9real-life cases. Two cases recovered with simple medical management, 4required air-bubble descemetopexy, and three required keratoplasty. Our study revealed that the main factor associated with poor outcomes is late diagnosis and management. Our series illustrates the importance of proactive management and timely diagnosis by performing anterior segment OCT in the setting of persistent postoperative corneal edema.

Progress in research on persistent corneal epithelial defects

Progress in research on persistent corneal epithelial defects

Topical insulin for refractory persistent corneal epithelial defects.

To evaluate insulin eye drops for persistent epithelial defects (PEDs) that are refractory to usual treatment in clinical practice and to analyze how it may improve epithelization. A prospective non-randomized hospital-based study was performed. Patients with PEDs that were refractory to conventional treatment were treated with insulin eye drops four times a day. Patients' demographics, PED etiology, concomitant treatments, and comorbidities were reviewed. The rate of PED closure and epithelial healing time were considered the primary outcome measures. 21 patients were treated with insulin drops (12 females and 9 males; mean age 72.2 years). Mean PED area before treatment was 17.6 ± 16.5 mm2 (median 13.2; range 3.9-70.6). PED comorbidities included seven eyes with infectious keratitis (33%), five eyes with calcium keratopathy (24%), ocular surgery on three eyes (14%), three eyes with lagophthalmos (14%), two eyes with bullous keratopathy (10%), and one patient with herpetic eye disease (5%). The eyes of 17 patients (81%) with refractory PEDs had reepithelized and four patients (19%) had still presented an epithelial defect by the end of the study follow-up period, although it had decreased in size. In patients where PED closure was achieved, mean time until reepithelization was 34.8 ± 29.9 days (median 23; range 7-114). In the remaining patients, a mean area reduction of 91.5% was achieved for the PEDs. Topical insulin can promote and accelerate corneal reepithelization of refractory PEDs. It also offers many other advantages, including excellent tolerance, availability, and cost-effectiveness.

Efficacy of platelet-rich plasma lysate in patients with corneal erosion or post-traumatic scarring of the tissues of the eyelids

Purpose : to evaluate the effectiveness of platelet-rich plasma (PRP) lysate in patients with corneal erosion or posttraumatic scarring of eyelid tissues. Material and methods . The study involved 30 patients aged 22 to 82 (51.5 ± 19.1 years): 10 with persistent corneal erosions, who were treated in 2 stages (2 weeks of standard keratoprotective therapy, then treatment supplemented with instillations of PRP lysate) and 20 patients with post-traumatic scarring of eyelid tissues, who were divided into a clinical group and a comparison group. PRP lysate was produced in the cell transplantation and immunotyping laboratory of N.V. Sklifosovsky Research Institute for Emergency Medicine. Results . In group 1, already on the 3rd day of PRP lysate use, a positive dynamic of the cornea was observed: all patients had fewer complaints of pain, photophobia, and lacrimation. Corneal biomicroscopy, performed daily over the entire epithelization period, revealed a decrease in hyperemia of the tarsal and bulbar conjunctiva and corneal edema, which indicated a weakened inflammatory response. On average, the area of the cornea at the start of traditional therapy was 21.6 [19.6; 30.65] mm2. After two weeks of treatment, at the time of adding PRP lysate, the average area of erosion fell to 15.7 [12; 18.9] mm 2 , after a week of treatment with lysate, it dropped to an average of 2.35 [0.4; 4.3] mm 2 . On day 14, all patients revealed complete epithelialization of the corneal defect. In patients with post-traumatic eyelid tissue scars, after a 3-month-long use of PRP lysate (study group), an improvement was noted in the cosmetic and functional state of the eyelids, on average by 4 points (M e = 12 [10; 12] points before and 8.5 [8; 9] points after treatment (on the Manchester scar assessment scale), in contrast to the patients who received no anti-scar therapy (comparison group), as the latter showed a deterioration in the condition of eyelid scars by 1–2 points (M e = 11 [10.25; 11.75] points at the beginning and 12 [11; 12] points at the end of the observation period). The acoustic density of scar tissue in the study group approached the normal values, in contrast to the comparison group, in which scar tissue appeared to be hypoechoic. Conclusion . Using PRP lysate aimed at improving the repair and regeneration processes in patients with corneal erosion or post-traumatic scarring of eyelid tissues is promising and requires further clinical study.

Comparison of visual outcome and complications following early and delayed cataract surgery in phacolytic glaucoma

To compare the Visual outcome, intraoperative and post operative complications following early and delayed Cataract surgery in Phacolytic glaucoma. A Prospective and interventional study in a district hospital. Confirmed cases of phacolytic glaucoma after medical control grouped into group A and group B. Group A patients under went small incision cataract surgery (SICS) within 7 days (early) and group B patients after 7 days(delayed). They were compared for complications and post operative distant corrected visual acuity (DCVA) at the end of 8 weeks.There were38 eyes from 38 patients. The demographic factors and clinical findings are comparable between two group. Cumulative intraoperative complications like difficulty in doing continuous curvilinear capsulorhexis (CCC), Zonular dialysis and posterior capsule (PC) tear with vitreous disturbance were more in group B 55.6%(10/18) compare to group A 35.0% (7/20). Postoperative DCVA of 6/12 or more was comparable between two group A and B 60.0% (12/20) and 55.6 % (10/18) respectively. Post operative persistent corneal edema in 5.0% (1/20) in group A, 5.5% (1/18) persistent uveitis and 5.5% (1/18) optic nerve damage in group B observed. Early surgical intervention is to be preferred choice in all cases of phacolytic glaucoma. However in patients with genuine personal, family and socio economical reasons delayed surgery will not alter final visual outcome. Adequate preoperative preparation are to be taken to reduce and handle intra operative complication.

Балльная оценка клинического течения инфицированного ожога роговицы при лечении различными способами в эксперименте

According to WHO data, nowadays at least 2.2 billion people worldwide currently have visual impairment or blindness, of which more than 11.9 million people worldwide have moderate to severe irreversible visual impairment that could be prevented. Objective: to assess the clinical course of a standard infected corneal burn during treatment using combined ophthalmic medicinal films levofloxacin + dexpanthenol and dexamethasone + dexpanthenol from a comparative perspective. Materials and methods. The article investigates the pharmacological activity of five different drug regimens for the treatment of an infected corneal burn in rabbits. Treatment of the first wave began 1 hour after the formation of a standard infected corneal burn. Treatment of the second wave began after the absence of signs of an inflammatory reaction was detected. The clinical course of the standard infected corneal burn was assessed immediately after the formation of the burn and the infection, 1 hour, 2, 3, 5 and 14 days after the experiment started. Results. Clinical recovery began on the 3rd day in experimental group 2 treated with combined ophthalmic medicinal films of levofloxacin 1.5 mg + dexpanthenol 1 p/day. On the 5th day of the experiment, recovery was recorded in the experimental group 1 treated with 1.5 mg levofloxacin-based eye films once a day, as well as in comparison group 2 treated with 0.5% levofloxacin 4 times a day and 5% dexpanthenol 6 times a day. On the 7th day after the formation of a standard infected corneal burn, clinical recovery was recorded in comparison group 1 treated with instillations of levofloxacin 0.5% 4 times a day. In the control group with placebo treatment no conjunctiva inflammatory reaction was recorded on the 14th day of the experiment, however, there was persistent corneal opacity in the form of a spot at the burn site. Conclusions. While treating a standard infected corneal burn, the use of combined ophthalmic medicinal films can shorten the clinical recovery period to 3 days, in comparison with treatment with instillations, where recovery occurred on the 5th day of the experiment.

Working conditions and occupational risks of anterior eye pathology in metalworking machine operators

Introduction. The profession of “machine operator in metalworking”, one of the most common professions in various industries, characterized by a large volume of abrasive operations, accompanied by dust formation, which creates a potential for the occurrence of diseases of the visual organ.The aim of the study is to provide a hygienic assessment of working conditions and occupational risk of visual organ pathology in metalworking machine operators.Materials and methods. Observation groups — machine operators for metalworking of two training groups (experience up to 5 years, experience of 6–20 years). Two comparison groups (administrative and technical personnel of the enterprise) are formed according to the same age-experience principle.Results. The working conditions of machine operators were classified as class 3.2. taking into account the severity and intensity of the work process and the noise level (80 dBA) in the workplace. Nitrogen oxide, carbon monoxide, and manganese were registered in the air of the working area in concentrations below the permissible concentration (PC), and the aerosol dihydroxide was registered above the PC in 25.8% of cases. In the main working groups, diseases of the anterior segment of the eye were more often registered, among which dry eye syndrome (DYS) prevailed (94.1%), chronic blepharoconjunctivitis (79.9%), persistent corneal opacification (21.7%). There was an increase in the prevalence of detected diseases with an increase in work experience (p≤0.05). In machine operators, the frequency of inhibition of lacrimal formation and decreased stability of the tear film was recorded significantly more often, with increasing work experience, the degree of violation of lacrimal formation and stability of the tear film increased. The chances of detecting pathology of the anterior segment of the eye in machine operators are 5.9 and 3.5 times higher than in the comparison group. There are different forces of connection, increasing with the increase of work experience in the profession, between the working conditions of machine operators and the occurrence of SHG (relatively strong), with chronic blepharoconjunctivitis and persistent corneal opacity (medium strength), which suggests the professional conditionality of this pathology.Conclusions. The results obtained suggest that the pathology of the anterior segment of the eye is professionally conditioned in metalworking machine operators and necessitate the introduction of preventive measures aimed at protecting the visual organ.

Prevalence of Persistent Corneal Epithelial Defects in Chronic Ocular Graft-Versus-Host Disease

To establish the prevalence, clinical characteristics, and risk factors for persistent corneal epithelial defects (PED) in patients with chronic ocular graft-versus-host disease (oGVHD) and to determine visual outcomes after healing. Retrospective cohort study. A chart review was conducted of patients in whom chronic oGVHD was diagnosed between January 2011 and December 2018 and their demographic and clinical characteristics were collected. Data were analyzed to determine prevalence of PED, and multivariate logistic regression was performed to determine the risk factors associated with it. A total of 405 patients at a mean age of 60 ± 13 years in whom chronic oGVHD was diagnosed; 58% were men. The prevalence of PED was 8.1%. The median time for PED development after hematopoietic stem cell transplantation was approximately 24months. Median time to PED resolution was 4.5weeks after starting therapy. The mean best-corrected visual acuity declined by 2 lines post-PED resolution. The prevalence rates of corneal ulcer and perforation were 6.2% and 4.0%, respectively, over 8 years. Logistic regression analysis, used to determine factors associated with PED, showed diabetes (P= .006), limbal stem cell deficiency (LSCD) (P= .02), filamentary keratitis (P= .02), subconjunctival fibrosis (P= .02), and a higher National Institutes of Health (NIH) oGVHD score (P= .01) were significant risk factors for PED development. The study found the prevalence rate of PED, corneal ulceration, and corneal perforation in chronic oGVHD to be 8.1%, 6.2%, and 4%, respectively. Analysis showed that oGVHD patients with diabetes, LSCD, filamentary keratitis, subconjunctival fibrosis, and a high NIH score were at higher risk of developing severe corneal disease.

Efficacy and Safety of Primary Glaucoma Device Implantation Surgery in Exfoliative Glaucoma: A Retrospective Consecutive Case Series.

Purpose To evaluate the efficacy and safety of primary glaucoma drainage implant (GDI) surgery for exfoliation glaucoma (XFG). Methods This study was a retrospective, consecutive case series study including 36 eyes of 36 patients with XFG who underwent primary GDI surgery. Intraocular pressure (IOP), the mean deviation (MD) from the visual field exam, corneal endothelial cell density (ECD), and the number of topical antiglaucoma agents used during the preoperative and postoperative periods were retrospectively analyzed. Surgical success was defined by the following criteria: (1) IOP ≤ 18 mmHg and an IOP reduction of 20% with 1 or no medication; (2) IOP ≤ 15 mmHg and an IOP reduction of 25% with 1 or no medication; and (3) IOP ≤ 12 mmHg and an IOP reduction of 30% with 1 or no medication. The probability of success of GDI surgery was determined via Kaplan–Meier survival analysis. Results The preoperative IOP was 25.9 ± 4.7 mmHg, and the postoperative IOP at 24 months was decreased to 14.2 ± 3.6 mmHg (p value < 0.001). The postoperative MD and ECD were similar to baseline (MD p value = 0.155; ECD p value = 0.055). However, a significant reduction in the number of antiglaucoma agents was observed (p value < 0.001). The surgical success rates were 77.8%, 63.9%, and 55.6% at 24 months for criteria 1, 2, and 3, respectively. Early hypotony (4 patients, 11.1%) and persistent corneal edema (5 patients, 13.9%) were the most common early and late postoperative complications, respectively. Conclusions In XFG, primary GDI surgery reduced IOP by 45.2% and had a 77.8% success rate according to criteria 1 at 24 months postoperatively. However, considering that ECD reduction continues to decline over time, primary GDI surgery should be carefully considered in XFG.

Simultaneous photorefractive keratectomy and accelerated collagen cross-linking in high-risk refractive surgery(Tehran protocol): 3-year outcomes.

To evaluate safety and efficacy of performing simultaneous photorefractive keratectomy (PRK) and collagen cross-linking (CXL) in myopic patients with preoperative risk factors for developing keratectasia. Seventeen eyes of 15 patients with at least one of the following risk factors were recruited: central keratometry (Kmax) between 48 and 50, difference between inferior, superior corneal power (I-S value) between 1.4 and 1.9 and corneal thickness between 450 and 480µm. Upon final stage of standard PRK, 0.02% mitomycin was applied for 30-50s, and then, accelerated CXL was performed for 5min. Pre- and postoperative Oculus Pentacam® imaging for keratometry values, measurement of uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were done for all patients. Mean follow-up time was 32.08 ± 7.79months (range 25-49months). Mean age of patients was 28.78 ± 3.80years. Mean postoperative spherical equivalent was + 0.19 ± 0.42 (- 0.5 to + 1.0 [D]). Mean UDVA and CDVA improved from 0.9062 ± 0.485 log MAR and 0.0148 ± 0.043 log MAR to 0.0173 ± 0.040 log MAR and 0.0057 ± 0.023 log MAR, respectively (P = 0.011, P = 0.735). Mild degree of early postoperative stromal haze was seen which did not persist more than 6months. There was no late stromal haze, corneal ectasia or other major postoperative complication in the follow-up period. Combined PRK and accelerated CXL is an efficient and safe procedure for high-risk refractive surgery candidates, with no increased risk of persistent corneal haze.

Clinical consequences of herpes simplex virus DNA in donor corneas: Different prognosis and management of endothelial keratoplasty and deep anterior lamellar keratoplasty.

There is still controversy over the necessity of screening donor corneas for herpes simplex virus (HSV). Currently, no study reported the outcomes of different types of keratoplasty with HSV-positive donor corneas. To describe the clinical consequences of four patients who underwent keratoplasty by sharing double corneas from a single donor, both of which were positive for HSV-1 DNA by polymerase chain reaction. A retrospective case series study. Both patients who underwent endothelial keratoplasty (EK) developed persistent corneal edema with or without keratic precipitates, and mild anterior chamber inflammation on postoperative day 3 and 17 respectively. Despite adequate antiviral treatment, they developed graft detachment subsequently and experienced graft replacement. Transmission electron microscopy showed denuded Descemet's membrane without any endothelial cells on both removed grafts and viral particles were identified within the residual posterior stroma of the thicker graft. As for those who underwent deep anterior lamellar keratoplasty, one patient presented with graft rejection for the sake of self-discontinuation of all anti-rejection agents. The other's graft remained clear at the final follow-up. HSV existed in the posterior stromal and endothelial layer of the donor corneas. Reactivation of HSV and severe endothelial loss may occur on corneal endothelial grafts in the early postoperative period while anterior lamellar grafts could be quiescent. Considering the possibility of graft failure caused by viral reactivation, it's of great significance to screen for viral DNA in donor corneas prior to the surgery, especially for EK.

In Vivo Evaluation of Corneal Nerves and Epithelial Healing After Treatment With Recombinant Nerve Growth Factor for Neurotrophic Keratopathy

To evaluate the renewal of corneal nerve structure and function in patients with neurotrophic keratopathy (NK) treated with recombinant human nerve growth factor (rhNGF) eye drops. Prospective, interventional, before-and-after case series. This study included 18 patients with NK with a persistent epithelial defect or corneal ulcer, treated with topical rhNGF, and age-matched healthy controls. Patients underwent clinical examination with corneal fluorescein staining, Schirmer 1 tear test, assessment of corneal sensitivity with the Cochet-Bonnet esthesiometer, and morphologic examination of the nerves by invivo confocal microscopy (IVCM) at baseline and at 4 and 8weeks of treatment. IVCM analysis was used to assess corneal sub-basal nerve density, number of nerve branches, and the diameter of nerve fibers. A complete resolution of the epithelial defect was observed in all patients within 8weeks. Schirmer 1 test showed a significant improvement of tear film secretion. Change from baseline in corneal sensation was significant (P < .001) but did not approach that of healthy controls. After 8weeks of treatment, there was a significant increase in the mean nerve density in affected eyes as compared to baseline (P= .007) as well as in the number of nerve branches (P= .008) and nerve fiber diameter (P= .007). Topical treatment with rhNGF was effective in promoting complete corneal healing of persistent epithelial defects and corneal ulcers in patients with NK. This was associated with an improvement of corneal sensitivity and an increase of sub-basal nerve density, diameter, and number of nerve branches, indicating improvement in structure and function of corneal nerves.

Fast and sustained healing of resistant corneal ulcers using corneal scrubbing and matrix regenerating therapy.

The aim of this study was to assess the efficacy and safety of corneal scrubbing associated with matrix regenerating agent on corneal wound healing in patients with persistent corneal ulcers. This was a retrospective case study in patients with difficult-to-treat corneal ulcer. Corneal scrubbing was performed with a sterile dry cotton bud to eliminate damaged epithelial cells and corneal deposits, promoting epithelial renewal. Regenerating agent was then administered as one eye drop every 2 days in addition to preservative-free ocular lubricants. A bandage contact lens was applied in case of moderate-to-severe corneal pain. Corneal ulcers were regularly assessed until healing. In total, 17 patients with a chronic corneal ulcer of various etiologies for several months on average were enrolled. Corneal scrubbing combined with regenerating agent administration led to a rapid corneal ulcer size reduction from 26.4 ± 20.6 mm2 after scrubbing (before regenerating agent) to 7.2 ± 7.1 mm2 at day 5, 3.3 ± 6.0 mm2 at day 10, and 0.9 ± 2.3 mm2 at day 18. Complete corneal ulcer healing was observed in 35.2% of patients within 10 days, in 70.4% within 18 days, and in all patients within 25 days. Corneal ulcer relapse was observed in two (11.8%) patients after 6 weeks and 5 months, respectively; both were successfully treated using the same procedure. The regenerating agent was well tolerated in all patients. In this study, combined corneal scrubbing and matrix regenerating therapy (with or without bandage contact lens) led to a rapid healing and successful resolution of persisting corneal ulcers, including large and deep corneal ulcers.

Management of Descemet’s Membrane Detachment after Cataract Surgery—A Case Series

Descemet’s membrane detachment (DMD) is an uncommon, vision-threatening, ocular surface complication of cataract surgery. Among several treatment strategies, sulfur hexafluoride (SF6) descemetopexy is the standard of care. Herein, we report three cases of DMD after cataract surgery managed with SF6 descemetopexy, showing different outcomes. Anatomical success was achieved in cases 1 and 2 while intraocular pressure (IOP) was elevated in case 2. In case 3, despite SF6 descemetopexy, recurrent DMD was observed. Due to persistent corneal edema and possible corneal decompensation in case 3, Descemet’s stripping automated endothelial keratoplasty was performed and a clear graft was found at the final visit. In conclusion, descemetopexy with 20 % SF6 is an effective and safe procedure for repairing DMD in most cases. Pupillary block with elevated IOP is another concern and prophylactic peripheral iridectomy is recommended. For recurrent DMDs, repeat descemetopexy could be considered. However, close monitoring is advocated since secondary management, such as endothelial keratoplasty, may be required.

Allogenic simple limbal epithelial transplantation (alloSLET) from cadaveric donor eyes in patients with persistent corneal epithelial defects

Background/aimTo describe the clinical outcome of allogenic simple limbal epithelial transplantation (alloSLET) utilising tissue from cadaveric donor eyes after failed re-epithelialisation of the corneal surface.MethodsMedical records of 14 eyes from...

Corneal Endothelial Cell Toxicity Determines Long-Term Outcome After Ocular Exposure to Sulfur Mustard Vapor.

Ocular exposure to sulfur mustard (SM) vapor causes acute loss of corneal endothelial cells (CECs). Persistent corneal endothelial pathologies are observed in eyes that do not recover from SM exposure, suggesting that endothelial toxicity contributes to mustard gas keratopathy (MGK). Here, we evaluated the contributions of endothelial loss to acute and chronic corneal injuries in SM-exposed eyes. Rabbit eyes were exposed in vivo to equivalent doses of SM using 9-, 11-, or 14-mm vapor caps. The effects of exposure area on corneal injury progression were longitudinally evaluated over 12 weeks using clinical evaluations. The effects of exposure area on CEC morphology, endothelial and epithelial ultrastructure, and endothelial barrier function were determined from 1 day to 12 weeks. SM exposure caused loss of CECs and failure of endothelial barrier integrity at 1 day, independent of exposure cap size. By 3 weeks, eyes exposed with the 14-mm vapor cap exhibited increased corneal permeability, repopulation of the endothelium by cells with fibroblastic morphology, and abnormal deposition of extracellular matrix. Eyes exposed with 9- or 11-mm vapor caps exhibited transient symptoms of injury that fully resolved, with the rate of recovery correlated with cap size. The nonlinear correlation between endothelial lesion size and probability of developing MGK suggests that the CEC loss is a determinative factor for emergence of MGK. These studies illustrate the importance of endothelial repair in preventing MGK. Furthermore, they exclude chemical modification of basement membrane as a mechanistic cause of recurrent epithelial erosions in MGK eyes.

Tenonplasty Combined With Amniotic Membrane Transplantation for Patients With Severe Ocular Burns Induced Anterior Segment Necrosis.

This article describes a novel surgical technique for successful repair of intractable corneoscleral necrosis caused by severe ocular burns. In this prospective case series, 19 eyes of 15 consecutive patients with sectional scleral necrosis and persistent corneal epithelial defects were treated with tenonplasty and amniotic membrane transplantation. The main outcome measure was the stability of the ocular surface after reepithelialization and repair of defects. All patients underwent successful combined surgery involving tenonplasty and amniotic membrane transplantation, in which the conjunctival and corneal surfaces were reconstructed. The interval from injury to surgery was 37.4 ± 24.5 days (3–91 days), and the ocular surfaces became stabilized in 82.2 ± 35.4 days (26–156 days, median 87 days). At the final visit, all cases presented with corneal opacity and neovascularization to various degrees. The best-corrected visual acuity decreased from 2.83 ± 1.02 LogMAR preoperatively to 2.87 ± 1.31 LogMAR postoperatively. The results imply that tenonplasty combined with amniotic membrane transplantation could provide vascular supply to the ischemic sclera, repair defects in the conjunctiva, and promote corneal reepithelialization, thus facilitating ocular surface stabilization after burns.

The Use of Autologous Serum to Reverse Severe Contact Lens-induced Limbal Stem Cell Deficiency.

To describe the efficacy of autologous serum (AS) eye drops to reverse severe contact lens (CL)-induced limbal stem cell (LSC) deficiency (LSCD). This is a prospective, uncontrolled, interventional case series that enrolled 20 eyes of 14 consecutive patients diagnosed with severe CL-induced LSCD at presentation, based on clinical examination, at a tertiary referral center for the period December 2016 to December 2018. All eyes underwent AS treatment for at least 2 weeks with a follow-up for at least 2 months. Demographic data and treatment outcomes were collected and analyzed. The mean patient age at presentation was 30.5 years (range, 19-49 years). The mean duration of soft contact lens wear was 15.6 years (SD, 7.58 years; range, 5-31 years). All study eyes had pain and blurred vision at presentation. All eyes had recurrent or persistent corneal epithelial defect, stromal scarring and opacity, and superficial vascularization and peripheral pannus at presentation. Aggressive treatment with AS succeeded in all eyes. Signs and symptoms of LSCD stabilized in all eyes within 2 weeks and resolved in 6 eyes (30.0%) in 2 weeks, 9 eyes (45.0%) in 4 weeks, and 5 eyes (25.0%) in 8 weeks. The mean follow-up time was 9.45 ± 1.79 weeks (range, 8-24 weeks). Early identification and aggressive treatment of the ocular surface disease with AS can medically reverse severe CL-induced LSCD and prevent the need for surgical intervention.