Recurrent Erosions Research Articles

Corneal epithelial-stromal constructs to study differences associated with diabetes mellitus

Diabetes mellitus (DM) is a common metabolic disease associated with severe macrovascular and microvascular complications that influence nearly every tissue in the body, including the anterior and posterior segments of the eye. In the cornea, DM is associated with recurrent epithelial erosion and reduced wound-healing capacity, which increases the risk of corneal scarring. We previously developed a co-culture model of the cornea consisting of immortalized human corneal epithelial cells (hCE-TJ) overlaying a self-assembled stromal layer generated by human corneal fibroblasts (hCFs) over a 4-week period. In this study, we investigated epithelial-stromal constructs generated from hCFs derived from subjects with Type 1 (T1DM) or 2 diabetes (T2DM) compared to controls. We found that T2DM constructs exhibited a disrupted epithelium and a thicker, stratified stromal layer compared to controls or T1DM. Both T1DM and T2DM stromal constructs expressed lower expression of thrombospondin-1 in isolated extracellular vesicles (EVs) compared to controls with no significant difference observed in the presence of epithelial cells, suggesting that reduced provisional matrix secretion in the corneal stroma may be a factor that promotes delayed corneal wound healing in diabetes. The tetraspanins are established extracellular vesicle (EV) markers and include CD63, CD81, and CD9, and were highly expressed by EVs in all three cell types. Control corneal stromal fibroblasts produced more and larger EVs when compared to T1DM and T2DM hCF-derived EVs, supporting a role for altered cell-cell communication in the context of DM. Further characterization of EVs and their cargo is expected to aid in the development of targeted treatments to improve corneal wound healing.

Splice modulation strategy applied to deep intronic variants in COL7A1 causing recessive dystrophic epidermolysis bullosa

Recessive dystrophic epidermolysis bullosa (RDEB) is a rare and most often severe genetic disease characterized by recurrent blistering and erosions of the skin and mucous membranes after minor trauma, leading to major local and systemic complications. The disease is caused by loss-of-function variants in COL7A1 encoding type VII collagen (C7), the main component of anchoring fibrils, which form attachment structures stabilizing the cutaneous basement membrane zone. Alterations in C7 protein structure and/or expression lead to abnormal, rare or absent anchoring fibrils resulting in loss of dermal-epidermal adherence and skin blistering. To date, more than 1,200 distinct COL7A1 deleterious variants have been reported and 19% are splice variants. Here, we describe two RDEB patients for whom we identified two pathogenic deep intronic pathogenic variants in COL7A1. One of these variants (c.7795-97C > G) promotes the inclusion of a pseudoexon between exons 104 and 105 in the COL7A1 transcript, while the other causes partial or complete retention of intron 51. We used antisense oligonucleotide (ASO) mediated exon skipping to correct these aberrant splicing events in vitro. This led to increased normal mRNA splicing above 94% and restoration of C7 protein expression at a level (up to 56%) that should be sufficient to reverse the phenotype. This first report of exon skipping applied to counteract deep intronic variants in COL7A1 represents a promising therapeutic strategy for personalized medicine directed at patients with intronic variants at a distance of consensus splice sites.

Navigating the Ravages of Riverbank Erosion: Socio-economic and Environmental Impacts in the Nalua Union of Bakerganj Upazila

The study delves into the persistent threats posed by climate change-induced phenomena, notably river bank erosion, within the Bengal Delta, focusing specifically on the Nalua Union in Bakerganj Upazila, Barishal District. Utilizing a multifaceted methodology encompassing satellite imagery analysis, field observations, and questionnaire surveys, the research aims to evaluate the potential displacement of residents due to river bank erosion and its attendant socio-economic and environmental repercussions. Nestled at the confluence of the Pandob and Karkhana rivers, the study area contends with recurrent and severe bank erosion, resulting in profound infrastructural and livelihood disruptions. Analysis of satellite imagery spanning 2016 to 2023 underscores the dynamic nature of erosion and accretion processes, with coastal erosion encompassing 2.15 sq. km and accretion covering 1.75 sq. km. Economic ramifications of erosion-induced damages amount to USD 300 million annually, disproportionately affecting agricultural sectors and rural communities. Beyond economic loss, the study investigates the non-economic consequences of river bank erosion, such as social disintegration and environmental damage. Displacement engenders social fragmentation, erodes communal ties, and imperils livelihoods, exacerbating vulnerability among impacted populations. Environmental impacts encompass soil degradation, biodiversity loss, and compromised access to potable water and fisheries resources. This study provides actual evidence for the complex relationship between natural dynamics and human vulnerabilities as a result of river bank erosion. The findings underscore the exigency for comprehensive mitigation and adaptation strategies to address the socio-economic and environmental exigencies precipitated by erosion-induced displacement in the Nalua Union and harmonious vulnerable locales. To develop long-term socioeconomic equilibrium and environmental resilience in coastal locations prone to riverbank erosion, such solutions must incorporate community resilience-building activities, ecosystem-centric approaches, and sustainable land management practices.

Navigating the Ravages of Riverbank Erosion: Socio-economic and Environmental Impacts in the Nalua Union of Bakerganj Upazila

The study delves into the persistent threats posed by climate change-induced phenomena, notably river bank erosion, within the Bengal Delta, focusing specifically on the Nalua Union in Bakerganj Upazila, Barishal District. Utilizing a multifaceted methodology encompassing satellite imagery analysis, field observations, and questionnaire surveys, the research aims to evaluate the potential displacement of residents due to river bank erosion and its attendant socio-economic and environmental repercussions. Nestled at the confluence of the Pandob and Karkhana rivers, the study area contends with recurrent and severe bank erosion, resulting in profound infrastructural and livelihood disruptions. Analysis of satellite imagery spanning 2016 to 2023 underscores the dynamic nature of erosion and accretion processes, with coastal erosion encompassing 2.15 sq. km and accretion covering 1.75 sq. km. Economic ramifications of erosion-induced damages amount to USD 300 million annually, disproportionately affecting agricultural sectors and rural communities. Beyond economic loss, the study investigates the non-economic consequences of river bank erosion, such as social disintegration and environmental damage. Displacement engenders social fragmentation, erodes communal ties, and imperils livelihoods, exacerbating vulnerability among impacted populations. Environmental impacts encompass soil degradation, biodiversity loss, and compromised access to potable water and fisheries resources. This study provides actual evidence for the complex relationship between natural dynamics and human vulnerabilities as a result of river bank erosion. The findings underscore the exigency for comprehensive mitigation and adaptation strategies to address the socio-economic and environmental exigencies precipitated by erosion-induced displacement in the Nalua Union and harmonious vulnerable locales. To develop long-term socioeconomic equilibrium and environmental resilience in coastal locations prone to riverbank erosion, such solutions must incorporate community resilience-building activities, ecosystem-centric approaches, and sustainable land management practices.

IC3D Classification of Corneal Dystrophies-Edition 3.

The International Committee for the Classification of Corneal Dystrophies (IC3D) was created in 2005 to develop a new classification system integrating current information on phenotype, histopathology, and genetic analysis. This update is the third edition of the IC3D nomenclature. Peer-reviewed publications from 2014 to 2023 were evaluated. The new information was used to update the anatomic classification and each of the 22 standardized templates including the level of evidence for being a corneal dystrophy [from category 1 (most evidence) to category 4 (least evidence)]. Epithelial recurrent erosion dystrophies now include epithelial recurrent erosion dystrophy, category 1 ( COL17A1 mutations, chromosome 10). Signs and symptoms are similar to Franceschetti corneal dystrophy, dystrophia Smolandiensis, and dystrophia Helsinglandica, category 4. Lisch epithelial corneal dystrophy, previously reported as X-linked, has been discovered to be autosomal dominant ( MCOLN1 mutations, chromosome 19). Classic lattice corneal dystrophy (LCD) results from TGFBI R124C mutation. The LCD variant group has over 80 dystrophies with non-R124C TGFBI mutations, amyloid deposition, and often similar phenotypes to classic LCD. We propose a new nomenclature for specific LCD pathogenic variants by appending the mutation using 1-letter amino acid abbreviations to LCD. Pre-Descemet corneal dystrophies include category 1, autosomal dominant, punctiform and polychromatic pre-Descemet corneal dystrophy (PPPCD) ( PRDX3 mutations, chromosome 10). Typically asymptomatic, it can be distinguished phenotypically from pre-Descemet corneal dystrophy, category 4. We include a corneal dystrophy management table. The IC3D third edition provides a current summary of corneal dystrophy information. The article is available online at https://corneasociety.org/publications/ic3d .

Corneal Epithelial Thickness Mapping: A Major Review.

The corneal epithelium (CE) is the outermost layer of the cornea with constant turnover, relative stability, remarkable plasticity, and compensatory properties to mask alterations in the underlying stroma. The advent of quantitative imaging modalities capable of producing epithelial thickness mapping (ETM) has made it possible to characterize better the different patterns of epithelial remodeling. In this comprehensive synthesis, we reviewed all available data on ETM with different methods, including very high-frequency ultrasound (VHF-US) and spectral-domain optical coherence tomography (SD-OCT) in normal individuals, corneal or systemic diseases, and corneal surgical scenarios. We excluded OCT studies that manually measured the corneal epithelial thickness (CET) (e.g., by digital calipers) or the CE (e.g., by confocal scanning or handheld pachymeters). A comparison of different CET measuring technologies and devices capable of producing thickness maps is provided. Normative data on CET and the possible effects of gender, aging, diurnal changes, refraction, and intraocular pressure are discussed. We also reviewed ETM data in several corneal disorders, including keratoconus, corneal dystrophies, recurrent epithelial erosion, herpes keratitis, keratoplasty, bullous keratopathy, carcinoma in situ, pterygium, and limbal stem cell deficiency. The available data on the potential role of ETM in indicating refractive surgeries, planning the procedure, and assessing postoperative changes are reviewed. Alterations in ETM in systemic and ocular conditions such as eyelid abnormalities and dry eye disease and the effects of contact lenses, topical medications, and cataract surgery on the ETM profile are discussed.

Recurrent herpetic erosion of the cornea: diagnosis, treatment and prevention of recurrences

A group of patients was found to have a special form of recurrent corneal erosion caused by types I and II herpes virus. This form represents an independent form of ophthalmic herpes - herpetic recurrent erosion (HRE) of the cornea. The herpetic etiology of recurrent corneal erosion was confirmed by the immunofluorescence study of scraping from the conjunctiva, which revealed a high concentration of the herpes simplex virus antigen. Treatment of patients (171 patients, 182 eyes) with HRE included 2 consecutive stages: stage I - relief of acute symptoms of the disease with the help of conservative treatment (instillations of interferon inducers, autologous serum, corneal protectors, tear substitutes, use of therapeutic soft contact lenses); in some cases, phototherapeutic keratectomy was used in the absence of the effect of conservative therapy, as well as in the localization of the focus in the optical zone. Stage II involved anti-relapse therapy based on the use of a Russian-produced herpes vaccine in the intercurrent period. After vaccination, observation for 2 years or more showed that 81.3% of patients achieved clinical recovery (complete cessation of HRE recurrences), 15.8% had a decrease in the frequency and severity of relapses, while 2.9% of patients did not respond to the treatment.

Risk stratification, prevention and management of perioperative corneal abrasion for non-ocular surgery: Systematic Review.

A corneal abrasion is a flaw in the cornea's epithelial surface, which is located in the front of the eye. It causes recurrent erosions, corneal inflammation, and chronic corneal defects. In a context with limited resources, the goal of this review was to provide an evidence-based procedure for perioperative risk stratification, prevention, and management of corneal abrasion during non-ocular surgery. A medical search engines of PUBMED, GOOGLE SCHOLAR, COCHRANE REVIEW, and PUBMED CENTERAL to get access for current and updated evidence on procedures on risk stratification, prevention and management of corneal abrasion for non-ocular surgery. The authors formulate the key questions, scope, and articles written in English language, human study focuses on corneal abrasion, articles in the last 20 year was implemented to identify or filter high-level evidences were included. Reports contain corneal abrasion due to ocular surgery were excluded. All the research articles, which were identified from searches of electronic databases, were imported into Endnote software, duplicate were removed advanced search strategy of electronic sources from databases and websites was conducted using Boolean operators (cornea AND (abrasion OR injury OR laceration)) AND ("Perioperative Period" OR "general anesthesia"). Screening of literatures was conducted with proper appraisal checklist. This review was reported in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement. From 8767 identified articles, two hundred articles were removed for duplication and 7720 studies were excluded, 1205 articles were retrieved and evaluated for eligibility. Finally, 24 were included in this systematic review. Advanced age, Prominent eyes, exophthalmus, ocular surface abnormalities (dry eye), expected duration of surgery (>1 h), the favourable position of the surgery, prone,Trendelenburg and lateral, risk of bleeding, surgical site of the surgery(head /neck) and diabetes mellitus were risk for corneal abrasion. The use of appropriate intervention with pharmacological and Non-pharmacological strategies minimizes the occurrence of perioperative corneal abrasion was crucial for the quality of care. Preventing and managing corneal abrasion improves patients' quality of life. However, there was insufficient evidence to draw conclusions, and high-quality trials of multimodal interventions matched to risk stratification and prevention of corneal abrasion needed to provide robust evidence to guide prevention and management of perioperative corneal abrasion.

Keratitis fugax Hereditaria caused by a pathogenic variant in NLRP3

Keratitis fugax hereditaria (KFH, MIM 148200) is an autosomal dominant periodic corneal autoinflammation caused by a single pathogenic variant c.61G>C (rs200154873) in the NLRP3 gene. NLRP3 protein is a key component of the NLRP3 inflammasome, which activation leads to the secretion of IL‐1 beta and IL‐18 leading to inflammation. KFH is characterized by periodic unilateral attacks causing pain, redness, and reduced vision. Repeated attacks lead to permanently reduced visual acuity in a subset of the patients. Currently, we have examined 94 individuals with KFH from 26 families. Age of onset varied from 6 to 20 years (median, 11). During the acute attack symptoms were eye pain, photophobia, conjunctival injection, and foreign body sensation. Half of the patients (48%, n = 45) developed corneal oval opacities. KFH was most often misdiagnosed as anterior uveitis (26%, n = 24), conjunctivitis (13%, n = 12), recurrent erosion (11%, n = 10), and herpetic keratitis (10%, n = 9). Geographically, KFH is most prevalent in Finland and Sweden according to allele frequencies in gnomAD, 0.014% in Finland and 0.011% in Sweden. Patient‐derived peripheral blood mononuclear cells are more prone to secrete IL‐1β after NLRP3 inflammasome stimulation, confirming that the c.61G>C is a gain‐of‐function variant. Furthermore, prednisolone is a potent drug to reduce IL‐1β secretion in the cell culture. We recommend prednisolone for the treatment of acute attack, and for permanently reduced vision due to corneal opacities and thinning, scleral contact lenses are the first‐line treatment. KFH is underrecognized and misdiagnosed corneal disease and should be recognized at least in the Scandinavian population.

The newest IC3D classification of corneal dystrophies

In the year 2015, the International Committee for the Classification of Corneal Dystrophies (IC3D) incorporated new clinical, histopathologic, and genetic information into the former 2008 classification. To this end, the IC3D sighted and evaluated worldwide peer‐reviewed articles for new information on corneal dystrophies published between 2008 and 2014. Using this information, corneal dystrophy templates including categories 1 to 4 and anatomic classification were updated. New clinical, histopathologic, and confocal photographs were added.On the basis of revisiting the cellular origin of corneal dystrophies, a modified anatomic classification was proposed consisting of (1) epithelial and subepithelial dystrophies, (2) epithelial‐stromal TGFBI dystrophies, (3) stromal dystrophies, and (4) endothelial dystrophies. The entity “Epithelial recurrent erosion dystrophies ERED” actually includes a number of potentially distinct epithelial dystrophies (Franceschetti corneal dystrophy, Dystrophia Smolandiensis, and Dystrophia Helsinglandica) but must be differentiated from dystrophies such as TGFBI‐induced dystrophies, which are also often associated with recurrent epithelial erosions. The chromosome locus of Thiel‐Behnke corneal dystrophy is only located on 5q31. The entity previously designated as a variant of Thiel‐Behnke corneal dystrophy on chromosome 10q24 may represent a novel corneal dystrophy. Congenital hereditary endothelial dystrophy (CHED, formerly CHED2) is most likely only an autosomal recessive disorder. The so‐called autosomal dominant inherited CHED (formerly CHED1) is insufficiently distinct to continue to be considered a unique corneal dystrophy. On review of almost all of the published cases, the description appeared most similar to a type of posterior polymorphous corneal dystrophy linked to the same chromosome 20 locus (PPCD1). Anterior segment OCT has emerged as a helpful tool to reveal in vivo features of several corneal dystrophies that previously required histopathologic examination in order to definitively diagnose them.This revision of the IC3D classification includes an updated anatomic classification of corneal dystrophies that more accurately classifies TGFBI dystrophies affecting multiple layers rather than being confined to one corneal layer. At this time, a 3rd edition of the IC3D classification of corneal dystrophies is under way.

Diagnostic errors and delay of keratitis fugax hereditaria

Aims/Purpose: To chart misdiagnoses associated with keratitis fugax hereditaria (KFH), an autosomal dominant periodic corneal autoinflammatory disease, and the frequency of misdiagnosed KFH in patients diagnosed with unspecified anterior uveitis, herpes keratitis, or unspecified keratitis.Methods: Charts of patients with genetically confirmed KFH (n = 94) were reviewed. Two Finnish biobanks provided 2037 DNA samples meeting the inclusion criterion of a diagnosis KFH can be misdiagnosed with and the exclusion criterion of having a common underlying cause of anterior uveitis, such as rheumatoid arthritis. The NLRP3 c.61G>C variant was detected using restriction fragment length polymorphism analysis, and Sanger sequencing for confirmation. Age, sex, ocular and other diagnoses, and laboratory results were collected from patients carrying the variant.Results: The time between first symptoms and the diagnosis of KFH ranged from 0 to 62 years (median, 21; interquartile range [IQR], 8–45). Analysis of patient charts revealed that the most common misdiagnoses were acute anterior uveitis (51% of all misdiagnoses/26% of all patients), conjunctivitis (26%/13%), or recurrent erosion (21%/11%). A mild anterior chamber inflammation was observed in 30% of patients, 0.5+ or 1+ by Standardization of Uveitis Nomenclature (SUN) criteria. Of the biobank samples, 12/2037 (0.59%; 95% confidence interval [CI] 0.56%–0.61%) carried the c.61G>C variant: 11 diagnosed with anterior uveitis, and one with unspecified keratitis. Three had previously been diagnosed with KFH. The age range of the 12 variant carriers varied from 38 to 79 (median, 63; IQR, 48–76) with nine females and three males.Conclusions: KFH is most frequently misdiagnosed as anterior uveitis. In Finland, it might be beneficial to add testing for the NLRP3 c.61G>C variant in existing laboratory test packages for anterior uveitis.

Aberrations in Cell Signaling Quantified in Diabetic Murine Globes after Injury.

The corneal epithelium is an avascular structure that has a unique wound healing mechanism, which allows for rapid wound closure without compromising vision. This wound healing mechanism is attenuated in diabetic patients, resulting in poor clinical outcomes and recurrent non-healing erosion. We investigated changes in cellular calcium signaling activity during the wound response in murine diabetic tissue using live cell imaging from both ex vivo and in vitro models. The calcium signaling propagation in diabetic cells was significantly decreased and displayed altered patterns compared to non-diabetic controls. Diabetic cells and tissue display distinct expression of the purinergic receptor, P2X7, which mediates the wound healing response. We speculate that alterations in P2X7 expression, interactions with other proteins, and calcium signaling activity significantly impact the wound healing response. This may explain aberrations in the diabetic wound response.

Heterozygous COL17A1 variants are a frequent cause of amelogenesis imperfecta

BackgroundCollagen XVII is most typically associated with human disease when biallelic COL17A1 variants (>230) cause junctional epidermolysis bullosa (JEB), a rare, genetically heterogeneous, mucocutaneous blistering disease with amelogenesis imperfecta (AI),...

Stevens-Johnson Syndrome Induced by Methotrexate, An Uncommon Adverse Drug Reaction: A Case Report

Adverse drug reactions (ADRs) can lead to severe consequences and increased mortality rates. This case report focuses on a 41-year-old woman, who developed methotrexate-induced Stevens-Johnson syndrome (SJS), emphasizing the importance of recognizing and managing such a patient. The patient exhibited recurrent vomiting, maculopapular rashes, erosions and ulcers in multiple locations, consistent with SJS. These symptoms highlight the severity of the adverse drug reaction. Treatment involved was the discontinuation of medications, oral ointments, gargles, prophylactic antibiotics, and blood transfusion. Significant improvement was observed after 15 days of treatment. This case report underscores the life-threatening nature of methotrexate-induced SJS. Early recognition, discontinuation of offending medications, and prompt intervention are crucial to mitigate harm. Raising awareness about ADRs and their management is vital for enhancing patient safety and outcomes.

Erosion resistance of treated dust soils based on the combined enzymatically induced carbonate precipitation and polyacrylic acid

The majority of cities worldwide are grappling with the challenge of dust pollution. Recently, the application potential of enzymatically induced carbonate precipitation (EICP), a novel environmentally friendly method, for dust control has been convincingly demonstrated. However, the long-term durability of EICP treatment is consistently a significant concern, particularly in regions prone to recurrent erosion caused by rainfall. As a result, the erosion durability of the EICP-treated dust soils requires further investigation. To address this, Polyacrylic acid (PAA) was added to the cementation solution in this study as the combined PAA and EICP treatment for dust control. The results showed that the addition of PAA slightly affected urea degradation; however, the combined PAA and EICP treatment significantly improved surface strength from 300 kPa to 500 kPa, especially for the wind-erosion resistance compared with the EICP treatment alone. The surface strength of samples treated with the combined PAA and EICP still exhibited a decrease due to repeated rainfall erosion, along with a reduction in calcium carbonate (CaCO3) contents. Nevertheless, the decreasing slopes of surface strength (k = 13.434, 14.002, or 14.186) in response to repeated rainfall for EICP-PAA-treated slopes were much smaller than those for EICP-treated samples (k = 14.271), as well as the decreasing slopes of CaCO3 contents, which suggested the slopes with the combined treatment had significantly improved durability. By comparing the cementation effect and the influence of repeated rainfalls on treated dust samples, the EICP-PAA (50 g/L) treatment achieved better dust control effects. Overall, the combined treatment of EICP-PAA shows promising potential for effectively suppressing dust generation and enhancing erosion durability.

Starry-like Cornea: A Case of Ocular Cystinosis

Ocular cystinosis is a rare autosomal recessive disorder caused by mutations in the CTNS gene, which encodes a lysosomal cystine transporter protein. This results in the accumulation of cystine crystals in various ocular structures, leading to a range of ocular manifestations. The incidence of cystinosis is estimated to be 1 in 100,000 to 200,000 live births, with a higher prevalence in certain populations such as those of European descent. We report the case of a 5-year-old child with ocular cystinosis. The ophthalmological examination revealed a photophobic child with a visual acuity of 3/10 in both eyes (Pigassou scale), and diffuse stromal crystal deposits over the entire cornea in both eyes. The rest of the examination was unremarkable. The patient was referred to pediatrics for work-up of storage disease and was diagnosed with ocular and nephrological cystinosis. The patient was able to start general treatment with Mercaptamine with improvement in renal function, but was unable to obtain local treatment due to lack of funds. The patient is still being followed in our clinic with stable corneal involvement. Ocular cystinosis is a very rare genetic disorder. There are three main types of cystinosis: nephropathic cystinosis and non-nephropathic cystinosis. Nephropathic cystinosis divides further on infantile and intermediate. The most common ocular manifestation of cystinosis is corneal cystine crystal deposit, which typically presents in the first year of life and can lead to photophobia, tearing, and decreased visual acuity. The corneal crystals can also cause recurrent erosions, which can be very painful. The severity of corneal involvement can range from mild punctate deposition to severe confluent crystal accumulation that can lead to corneal scarring and vision loss. Cysteamine drops, which are a form of cysteamine hydrochloride, can help dissolve the cystine crystals and improve corneal clarity, prevent further vision loss, and reduce the frequency of recurrent erosions. Early diagnosis and treatment are crucial in preventing further ocular damage in individuals with cystinosis. Regular ophthalmologic examinations should be conducted to monitor for ocular manifestations and initiate treatment as early as possible. A multidisciplinary approach is necessary, involving ophthalmologists, nephrologists, and other specialists, to manage the systemic manifestations of cystinosis.

Cuff meshoma post-laparoscopic sacrocolpopexy: vaginal-endoscopic mesh excision.

The objective was to present endoscopic images of a meshoma and describe the complete excision of a complicated mesh after sacrocolpopexy (SCP) using a combined vaginal-endoscopic technique. We present a video documentation of an innovative technique. A 58-year-old woman was referred with painless, foul-smelling vaginal discharge and recurrent vaginal mesh erosions. She had undergone a laparoscopic SCP 12years ago and her symptoms had begun 5 years ago. A pre-operative MRI scan revealed a cuff meshoma and an inflammatory sinus around the mesh extending from the cuff to the sacral promontory. Under general anesthesia, a 30° hysteroscope was inserted transvaginally into the sinus, where the retained mesh was seen in the form of a shrunken meshoma, and then the mesh arms were recognized extending cephalad into a sinus tract. Under direct endoscopic visualization, the mesh was carefully mobilized at its highest point with the use of laparoscopic grasping forceps. Then, the mesh was dissected with hysteroscopic scissors in close proximity to the bone. No peri-operative complications were recognized. A combined vaginal-endoscopic approach was successfully used to remove an eroded mesh and cuff meshoma after SCP. This procedure offers a minimally invasive, low-morbidity, and rapid-recovery approach.

Immune Cells Localize to Sites of Corneal Erosions in C57BL/6 Mice.

Recurrent epithelial erosions develop in the cornea due to prior injury or genetic predisposition. Studies of recurrent erosions in animal models allow us to gain insight into how erosions form and are resolved. While slowing corneal epithelial cell migration and reducing their proliferation following treatment with mitomycin C reduce erosion formation in mice after sterile debridement injury, additional factors have been identified related to cytokine expression and immune cell activation. The relationship between recruitment of immune cells to the region of the cornea where erosions form and their potential roles in erosion formation and/or erosion repair remains unexplored in the C57BL/6 mouse recurrent erosion model. Here, high resolution imaging of mouse corneas was performed at D1, D7, and D28 after dulled-blade debridement injury in C57BL/6 mice. Around 50% of these mice have frank corneal erosions at D28 after wounding. A detailed assessment of corneas revealed the involvement of M2 macrophages in both frank and developing erosions at early stages of their formation.

Comparison of penetrating keratoplasty versus lamellar keratoplasty for macular corneal dystrophy: a retrospective study of a single-center experience

Background: Although penetrating keratoplasty (PK) still remains the dominant form of transplantation for macular corneal dystrophy (MCD) patients, many studies evaluating these new forms of selective lamellar keratoplasty (LK) now suggest equivalent or better visual outcomes. This study aimed to explore the difference in outcomes and complications that follows each type of these operations. Methods: A retrospective, single-center study was performed at King Abdulaziz medical city in 2022. The study included patients with a histological diagnosis of MCD who undergone either PK or LK. Data was collected from health records using a form that consisted of patient characteristic, type of operation and post-operative outcomes, including visual acuity, survival rate and complications. Results: The study included a total of 54 eyes of patients who have MCD. A best corrected visual acuity (BCVA) of 0.5 or better was achieved in 82.5% of eyes of PK group and 42.9% of eyes of LK group. Graft survival rate was 90% (36 eyes) and 85.7% (12 eyes) in PK and LK groups respectively. Regarding complications, four PK eyes (10%) and one LK eye (7.1%) had high intraocular pressure, three PK eyes (7.5%) and one LK eye (7.1%) developed rejection, one PK eye (2.5%) developed recurrent epithelial erosion, and another one PK eye (2.5%) developed Traumatic epithelial laceration. Conclusions: PK operations resulted in a better post-operative visual acuity compared to LK group. The graft survival rate was slightly better for the PK group. PK was associated with higher incidence of complications than LK group.

Evaluation of Clinical and Oral Findings in Patients with Epidermolysis bullosa.

Introduction: Epidermolysis bullosa (EB) is a genetically inherited disease characterized by recurrent bullae and erosions on the skin with numerous signs of dental caries and poor oral hygiene. The aim of this study was to investigate the general clinical and oral findings of patients with EB. Materials and Methods: In this prospective study, the clinical and oral findings and family history of 26 cases with EB were evaluated. The type of EB, gender, age, parental consanguinity, dental caries, oral findings, distribution of lesions and presence of associated anomalies, clinical and oral findings correlated with gender were recorded. Results: All 26 patients with EB had a history of consanguinity and siblings with EB to varying degrees. In our study, malnutrition, anemia and growth retardation, gastrointestinal system complications, hair thinning, hand and nail deformity, ocular problems and renal disease (in one case) were observed with variable frequencies. When the intraoral findings of the patients were investigated, extensive dental caries in all EB types, enamel hypoplasia in junctional EB (JEB) and the presence of tooth-root to be extracted in dystrophic EB (DEB), intraoral bullae and lesions, ankyloglossia, vestibular sulcus insufficiency, microstomia and maxillary atrophy were observed. Three cases had restorative treatment and one case had prosthetic rehabilitation. Conclusions: Oral involvement can be seen with varying frequencies depending on the type of EB and the severity of the disease. It may result from delayed oral and dental rehabilitation due to physical disabilities, limitations and more pressing medical problems. Microstomy, pain from mucosal lesions, and restricted access to the mouth can be caused by poor oral hygiene. Oral complications and caloric needs of individuals with EB should be determined, and individual prophylaxis should be applied to prevent caries formation and protect teeth.