Recurrent Corneal Research Articles

Histologic evaluation of the immediate effects of diamond burr debridement in experimental superficial corneal wounds in dogs

To evaluate the corneal changes immediately after diamond burr debridement of superficial corneal wounds in dogs. Spontaneous chronic corneal epithelial defects (SCCEDs) are the most common form of canine recurrent corneal ulcers. The diamond burr has been used in the management of corneal lesions in humans since 1983. Recently, it has been successfully used in the treatment of SCCEDs in dogs; however, little has been documented as to its mechanism of action. Five adult female research dogs euthanized for reasons unrelated to the study were included, providing 10 normal eyes. An excimer laser spatula was used for epithelial removal after delineation with an 8 mm punch biopsy trephine. Diamond burr debridement was performed for 30 and 45 s in five eyes each (groups 1 and 2 respectively). The procedure was performed on the ventral half of the experimental defect as well as ventral normal cornea, immediately after euthanasia, and prior to enucleation. Samples were processed routinely for histologic evaluation and stained with periodic acid-Schiff. No stromal defects could be identified under light microscopy. In experimental corneal wounds, multi-focal areas remained covered by the epithelial basement membrane (BM) after diamond burr treatment in both groups (group 1 = 48% ± 16SD, group 2 = 26% ± 12SD). Removal of BM on group 2 was significantly higher than group 1 (P < 0.05). CONCLUSIONS : The diamond burr allows a safe method of debridement and does not create defects beyond the epithelial BM in corneal wounds in normal dogs. Evaluation of the diamond burr debridement in cases of SCCEDs is warranted.

A randomised, prospective study to investigate the efficacy of riboflavin/ultraviolet A (370 nm) corneal collagen cross-linkage to halt the progression of keratoconus

AimsA blind, randomised, prospective, bilateral study to investigate the efficacy of riboflavin/ultraviolet A corneal collagen cross-linkage to halt the progression of keratoconus.Methods24 patients with early/moderate bilateral keratoconus with recent progression...

Treatment of Recurrent Corneal Erosion by Extended-wear Bandage Contact Lens

To assess the efficacy of using a bandage contact lens (BCL) for 3 months for recurrent corneal erosions (RCE) to facilitate epithelial adhesion. Retrospective study of patients presented to the Casey Eye Institute (Portland, OR) with RCE after failing at least 6 weeks of medical lubrication therapy. Subjects were treated with an extended-wear BCL for 3 months and then followed for approximately 1 year. The main outcome measure was recurrence of RCE. Best-corrected visual acuity was measured before and after BCL therapy. From the 12 patients studied, 9 (75%) had no recurrence of RCE after approximately 1 year of follow-up. Three subjects had subjective complaints of recurrent erosion during the follow-up period with 1 of these 3 subjects having objective findings of a recurrent erosion. Three-month BCL treatment is a safe and effective medical therapy with a relatively low recurrence rate of RCE.

Progressive Keratolysis with Pseudopterygium Associated with Erythema Elevatum Diutinum

To report a patient with a rare case of progressive keratolysis with pseudopterygium associated with erythema elevatum diutinum (EED). Interventional case report and literature review. One patient with ocular presentation of EED was identified. A 64-year-old woman presented with recurrent pterygium and painful corneal thinning with impending perforation of the left eye. Examination revealed intensely inflamed pseudopterygium, paracentral and peripheral corneal ulcerations, and descemetocele with a pinpoint leakage. Clinical course and laboratory and histopathologic findings. Disseminated skin lesions developed during hospital admission. Examination revealed multiple, well-demarcated, discrete, red to violaceous, firm nodules and plaques on the knuckles and dorsum of the hands, and the extensor surface of the forearms, elbows, knees, right ankle, and buttocks. A skin biopsy of the recent lesions showed a dense and diffuse inflammatory cell infiltration, predominantly neutrophilic infiltrates and nuclear dust (leukocytoclasis), located around small blood vessels in the dermis, consistent with the diagnosis of EED. The diagnosis of progressive keratolysis with pseudopterygium associated with EED was made. Spontaneous, rapid resolution of both cutaneous and ocular lesions occurred after dapsone therapy. Erythema elevatum diutinum is a rare, chronic, and recurrent disease that has both dermatologic and ocular manifestations. Peripheral ulcerative keratitis seems to be the most common ocular finding and may be the initial presenting feature of EED. Ophthalmologists should be aware of this rare entity in the differential diagnosis of ulcerative or nonulcerative peripheral keratitis.

Tectonic Deep Anterior Lamellar Keratoplasty in Impending Corneal Perforation Using Cryopreserved Cornea

We report a case of tectonic corneal transplantation for impending corneal perforation to preserve anatomic integrity using cryopreserved donor tissue. An 82-year-old woman exhibiting impending corneal perforation suffered from moderate ocular pain in the left eye for one week. After abnormal tissues around the impending perforation area were carefully peeled away using a Crescent blade and Vannas scissors, the patient received tectonic deep anterior lamellar keratoplasty using a cryopreserved cornea stored in Optisol GS® solution at -70℃ for four weeks. At six months after surgery, the cornea remained transparent and restored the normal corneal thickness. There were no complications such as corneal haze or scars, graft rejection, recurrent corneal ulcer, and postoperative rise of intraocular pressure. Cryopreserved donor lamellar tissue is an effective substitute in emergency tectonic lamellar keratoplasty, such as impending corneal perforation and severe necrotic corneal keratitis.

Recurrent corneal ulceration in presence of synthetic microfibrils

Recurrence of microbial keratitis in the presence of protozoal infection is very rare and infrequently reported unless predisposing factors are present. The association of recurrent microbial keratitis and synthetic microfibrils has never previously been reported to our knowledge. This single interventional case study describes the clinical course and treatment of a contact lens wearer who was treated for Acanthamoeba keratitis with superinfection from bacterial organisms in the presence of synthetic microfibrils. The presence of synthetic fibrils on a corneal ulcer base may act as a nidus for pathological organisms and interfere with normal corneal healing. This may result in infection recurrence and the growth of resistant opportunistic organisms.

Phototherapeutic Keratectomy Outcomes in Superficial Corneal Opacities

PurposeCompare the effectiveness of Phototherapeutic keratectomy (PTK) in treatment corneal dystrophies versus superficial corneal scars: visual outcomes, recurrence rate and safety profile.MethodsPTK was performed in 51 eyes of 51 patients. Data regarding the indications for PTK, ablation depth, symptomatic relief, pre-and postoperative best spectacle-corrected visual acuity (BSCVA), spherical equivalent changes, recurrence and complications were analyzed. The indications for PTK in our study were classified into two categories – group A: patients with corneal dystrophies (n = 23) and the other group B (n = 28) with other indications.ResultsThe average age of the patients was 47 years (±16.4). The mean follow up period was 15.16 months (±10.01 months). Post operatively, there were no significant complications. While the overall BSCVA in the patients improved from 20/41 (0.484) to 20/32 (0.645), group A showed improvement from 20/35 (0.561) to 20/29 (0.687), as compared to group B in which BSCVA improved from 20/47 (0.421) to 20/33 (0.611). The most common indication in group A was granular corneal dystrophy (n = 10) and the most common indication in group B was post traumatic/infectious corneal scar or opacity (n = 10). Eighty-six percent (n = 44) of all patients had alleviation of symptoms. Recurrence of symptoms was seen in 3 eyes of recurrent corneal erosions which required retreatment.ConclusionPTK is a safe and effective procedure. The outcome of this study suggests that PTK improves BSCVA. PTK appears to improve ocular surface health. Furthermore, PTK can be recommended to most patients with corneal dystrophies as a treatment modality prior to other more invasive procedure (viz. penetrating keratoplasty).

Efficacy of Different Excimer Laser Techniques in the Management of Recurrent Corneal Erosions

To investigate the efficacy of two excimer laser techniques for recurrent corneal erosions (RCEs). Of 100 patients with RCEs not responding to common treatments, 50 received transepithelial (group 1) and 50 received subepithelial (group 2) treatment of 20 pulses of a 193-nm excimer laser (170 J/cm(2)). Postoperative follow-up occurred at 4 and 52 weeks. Outcome measures were frequency of RCEs, haze formation, and refractive changes. At first follow-up, 7 patients (14%) in each group displayed recurrence. At second follow-up, 12 patients in group 1 (24%) and 10 patients in group 2 (20%) had RCE. Follow-up recurrence risk was 6% to 27% in both groups at 4 weeks and 13% to 38% in group 1 and 10% to 34% in group 2 at 52 weeks. The spherical equivalent remained unaffected in group 1, but a statistically significant change was observed in group 2. Excimer laser treatment (transepithelial and subepithelial) of RCEs can be performed successfully on the intact epithelium without adjunct therapy or pain. The transepithelial technique is a simple and relatively painless way to reduce the rate of RCE and is equivalent to the well-established subepithelial treatment.

Hornhautulzera bei systemischen Autoimmunerkrankungen

Keratolysis is a rare severe complication following systemic autoimmunologic diseases. Despite of complex therapeutic treatments, the prognosis is very poor. Ten eyes from seven patients with corneal ulcers were reported (age 45 - 73 years, mean 63 years; 6 women, 1 man). The corneal ulcer was perforated in 7 eyes. Five patients suffered from rheumatoid arthritis, and one patient developed a Sjögren's syndrome. Besides, one patient had shown both autoimmunologic diseases. After clinical attendance, visual acuity in the eyes with nonperforated ulcers was between 0.1 and 0.4, and in the eyes with perforated ulcers between light perception and 0.2. In 7 eyes with perforated corneal ulcers an emergency tectonic conjunctival plasty and, 1 - 2 days later, a keratoplasty had been performed. Postoperatively, local therapies had been initiated with antibiotic and immunosuppressive eyedrops as well as with conventional drops for dry-eye symptoms. Because of the autoimmunologic diseases of the patients, a systemic immunosuppressive therapy had been arranged. Follow-up period had been between 4 weeks and 3,5years (mean 16 months). In the three eyes with nonperforated ulcers which received an antibiotic and immunosuppressive treatment, visual acuity was found at 1 / 20 and 0.4. However, in spite of stabilized findings in the 5 eyes with perforated ulcers, the visual acuity was in this case only between light perception and 0.05. One patient with a perforated ulcer and one patient with a recurrent corneal perforation after keratoplasty refused further operative procedures. Finally, both eyes had to undergo evisceration. Despite of intensive local and systemic immunosuppressive as well as operative therapies, corneal ulcers associated with autoimmunologic diseases (rheumatoid arthritis, Sjögren's syndrome) may cause a marked decrease of visual acuity or the loss of an eye. With regard to the healthy eye, an immunosuppressive therapy for life is most important.

Transplante autólogo de conjuntiva com uso de cola de fibrina em pterígios primários

To assess the rate of recurrence and complications after primary pterygium removal with conjunctival autograft using fibrin tissue adhesive. Secondarily, to compare these results with a retrospective series that underwent the same surgery using sutures. A hundred and six eyes of 100 patients who underwent surgery with fibrin glue were prospectively studied, while 58 eyes of 51 patients who underwent surgery with sutures were retrospectively evaluated. Data included: age, gender, eye involved, location, grade and pterygium invasion and post-operative complications. Patients were followed for at least 5 months. Among 106 eyes undergoing surgery with fibrin glue, 12 (11.3%) had recurrence, including 4 (3.8%) conjunctival and 8 (7.5%) corneal. Mean age was statistically inferior in the recurrence cases compared to others (mean of 34.6 vs. 43.7; P=0.033). The time for recurrence ranged from 1.6 to 13.1 months (mean of 4.4). Among the corneal recurrences, 2 eyes had invasion beyond the limbus of up to 0.5 mm and 6 eyes from 0.6 to 1.0 mm. No eye underwent reoperation. Other complications included: transitory granuloma formation in 3 cases, partial graft detachment or slippage in 3 and dellen in 1. In the suture group, 15 eyes (25.9%) had recurrence, including 8 conjunctival (13.8%) and 7 (12.1%) corneal. The time for recurrence ranged from 0.7 to 9.7 months (mean 4.5 months). The conjunctival recurrence rate was statistically inferior in the glue group compared to the suture (P=0.023), however no statistically significant difference was observed in relation to corneal recurrence (P=0.232). The use of fibrin glue as an alternative to sutures in pterygium surgery was associated with good results and few complications. Despite a decrease in conjunctival recurrence rates, this technique does not appear to significantly decrease corneal recurrences.

Eye diseases associated with obstructive sleep apnea syndrome in an Asian population

Abstract Background: Sleep apnea syndrome is one of the leading causes of excessive daytime sleepiness. There is no literature exploring the prevalence of sleep-associated disorders in the eye of Asians with obstructive sleep apnea syndrome (OSA). Objective: Study the prevalence of eye abnormalities in Asian patients with OSA. Material and method: Asian patients with definite OSA diagnosis via the polysomnography were recruited into the study. Complete eye examination and special investigations were performed to define eye diseases: floppy eyelids, dry eyes, keratoconus, Fuchs’ endothelial dystrophy, recurrent corneal erosions, open-angle glaucoma, ophthalmoplegia, papilledema and optic neuropathy. Results: One-hundred Asian OSA patients were examined. We found that floppy eyelids, dry eyes, and normal tension glaucoma were more prevalent compared to the normal population. Abnormal endothelial change and papilledema were detected. Optic neuropathy and ophthalmoplegia were not found in this study, although some patients did have subnormal contrast sensitivity. Conclusion: There is a higher prevalence of floppy eyelids, dry eyes, and glaucoma in OSA patients. Complete eye examination is recommended in OSA patients to detect early eye abnormalities.

Alcohol delamination in the treatment of recurrent corneal erosion: an electron microscopic study

AimTo investigate by electron microscopy the plane of separation of the epithelial sheet from its substratum in the procedure of alcohol delamination (ALD) in patients with recurrent corneal erosion syndrome.MethodsTen...

Dystrophia Smolandiensis: a novel morphological picture of recurrent corneal erosions

The aim of this study was to describe morphological changes in Dystrophia Smolandiensis, a corneal disease that is characterized by recurrent corneal erosive episodes and the formation of central corneal keloid-like opacities in approximately half of those affected. The corneas of seven affected individuals were examined using in-vivo confocal microscopy. Specimens of one primary corneal graft, one regraft and one biopsied keloid-like region--all obtained from members of a large family with the disease--were re-examined with a light microscope. Sections were stained with Congo red and analysed immunohistochemically for fibronectin and S100A4. Light microscopic examination revealed epithelial hyperplasia, absence of Bowman's layer and subepithelial fibrosis. Fibronectin was expressed in the area of subepithelial fibrosis, and the keratocytes in this area generally expressed S100A4. The biopsy specimen stained positive for Congo red, suggesting an amyloid deposit. In-vivo confocal microscopy confirmed epithelial abnormalities, loss of Bowman's layer and significant alterations of the subbasal nerve plexus in affected individuals. The morphological picture in Dystrophia Smolandiensis is novel for a condition dominated by recurrent corneal erosions at the clinical level. Although no single morphological feature unique to the disease could be found, the general morphological pattern of pathology (true keloid formation, absence of Bowman's layer, subepithelial fibrosis and abnormal subbasal nerves) probably reflects a novel phenotypic expression of the healing response to recurrent erosion of the corneal epithelium. However, the pathogenesis of Dystrophia Smolandiensis remains to be elucidated fully.

Long‐term follow up of autologous serum treatment for recurrent corneal erosions

The aim of the study was to evaluate long-term results of autologous serum treatment for recurrent corneal erosions. In this prospective single-centre study, 33 eyes of 33 patients (21 male and 12 female) were treated with autologous serum eye drops for recurrent corneal erosions. Mean age of the patients was 49.3 ± 9.8 standard deviation (range 24-73) years. All subjects had failed to respond to other treatments. Autologous serum drops were administered for a 6-month period: six times daily for the first 3 months and four times daily for the remaining 3 months. Detailed informed consent was obtained from the entire patient group before the study. The mean follow-up period was 30 ± 6.3 standard deviation (range 12-48) months. None of the patients experienced a recurrence while under treatment. Twenty-eight patients (85%) had complete healing of erosions with no relapses of the disease over the whole follow-up period. Five patients (15%) presented a single recurrence 3-12 months after the end of the treatment. No sight-threatening complications were reported over the follow up. There was no statistically significant difference in the best spectacle-corrected visual acuity values (t(stat) = 2.1, F = 0.096, degree of freedom = 40,166, P < 0.41) or in the intraocular pressure measurements (P < 0.38) between the pre- and post-treatment patient groups. Autologous serum drops proved to be a safe and efficient treatment modality for patients with recurrent corneal erosion syndrome as observed through a long-term follow up.

Recurrent Corneal Erosion Syndrome: A Study of 364 Episodes.

The purpose of the study was to investigate the management of recurrent corneal erosion syndrome (RES). A retrospective case series design was employed in which all RES cases presenting to the Duke University Eye Center from 1995 to 2002 were included. In total, 364 episodes of RES occurred in 261 patients during the study period. Of this 61% of patients were female (P < .001), average age was 46.0 years, and etiologies included trauma (51.3%), anterior basement membrane dystrophy (29.1%), other etiologies (10.3%) and unknown (9.2%). Treatments included conservative therapy (83.2%), anterior stromal puncture (ASP)(12.6%) and phototherapeutic keratectomy (PTK)(4.1%). Recurrence by treatment was 31.0% for conservative therapy, 23.9% for ASP and 26.7% for PTK. Subjects treated with ASP and PTK had failed prior treatment efforts. Conclusions include that RES was commonly associated with trauma and the female gender, and that one-third of conservatively treated episodes and one-quarter of surgically treated episodes (ASP or PTK) recurred.

The Boston Keratoprosthesis in 2 Patients With Autoimmune Polyendocrinopathy-Candidiasis-Ectodermal Dystrophy

To report the results of Boston keratoprosthesis in patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED). Case 1 is a 36-year-old woman with APECED and ocular history of corneal ulcers in both eyes who presented with severe dry eyes. Her ocular examination showed diffuse corneal vascularization and stromal scarring in the left eye. She underwent Boston type 1 keratoprosthesis, cataract extraction, and sulcus intraocular lens implant in the left eye to improve visual acuity. Case 2 is a 49-year-old man with possible APECED and ocular history of phlyctenular keratitis, recurrent corneal erosions, and scarring presented with dense corneal vascularization and scarring in both eyes. He underwent a Boston type 1 keratoprosthesis, clear lens extraction, and posterior chamber intraocular lens implant in the right eye. The surgeries were uneventful. On postoperative day 1, visual acuity of 20/40 was achieved in both patients and it remained stable during the 2-year follow-up period. There were no postoperative complications seen in either patient. APECED is a rare disorder, which can be associated with bilateral keratitis or diffuse corneal vascularization in addition to systemic findings and ectodermal signs. The Boston type 1 keratoprosthesis is a promising treatment option to improve visual acuity in patients with APECED with corneal involvement.

Role of matrix metalloproteinases in recurrent corneal melting

The aim of this study was to compare the presence and activity of matrix metalloproteinases (MMPs) 1, 2, 3, 7, 8, 9 and 13 in human melted and cadaverous corneas. Twelve melted corneal specimens from three patients with rheumatoid arthritis, one patient with ocular cicatricial pemphigoid and one patient with melting attributed to spastic entropion and ten control corneal buttons were used. The presence of MMPs was detected using indirect enzyme immunohistochemistry. The active forms of MMP-2 and -9 and MMP-3 and -7 were examined by gelatin and casein zymography, respectively. The concentrations of active MMP-1 and -3 were measured using activity assays. Increased immunostaining intensity for MMP-1 and -9 was seen in the corneal epithelium and the anterior stroma of all, and for MMP-2, -3, -7 and -8 of almost all, melted corneas compared to the negative or slightly positive staining of the controls. The posterior stroma showed the presence of MMP-1, -2, -3 and -9 in almost all and of MMP-7 and -8 in half of all melted specimens. A markedly higher level of active MMP-2 was detected in six and active MMP-9 in all of eleven pathologic specimens compared to control specimens, using gelatin zymography. The proenzymes of MMP-3 and -7 and the MMP-7 intermediate cleavage product were detected only in melted corneas using casein zymography. Significantly increased MMP-1 and -3 activity was also found in the melted corneas using activity assays. The markedly increased immunostaining for MMP-1, -2, -3, -7, -8 and -9 as well as the elevated levels of the active forms of MMP-1, -2, -3 and -9 in melted corneal specimens from patients with various diagnoses suggest that although different stimuli may trigger the pathways that lead to the destruction of the extracellular matrix, these enzymes could play a subsequent role in this process.

Clinical Research on Surgical Treatment for Double-Head Pterygium

Purpose: To evaluate two surgical methods-amniotic membrane transplantation (AMT) and split-conjunctival grafts (SCG)-for double-head pterygium, with regard to the postoperative outcome and recurrence rate. Methods: In a total of 16 eyes (14 patients), 7 eyes (6 patients) receiving amniotic membrane transplantation and 9 eyes (8 patients) receiving split-conjunctival grafts were compared to evaluate recurrence and complications. Results: Within the amniotic membrane transplantation group, two eyes (29%) had corneal recurrence, and 3 eyes (43%) had conjunctival recurrence. The mean follow-up period was 21.93.5 months, and all recurrences were on the nasal side. The average period preceding the corneal recurrences was 7.21.8 months. Within the split-conjunctival grafts group, the mean follow-up was 13.62.1 months, and neither the corneal nor conjunctival recurrences were observed. In addition, the eyes of this group were more aesthetically stable, with only one eye exhibiting pseudo-pterygium at the donor site. Conclusions: In cases of double-head pterygium without contraindication of conjunctival autograft, the split-conjunctival grafts produced fewer recurrences and showed enhanced cosmetic results, as compared to the amniotic membrane transplantation, indicating that the split-conjunctival grafts is the superior choice over amniotic membrane transplantation.

Epithelial Debridement for Epithelial Basement Membrane Abnormalities Associated with Endothelial Disorders

Epithelial basement membrane dystrophy (EBMD) is a corneal condition most commonly observed as a primary disease; less commonly it can also be seen as secondary to endothelial cell dysfunction. Epithelial debridement with or without polishing of the Bowman layer is a safe and effective way of removing the dystrophic basement membrane and promoting a smoother epithelial surface. Indications for debridement include symptoms of recurrent corneal erosions and vision loss attributable to epithelial irregularity. In this article we also present follow-up data on patients for whom we have previously performed epithelial debridement for EBMD in the setting of Fuchs endothelial dystrophy and iridocorneal endothelial syndrome, with favourable visual outcomes. We also present two new cases of EBMD that limited visual acuity after Descemet stripping automated endothelial keratoplasty, who responded successfully to epithelial debridement.

Trabeculectomy with Mitomycin C in Refractory Glaucoma Associated with Nonnecrotizing Anterior Scleritis

Surgically induced necrotising scleritis (SINS) following sequential laser-assisted in situ keratomileusis (LASIK) and pterygium excision with conjunctival autograft.Purpose: To report a case of SINS occurring 1 month after uncomplicated pterygium excision with conjunctival autograft.Setting: Department of Ophthalmology, Singleton Hospital, Abertawe Bro Morgannwg University NHS trust, United KingdomMethod: A 70-year-old male presented with a 10 day history of redness and reduced vision in the right eye. Bilateral hyperopic LASIK and right eye pterygium excision with conjunctival autograft had been performed elsewhere, 6 months and 1 month prior to presentation. BCVA were 6/60 OD and 6/6 OS. A 2mm full thickness nasal corneal perforation with adjacent scleral melt (6.5x4mm) was evident. Tectonic full thickness corneal and scleral patch grafting with amniotic membrane graft overlay was performed with systemic immunosuppression (prednisolone 60mg od).Results: Recurrence of the corneascleral melt occurred one month postoperatively on reduction of prednisolone to 15mg od. This was initially managed successfully with cyclophosphamide 100mg and prednisolone 80mg. Two months postoperatively recurrent corneal perforation required the application of cyanoacrylate glue. At latest follow up four months postoperatively the corneal glue is insitu with no evidence of recurrent melt.Conclusions: SINS following pterygium excision with conjunctival autograft is rare with only 2 case reports in the literature. This is the first reported case of SINS occurring after pterygium excision with conjunctival autograft with preceeding LASIK.