Recurrent Erosions Research Articles

Autologous skin micro-grafts and allogenic skin allograft for mitten hand deformity treatment in epidermolysis bullosa

<p><strong>Background:</strong> In the genetic skin blistering disorder dystrophic epidermolysis bullosa recurrent blisters and erosions on mechanically stressed areas, as the hands, result in subsequent scarring and development of pseudosyndactylies and contractures. In its most severe form, all fingers are constrained into a fist of scarred (“mitten-hand”-deformity). No causative therapy exists and only a surgical release of the fingers is possible. Hereby, the development of large skin defects is inevitable; the lack of healthy autologous skin for grafting remains a difficult challenge.</p><p><strong>Methods:</strong> We propose a new technique: It adopts a treatment strategy from the therapy of large extent burns and consists of a combination of autogenic and allogenic skin grafting.</p><p><strong>Results:</strong> We present a beneficial outcome in 18 mitten hand deformities treated with this technique. In all patients, the initial functional outcome was improved. Nearly all patients got a considerably widened grip span and durable skin conditions post-operatively. Mean follow-up was 3 years. Typically, recurrence of the scarring occurred from 6 months to 2 years after operation.</p><p><strong>Conclusions:</strong> This is the first report on the use of the combination of autogenous pinch skin grafts with allogenic (parental) skin overlay for skin defects in EB. It provides undisturbed wound healing under a “biological dressing”, furthermore, a temporary take of the parental skin was visible. Defects were permanently covered with skin of increased mechanical stability, hand function improved remarkably. However, long term follow-up showed beginning recurrence in most of the patients comparable to recurrence rates described in the literature.</p>

Phototherapeutic keratectomy versus epithelial debridement combined with anterior stromal puncture or diamond burr for recurrent corneal erosions

ObjectiveTo compare outcomes of phototherapeutic keratectomy (PTK) versus epithelial debridement combined with anterior stromal puncture (ASP) or diamond burr for the treatment of recurrent corneal erosions (RCES) in a large tertiary centre. MethodsPatients with a diagnosis of RCES secondary to trauma or epithelial basement membrane dystrophy who underwent a surgical procedure between 2009 and 2019 were included in the study. The following data were collected: demographics, ocular history, prior medical treatment, ocular surgeries, intervention, complete epithelialization at postoperative week 1, recurrences, and complications. Recurrence was defined as either an objective finding of a corneal epithelial defect or symptoms suggestive of recurrent epithelial erosion on history. Recurrence rate and time to epithelialization were compared between groups. ResultsA total of 97 eyes (73 patients) were included in the study. Mean patient age was 51 ± 16.1 years, and mean follow-up was 474 days. RCES was secondary to epithelial basement membrane dystrophy in 80% (n = 78 of 97), trauma (15%, n = 15 of 97), or idiopathic (4%, n = 4 of 97). Epithelial debridement with ASP was performed in 34 eyes (35%), diamond burr in 33 eyes (33%), and PTK in 30 eyes (31%). Compared with epithelial debridement with ASP (recurrence 29.4%), the recurrence rate was significantly lower for both the diamond burr (9.1%, p = 0.031) and PTK groups (10%, p = 0.048). The diamond burr and PTK groups also had a significantly higher rate of complete epithelialization at 1 week (p < 0.05). ConclusionCompared with epithelial debridement with ASP, diamond burr and PTK have significantly lower rates of recurrence and time to epithelialization and may be considered first for surgical management of RCES.

Use of Bandage Contact Lenses for Recurrent Erosion Syndrome: Success and Complications

Use of Bandage Contact Lenses for Recurrent Erosion Syndrome: Success and Complications

The popped-out intraocular lens: A case of posterior chamber intraocular lens extrusion

A 70-year-old female with uncontrolled diabetes mellitus presented with complaints of defective vision in the left eye for 3 weeks. History revealed vigorous rubbing of LE followed by defective vision and use of self-prescribed antibiotic drops without ophthalmic consultation. The patient denied any history of trauma. She had undergone cataract surgery with posterior chamber intraocular lens (PCIOL) implantation 6 years back. Examination revealed poor ocular hygiene, blepharitis, and transcorneal extrusion of the PCIOL. The IOL was removed under strict aseptic conditions under antibiotic cover. Social neglect, repeated eye rubbing due to blepharitis and uncontrolled diabetes could have been the underlying cause for the painless extrusion of the PCIOL. Uncontrolled diabetes mellitus leads to corneal neuropathy characterized by decreased corneal sensitivity, recurrent erosions, corneal ulceration, and melting. This case signifies the importance of maintaining proper ocular hygiene, strict control of diabetes mellitus, and the use of appropriate ocular medications.

Clinical and morphological characteristics of corneal epithelial dystrophy (clinical observations)

This paper presents clinical observations that can be regarded as degeneration of the basement membrane of the corneal epithelium. Difficulties in identifying such forms of corneal dystrophies, on the one hand, are associated with limitation and polymorphism of the clinical picture, and, on the other hand, with insufficient information content of the basic diagnostic methods (i.e. the methods used during the initial examination). The presented clinical cases allow singling out the alarming and pathognomonic signs of the disease in the diagnostic algorithm. In the first case, attention should be paid to biomicroscopic changes in the superficial layers of the cornea and the optical defects, which can be regarded as a manifestation of an irregularity of corneal refraction. Identification of pathognomonic signs of the disease is possible on the basis of a detailed, close-to-morphological study of the structure of superficial corneal layers using confocal microscopy and optical coherence tomography. At the same time, the localization of the detected changes at the level of epithelial basement membrane and its basal sections is of crucial significance for substantiating the diagnosis. In addition, according to the literature data, recurrent erosions of the cornea of unclear etiology should be attributed to presumptive signs of degenerative changes in the basement membrane of the epithelium.

Recurrent erosion of COA1/MITRAC15 exemplifies conditional gene dispensability in oxidative phosphorylation

Skeletal muscle fibers rely upon either oxidative phosphorylation or the glycolytic pathway with much less reliance on oxidative phosphorylation to achieve muscular contractions that power mechanical movements. Species with energy-intensive adaptive traits that require sudden bursts of energy have a greater dependency on glycolytic fibers. Glycolytic fibers have decreased reliance on OXPHOS and lower mitochondrial content compared to oxidative fibers. Hence, we hypothesized that gene loss might have occurred within the OXPHOS pathway in lineages that largely depend on glycolytic fibers. The protein encoded by the COA1/MITRAC15 gene with conserved orthologs found in budding yeast to humans promotes mitochondrial translation. We show that gene disrupting mutations have accumulated within the COA1 gene in the cheetah, several species of galliform birds, and rodents. The genomic region containing COA1 is a well-established evolutionary breakpoint region in mammals. Careful inspection of genome assemblies of closely related species of rodents and marsupials suggests two independent COA1 gene loss events co-occurring with chromosomal rearrangements. Besides recurrent gene loss events, we document changes in COA1 exon structure in primates and felids. The detailed evolutionary history presented in this study reveals the intricate link between skeletal muscle fiber composition and the occasional dispensability of the chaperone-like role of the COA1 gene.

Withdrawal: "Torus lesions of the jaw: Diagnosis and clinical implications" Gary G. Ghahremani, David R. Naimi, Zohreh K. Ghahremani.

This article is being re-evaluated as of 05 July 2021 for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/ijcp.13697.

Cellular Contractility Profiles of Human Diabetic Corneal Stromal Cells.

Diabetic keratopathy is a corneal complication of diabetes mellitus (DM). Patients with diabetic keratopathy are prone to developing corneal haze, scarring, recurrent erosions, and significant wound healing defects/delays. The purpose of this study was to determine the contractility profiles in the diabetic human corneal stromal cells and characterize their molecular signatures. Primary human corneal fibroblasts from healthy, Type 1 DM (T1DM), and Type 2 DM (T2DM) donors were cultured using an established 3D collagen gel model. We tracked, measured, and quantified the contractile footprint over 9 days and quantified the modulation of specific corneal/diabetes markers in the conditional media and cell lysates using western blot analysis. Human corneal fibroblasts (HCFs) exhibited delayed and decreased contractility compared to that from T1DMs and T2DMs. Compared to HCFs, T2DMs demonstrated an initial downregulation of collagen I (day 3), followed by a significant upregulation by day 9. Collagen V was significantly upregulated in both T1DMs and T2DMs based on basal secretion, when compared to HCFs. Cell lysates were upregulated in the myofibroblast-associated marker, α-smooth muscle actin, in T2DMs on day 9, corresponding to the significant increase in contractility rate observed at the same time point. Furthermore, our data demonstrated a significant upregulation in IGF-1 expression in T2DMs, when compared to HCFs and T1DMs, at day 9. T1DMs demonstrated significant downregulation of IGF-1 expression, when compared to HCFs. Overall, both T1DMs and T2DMs exhibited increased contractility associated with fibrotic phenotypes. These findings, and future studies, may contribute to better understanding of the pathobiology of diabetic keratopathy and ultimately the development of new therapeutic approaches.

The presence of Prevotella melaninogenica within tissue and preliminary study on its role in the pathogenesis of oral lichen planus.

Oral lichen planus (OLP) is a chronic inflammatory disease that occurs in the oral mucosa with characteristic white striations lesions, recurrent erosions, and pains. The etiology and pathogenesis of OLP are still unclear. We analyzed the bacterial community structure of buccal mucosa in patients with OLP and normal controls by high-throughput sequencing. Fluorescence in situ hybridization (FISH) was used to detect Prevotella melaninogenica (P.melaninogenica) in 13 OLP samples and 10 controls. The amounts of P.melaninogenica in OLP buccal mucosa and the expression of inflammatory cytokines in co-culture of mouse-derived macrophages with P.melaninogenica were detected by RT-qPCR. The P.melaninogenica was more abundant in OLP than in healthy controls, and the differences were significant at the level of the phylum, family, genus, and species (p<.05). FISH showed that P.melaninogenica can invade the epithelium and even the lamina propria of OLP, while no invasion was found in the normal mucosa. Prevotella melaninogenica can adhere to and invade macrophages and then activate the transcription of IL-1β, IL-6, and TNF-α in NF-κB signaling pathway. Prevotella melaninogenica may be involved in the pathogenic process of OLP, and its specific mechanism deserves further study.

Ocular surface topographic evaluation in patients of astigmatism in normal and pathologic eyes

Keratometry is the measurement of anterior surface of corneal curvature in its steepest and flattest axis by various methods. There are many advances in measurement of keratometric values. Corneal topography and Modern videokeratoscopes provide an accurate representation of the anterior corneal surface to allow assessment of corneal irregularities in keratoconus, pellucid marginal degeneration, preoperative cataract workup - IOL calculation/TORIC lens implantation, refractive surgery preoperative assessment and post-op evaluation, evaluating pathologies like coneal dystrophies, scars, pterigium, recurrent erosions and contact lens fitting and evaluating the corneal contribution to optical aberrations of the whole eye Astigmatism (more than 0.5 diopters) is a commonly encountered refractive error, accounting for about aprx. 13-40 per cent of the refractive errors of the human eye according to various studies. In our study, 200 eyes of patients were studied over period of 2 year, with autorefractometer which measures total astigmatism (corneal and lenticular) and Bausch and Lomb manual keratometer and oculus topographer which measures anterior corneal astigmatism and results were compared. In our study 92.5% of eyes had regular astigmatism while 7.5% of eyes had irregular astigmatism. Various causes of corneal astigmatism were pterygium, keratoconus, PMCD, corneal degeneration, corneal opacity in that order. No significant clinical cause was found in 74.5% of eyes. Maximum repeatability was found with oculus topographer followed by autorefractometer and Bausch and Lomb manual keratometer.

Autologous Blood Products: When, Where, and How?

Autologous blood eye drops have become an interesting, well-known, and widely used therapeutic option for many ocular surface diseases since their introduction into the ophthalmologic field forty-six years ago. The foundation for their use in the treatment of pathologies such as severe keratoconjunctivitis sicca, persistent epithelial defects, ocular chemical burns, recurrent epithelial erosions, Stevens-Johnson syndrome, ocular graft versus host disease, and, lately, in many other ocular surface conditions, relies on the fact that they contain proteins, vitamins, cytokines, and growth factors that participate in the signaling pathways of corneal epithelial healing in similar amounts to those found in normal, healthy tear films

AB024. A case of bullous systemic lupus erythematosus confined to the oral mucosa

Bullous systemic lupus erythematosus (BSLE) is a rare antibody-mediated blistering disease that presents in association with systemic lupus erythematosus (SLE). Features of BSLE can present as a diagnostic challenge as they often mimic other bullous skin diseases. We present a case of a 45-year-old female with history of celiac disease, Raynaud’s syndrome, chilblains, and Sicca symptoms who presented with 10 months of recurrent vesicles and erosions of the gingiva. Review of symptoms was positive for arthralgias and recurrent photosensitive rashes. Physical examination was notable for multiple 4 mm vesicles with mild surrounding erythema confined to anterior upper gingiva without further mucosal or cutaneous involvement. Two biopsies obtained prior to presentation revealed a mixed inflammatory infiltrate with focal eosinophils, negative for viral cytopathic changes. A biopsy of the maxillary frenum for direct immunofluorescence (DIF) demonstrated a weak, fine linear deposition of IgG and IgA along the basement membrane zone initially suspicious for mucous membrane pemphigoid. Serum ELISA for antibodies against BP180, BP230, and collagen VII were negative. Further lab workup was notable for an ANA of 1:160, anti-Ro60 774 (normal 0–19), anti-Sm 20.7 (normal 0–19), and C4 15.1 (normal 16.3–47.8). The patient was found to meet SLICC criteria (joint disease, chronic cutaneous lupus (chilblains), positive ANA, positive Anti-Sm, and low C4) for SLE diagnosis. The patient was started on dapsone 100 mg by mouth daily with improvement in symptoms. BSLE can affect the oral mucosa and has been described in the absence of anti-collagen VII positivity, but has not been described in the absence of cutaneous bullae. Although atypical, the DIF staining pattern in the context of SLE raises support for a diagnosis of oral BSLE. Teaching point: BSLE can manifest as an oral vesicular eruption and can be differentiated from other oral bullous diseases based on histologic and immunopathologic features

111 First-time Transcorporal vs Standard Artificial Urinary Sphincter Placement in Patients with Prior Tadiation for Prostate Cancer: A Comparison of Outcomes

The artificial urethral sphincter (AUS) is the gold standard treatment for male stress urinary incontinence which commonly Results from prostatectomy or pelvic radiation for prostate cancer. Radiation therapy is a well-established risk factor for complications following artificial urinary sphincter placement including increased risk of sphincter erosion and need for revision surgery. Patients with a history of radiation are 1.56 times more likely to undergo artificial urinary sphincter revision surgery with rates of infection or erosion as high as 50% at 2 years. The transcorporal technique for artificial urinary sphincter placement has primarily been used for revision surgery to mitigate the risks of recurrent urethral erosion by interposing the tunica albuginea between the cuff and thin dorsal urethra.

Bulbar urethrocavernous fistula in setting of inflatable penile prosthesis: a case report

BackgroundUrethral injury or erosion of an inflatable penile prosthetic (IPP) cylinder is a rare complication of IPP placement. It can present with varying symptoms and management can be difficult with risk for future complications.We present a patient with an eroded IPP who developed a secondary contralateral urethrocavernous fistula requiring repeat urethroplasty. We also describe the literature surrounding these complications and strategies to prevent them.Case presentationA 69-year-old man with poorly controlled diabetes presented to our clinic with 6 months of intermittent white urethral discharge first noted after IPP removal and replacement by an outside urologist for device malfunction. Office cystoscopy revealed an eroded right-sided prosthetic cylinder in the bulbar urethra. The patient was taken to the operating room for IPP explantation with closure of right corporal defect, left sided malleable prosthesis placement, and primary excision with anastomosis of his bulbar urethra. A catheter was left in place for two weeks postoperatively, at which time a peri-catheter retrograde urethrogram was performed which showed no evidence of contrast extravasation and his catheter was subsequently removed. Several months later, he presented with recurrent urethral discharge without evidence of recurrent erosion on cystoscopy with development of scrotal abscesses following office cystoscopy, concerning for an unidentified urethral defect. He returned to the operating room for scrotal exploration and was noted on cystoscopy to have a pinpoint fistula between his left corporal body and his bulbar urethra. He underwent left sided malleable prosthetic explant, and non-transecting bulbar urethroplasty. Peri-catheter retrograde urethrogram two weeks later showed no contrast extravasation and he has had no recurrence of urethral discharge or scrotal abscesses since.ConclusionsUrethral erosion and urethrocavernous fistula formation are rare complications of penile prosthesis placement. Risks are elevated in patients with corporal fibrosis, diabetes, those undergoing penile implant revision surgery, and those requiring prolonged urethral catheterization.

Use of Acellular Umbilical Cord-Derived Tissues in Corneal and Ocular Surface Diseases.

Blood derived products have become a valuable source of tissue for the treatment of ocular surface diseases that are refractory to conventional treatments. These can be obtained from autologous or allogeneic sources (patient’s own blood or from healthy adult donors/umbilical cord blood, respectively). Allogeneic cord blood demonstrates practical advantages over alternatives and these advantages will be discussed herein. Umbilical cord blood (UCB) can be divided, generally speaking, into two distinct products: first, mononuclear cells, which can be used in regenerative ophthalmology, and second, the plasma/serum (an acellular fraction), which may be used in the form of eyedrops administered directly to the damaged ocular surface. The rationale for using umbilical cord serum (UCS) to treat ocular surface diseases such as severe dry eye syndrome (DES), persistent epithelial defects (PED), recurrent epithelial erosions, ocular chemical burns, graft versus host disease (GVHD), among others, is the considerably high concentration of growth factors and cytokines, mimicking the natural healing properties of human tears. Allogeneic serum also offers the opportunity for therapeutic treatment to patients who, due to poor heath, cannot provide autologous serum. The mechanism of action involves the stimulation of endogenous cellular proliferation, differentiation and maturation, which is highly efficient in promoting and enhancing corneal epithelial healing where other therapies have previously failed.

Nuclear translocation of β-catenin induced by E-cadherin endocytosis causes recurrent erosion of diabetic cornea.

Recurrent epithelial erosion and refractory corneal ulcer are the clinical features of diabetic keratopathy (DK), which eventually lead to corneal scar and visual disturbance. In this study, we sought to determine the abnormalities of cell junction in diabetic corneal epithelial cells and the effect of high glucose on the β-catenin/E-cadherin complex. Corneal histology showed that corneal epithelial cells of high glucose mice were loosely arranged, and the immunohistochemistry showed that the expression of E-cadherin decreased, the levels of β-catenin increased in nuclear. High glucose-induced degradation and endocytosis of E-cadherin of corneal epithelial cells reduce the formation of β-catenin/E-cadherin complex and promote the nuclear translocation of β-catenin. Moreover, high glucose also activated the transcription and expression of matrix metallopeptidase and snail, which interfered with the adhesion of corneal epithelial cells to the basement membrane. These findings reveal that DK is associated with the dissociation of cell junctions. The maintenance of the stability of the β-catenin/E-cadherin complex may be a potential therapeutic target of refractory corneal ulcers in patients with diabetes.

Experience in managing glaucoma filtration surgery complications with oral doxycycline: A case series.

To report the clinical profile and effectiveness of oral doxycycline as a non-invasive treatment for glaucoma filtering surgery complications. Prospective case series. Doxycycline is widely used in treating corneal melts, ocular surface diseases, meibomian gland disease, recurrent epithelial cell erosion, rosacea, and keratitis sicca. This prospective case series highlights the successful treatment of five patients with leaking blebs and conjunctiva erosion from glaucoma filtration surgery with the use of oral doxycycline. There was no adverse event reported in our cases. This study suggests that oral doxycycline may be a feasible non-surgical treatment modality due to its ability to inhibit collagenolysis, restore the Meibomian gland function, thereby stopping breakdown and promote conjunctival tissue healing.

Three-year outcomes of alcohol delamination of corneal epithelium for recurrent corneal erosions of traumatic etiology.

Purpose:Alcohol delamination of the corneal epithelium (ADCE) is a therapeutic option for patients with recurrent corneal erosion (RCE) who do not respond to nonsurgical management of lubricants and extended wear contact lens. The aim of the study is to report on three-year efficacy and safety of ADCE for RCE of traumatic etiology.Methods:This is a retrospective review of consecutive patients who underwent ADCE for traumatic RCE in a local hospital between January 2010 and January 2020. The outcomes at a 3-year follow-up review are included. Nonsurgical therapy used; intra- and postoperative complications were recorded. ADCE was only offered to those who remained symptomatic despite maximum topical lubrications and/or extended wear contact lens. Success was defined as the absence of recurrence of corneal erosion.Results:Twenty-six eyes of 26 patients with RCE caused by trauma underwent ADCE. The mean age of patients was 39 years. The follow-up period was a minimum of 36 months. Three eyes (11.5%) had recurrence of corneal erosion after ADCE at the 3-year follow-up. Recurrence was noted at months 2, 23, and 36 postoperatively in these patients. All patients reported significant improvement in symptoms associated with recurrent erosion. Ten eyes (38.5%) stopped all topical lubricants postoperatively. No intra- or postoperative complications were noted in our study.Conclusion:This study documents the long-term safety and efficacy of alcohol delamination of corneal epithelium at 3 years for patients with RCE of traumatic origin.

Диагностика, лечение и профилактика рецидивирующей герпетической эрозии роговицы

Диагностика, лечение и профилактика рецидивирующей герпетической эрозии роговицы

Novel nanopolymer RNA therapeutics normalize human diabetic corneal wound healing and epithelial stem cells

Human diabetic corneas develop delayed wound healing, epithelial stem cell dysfunction, recurrent erosions, and keratitis. Adenoviral gene therapy modulating c-Met, cathepsin F and MMP-10 normalized wound healing and epithelial stem cells in organ-cultured diabetic corneas but showed toxicity in stem cell-enriched cultured limbal epithelial cells (LECs). For a safer treatment, we engineered a novel nanobiopolymer (NBC) that carried antisense oligonucleotide (AON) RNA therapeutics suppressing cathepsin F or MMP-10, and miR-409-3p that inhibits c-Met. NBC was internalized by LECs through transferrin receptor (TfR)-mediated endocytosis, inhibited cathepsin F or MMP-10 and upregulated c-Met. Non-toxic NBC modulating c-Met and cathepsin F accelerated wound healing in diabetic LECs and organ-cultured corneas vs. control NBC. NBC treatment normalized levels of stem cell markers (keratins 15 and 17, ABCG2, and ΔNp63), and signaling mediators (p-EGFR, p-Akt and p-p38). Non-toxic nano RNA therapeutics thus present a safe alternative to viral gene therapy for normalizing diabetic corneal cells.