Treatment Of Corneal Epithelial Defects Research Articles

Effects of topical Coenzyme Q10, Xanthan Gum and Sodium Hyaluronate on corneal epithelial wound healing

ABSTRACT Clinical Relevance Effective treatment of corneal epithelial defects is crucial to prevent secondary infectious keratitis and visual impairment due to loss of corneal transparency. Therefore, it is important to determine the effect of different topical agents on corneal wound healing response. Background The aim was to compare the effects of three different eye drops on corneal epithelial wound healing in an experimental model. Methods Twenty-four eyes of 24 female BALB/c mice were included. A 2 mm central corneal epithelial defect was created. Topical Coenzyme Q10 + Vitamin E D-α-TPGS 4 × 1 was applied to Group A (n = 6), topical Sodium hyaluronate + Xanthan Gum + 0.3% Nethylmicine 4 × 1 to Group B (n = 6) and topical Sodium hyaluronate 4 × 1 to Group C (n = 6). Group D (n = 6) was the control group without treatment. Clinical scoring according to corneal fluorescein staining and histopathological evaluations was performed. Results Clinical scores according to corneal fluorescein staining were similar in all groups on days 1 (p = 0.05), 2 (p = 0.15) and 3 (p = 0.62). Electron microscopy revealed disruption of intercellular junctions between corneal epithelial cells and intracellular vacuole formation in all groups except Group A. Corneal epithelial thickness and superficial epithelial microvillus arrangement were close to normal in Group A. Conclusion Although there was no difference in clinical scores between groups, electron microscopy revealed a better organised epithelium with normal configuration of microvilli and less vacuolisation in Group A.

Human platelet lysate delivered via an ocular wound chamber for the treatment of corneal epithelial injuries

Current strategies to address corneal surface defects are insufficient to successfully resolve damage caused by injury and/or disease. To address this issue, we have developed an ocular wound chamber (OWC) that creates a fluid-filled environment by encompassing damaged ocular and periocular tissues allowing for the continuous delivery of therapeutics. This study tested human platelet lysate (hPL) as a treatment for corneal epithelial defects when used with the OWC. Corneal epithelial injuries were created in anesthetized guinea pigs by debridement of the central cornea. An OWC was placed over the injured eye and animals randomly grouped followed by injection of either 20% hPL, 100% hPL, or vehicle (balanced salt solution, BSS) into the chamber. Eyes were assessed at 0, 24, 48, and 72 h using intraocular pressure (IOP), optical coherence tomography (OCT), and fluorescein imaging. Whole globes were histologically processed, and hematoxylin and eosin (H&E) stained. No differences in IOP were recorded as a result of corneal wounding, chamber placement, and/or therapeutic application. OCT images demonstrated increased corneal swelling at 48 h and 72 h in the vehicle group compared to 20% hPL. Fluorescein staining showed increased corneal re-epithelialization in the 20% and 100% hPL groups at 48 h compared to vehicle only. H&E staining revealed increased stromal cellular infiltrate in the BSS group. This study demonstrates the delivery of hPL via the OWC improves corneal re-epithelialization and supports the expanded usage of the chamber in combination with hPL to manage a variety of corneal surface injuries, diseases and/or periocular conditions.

Comparison of exosomes derived from induced pluripotent stem cells and mesenchymal stem cells as therapeutic nanoparticles for treatment of corneal epithelial defects.

Induced pluripotent stem cells and mesenchymal stem cells are pluripotent stem cells that represent promising therapies for treating various tissue injuries and wound healing. Exosomes are nanosized extracellular vesicles that have been identified as important mediators of therapeutic functions, which are performed via cell communication. In this study, we compared the efficacy of induced pluripotent stem cells-derived exosomes (iPSCs-Exos) and mesenchymal stem cells-derived exosomes (MSCs-Exos) in treating corneal epithelial defects. The characteristics of the two types of exosomes were not significantly different. Compared to MSCs-Exos, iPSCs-Exos had a better in vitro effect on the proliferation, migration, cell cycle promotion and apoptosis inhibition of human corneal epithelial cells. iPSCs/MSCs-Exos promoted cell regeneration by upregulating cyclin A and CDK2 to drive HCECs to enter the S phase from the G0/G1 phase. In vivo results from a corneal epithelial defect model showed that both iPSCs-Exos and MSCs-Exos accelerated corneal epithelium defect healing while the effects of iPSCs-Exos were much stronger than those of MSCs-Exos. This study demonstrated that iPSCs-Exos had a better therapeutic effect on corneal epithelial defect healing. Thus, a novel potential nanotherapeutic strategy for treating corneal epithelial defects and even more ocular surface disease could be undertaken by using iPSCs-Exos dissolved in eye drops.

Topical Umbilical Cord Serum for Corneal Epithelial Defects after Diabetic Vitrectomy.

PurposeTo evaluate the role of topical umbilical cord serum (TUCS) therapy in treating corneal epithelial defects (CEDs) after diabetic vitrectomy.MethodsIn this double-masked, randomized clinical trial, we included 80 eyes of 80 patients who were candidates for vitrectomy due to proliferative diabetic retinopathy complications. In cases of corneal edema obscuring the fundus view during surgery, the corneal epithelium was removed using a 6-mm trephine and a blade no.15. The day after the surgery, patients were randomly divided into two groups: (1) the TUCS group that received 20% TUCS six times/day in addition to the conventional treatment of CED and (2) the control group, which was prescribed artificial tears as placebo in addition to the conventional treatment of CED. The rate of healing of CEDs was measured via two maximum linear dimensions perpendicular to each other at the start of therapy and on postoperative days 1–5, 7, and 12.ResultsOf 80 eyes, 40 were assigned to each treatment group. The mean times to complete CED healing were 2.4 0.7 and 3.8 2.1 days in the TUCS and control groups, respectively (P 0.001). Persistent CED occurred in two eyes in the control group but in no eyes in the TUCS group.ConclusionTUCS therapy may be safe and effective in healing CEDs after vitrectomy in patients with diabetes.

Evaluating the Efficacy and Safety of ZKY001 Eye Drops in the Treatment of Corneal Epithelial Defects

Evaluating the Efficacy and Safety of ZKY001 Eye Drops in the Treatment of Corneal Epithelial Defects

Topical anaesthetic in the treatment of corneal epithelial defects: What are the risks?

Recent publications have suggested that topical anaesthetic eye drops can be used safely and are effective in providing pain relief for the treatment of corneal abrasions. Complications resulting from the injudicious prescribing of topical anaesthetic eye drops are seen with some frequency inthe Royal Victorian Eye and Ear Hospital's (RVEEH's) emergency department. The aim of this article is to review theliterature and provide a clinical perspective to challenge the safety oftopical anaesthetic eye drops for corneal abrasions. The literature relevant to this clinical question is reviewed, with an emphasis on a critical evaluation of the publications in question. Cases from the RVEEH areused for illustrative purpose. An alternative option for analgesia is suggested.

Therapeutic Proteins for Treatment of Corneal Epithelial Defects.

Corneal epithelial disorders take pride of place in modern ophthalmology. Defects of corneal epithelium are commonly accompanied by blurry vision, photophobia and tearing. Since cornea is the most densely innervated tissue of organisms, its disruption leads to development of a severe pain syndrome. Mild corneal erosions commonly undergo quick spontaneous recovery. Suppression of corneal wound healing due to various pathological causes results in development of severe recurrent erosions and persistent corneal defects. These pathological events can in turn lead to corneal scarring, opacification, and ulceration of cornea, and ultimately to the permanent vision impairment. The etiology of the underlying corneal diseases that commonly involves inflammatory, neurotrophic and systemic factors, should be considered for treating such defects. Therefore, the research focus has been shifted to establish therapeutics based on proteins and peptides. Due to varied mechanisms of action, proteinbased pharmaceuticals can be involved in the protection of corneal surface, mimicking tear components, stimulation of corneal wound healing, regeneration of corneal innervation, suppressing oxidative stress, inflammation and neovascularization. The active components can be naturally occurring (blood- or tear-derived) or be created de novo and optimized in order to achieve the level of activity required. Such pharmaceuticals are characterized by low toxicity and absence of systemic side-effects due to their low absorption into the bloodstream, if administrated topically. This review summarizes existing data on protein-based drugs for treatment of corneal epithelial defects that are currently under preclinical development or testing in clinical trials, or approved for medical use.

Utilization of metabolic energy in treatment of ocular surface disorders: polyphosphate as an energy source for corneal epithelial cell proliferation.

Impaired regeneration of the corneal epithelium, as found in many ocular surface diseases, is a major clinical problem in ophthalmology. We hypothesized that corneal epithelial regeneration can be promoted by the physiological, energy-delivering as well as “morphogenetically active” polymer, inorganic polyphosphate (polyP). Corneal limbal explants (diameter, 4 mm) were cultivated on collagen-coated well plates in the absence or presence of polyP (chain length, ∼40 Pi units; 50 μg ml−1) or human platelet lysate (hp-lysate; 5% v/v). Cell outgrowth and differentiation were analyzed after staining with DRAQ5 (nuclei) and rhodamine phalloidin (cytoskeleton), as well as by environmental scanning electron microscopy (ESEM). Cell growth/viability of hCECs was assessed by XTT assay. The expression of SDF-1 was quantitated by qRT-PCR. Exposure to hp-lysate (also containing polyP) increased cell migration already at day 1. Even stronger was the effect of polyP. This effect was blocked by a mast cell serine protease. The formation of cell multilayers was enhanced by hp-lysate or even more by polyP. ESEM revealed continuous cell junctions and prominent microvilli on the surface of adjacent cells exposed to polyP; those structures were only rarely seen in the controls. The hp-lysate and, more potently, polyP increased the proliferation of hCECs, as well as SDF-1 expression. The findings indicate the potential usefulness of the natural polymer, polyP, for topical treatment of corneal epithelial defects. Future studies are directed to develop suitable formulations of polyP, such as biomimetic polyP nano/microparticles showing an adjustable release kinetics.

Risk factor analysis of persistent corneal epithelial defects after vitrectomy in patients with proliferative diabetic retinopathy

Objective To analyze the risk factors for persistent corneal epithelial defects (PCED) after pars plana vitrectomy (PPV) in patients with proliferative diabetic retinopathy (PDR). Methods A total of 201 PDR patients (201 eyes) who received PPV were enrolled in this retrospective study. There were 86 males (86 eyes) and 115 females (115 eyes). The patients aged from 30 to 81 years, with the mean age of (57.94±9.65) years. Among them, 159 patients were ≥50 years of age, and 42 patients were 1000 points were performed in 123 eyes. Sixty-one eyes involved intravitreal silicone oil tamponade, 18 eyes involved intravitreal tamponade with C3F8, and 122 eyes were not involved with intraocular tamponade. Postoperative persistent intraocular hypertension was defined as an intraocular pressure (IOP) ≥21 mmHg (1 mmHg=0.133 kPa) after PPV with necessary treatment using IOP-lowering medications for ≥2 weeks. The diagnostic criteria for corneal epithelial defects were taken from the Expert Consensus on Clinical Diagnosis and Treatment of Corneal Epithelial Defect in China (2016). The corneal epithelial defect was diagnosed as PCED if it was treated with common methods such as a lacrimal substitute or corneal contact lens, but showed no improvement and no signs of healing for ≥2 weeks. The incidence of PCED after eye surgery was recorded and its related risk factors were analyzed. A multivariate logistic regression was used to analyze the risk factors for PCED, which were expressed as a odds ratio (OR) and a 95% confidence interval (CI). Results Of 201 eyes, 16 eyes (7.96%) presented with PCED after surgery and 185 eyes (92.04%) with no PCED. There was no significant difference in the age, sex, and eyes between the patients with or without PCED (χ2=6.548, 0.927, 0.044; P=0.011, 0.336, 0.833). A multivariate logistic regression showed that intraoperative epithelial debridement (OR=13.239, 95%CI 2.999−58.442, P=0.001), intraoperative treatment in combination with cataract surgery (OR=7.448, 95%CI 1.975−28.091, P=0.003), intravitreal tamponade with C3F8 (OR=11.344, 95%CI 2.169−59.324, P=0.004), and postoperative persistent intraocular hypertension (OR=10.462, 95%CI 2.464−44.414, P=0.001) were risk factors for PCED after PPV. Conclusion Intraoperative epithelial debridement, intraoperative treatment in combination with cataract surgery, intravitreal tamponade with C3F8, and postoperative persistent intraocular hypertension are risk factors for PCED in patients with PDR after PPV. Key words: Epithelium, corneal/injuries; Vitreoretinal surgery; Diabetic retinopathy

Growth factor and interleukin concentration in amniotic membrane suspension (AMS) and amniotic tissue homogenates (AMTH)

AbstractApplication of AMS or AMTH eye drops was suggested as a potential non‐surgical treatment alternative of therapy resistant corneal epithelial defects. We determined the concentration of growth factors EGF and FGFb and interleukins IL‐6 and IL‐8 in AMS and AMTH following different preparation methods. In AMTH EGF concentration was about 1.7‐17x and FGFb concentration about 1.2‐8.5x higher than in AMS. With higher EGF and FGFb concentrations and lack of IL‐6 and IL‐8 in AMTH, its use may be more appropriate in treatment of corneal epithelial defects. However, the most effective preparation method and the harvesting timepoint are yet to be determined.

PP-005 Results of treatment of corneal epithelial defects by the application of Plasma Rich in Growth Factors eye drops

BackgroundPlasma Rich in Growth Factors (PRGF) preparations are being increasingly used as a source of growth factors in bone reconstruction, implant consolidation in dentistry and more recently in eye diseases.PurposeRetrospective...

Topical 100% Serum Eye Drops for Treating Corneal Epithelial Defect after Ocular Surgery

The purpose of this study was to investigate the efficacy and safety of topical 100% serum eye drops for corneal epithelial defect after ocular surgery. A total of 181 patients who received topical 100% serum therapy for the treatment of corneal epithelial defect following several different types of ocular surgery were recruited into this study. Each patient already failed conventional medical therapy before being prescribed 100% serum eye drops. Slit-lamp biomicroscopic examination with fluorescein staining was performed at baseline and all follow-up visits. The main outcome measures were the rate of complete healing of the corneal epithelial defect and incidence of adverse events. One hundred and seventy-eight eyes (98.34%) received autologous serum eye drops, and 3 (1.66%) received allogeneic serum eye drops. The overall success rate of treating persistent postoperative epithelial defect using 100% serum eye drops was 93.92% (95% CI 0.88–0.98). The median time to complete corneal epithelialization was 4 days (95% CI 4-5). Adverse reactions were observed in 3 patients (1.66%), including sticky sensation with minimal eye discomfort and asymptomatic trace corneal subepithelial infiltration. No serious complications were reported. In conclusion, 100% serum eye drops are effective, safe, and tolerable for treating postoperative corneal epithelial defect following ocular surgeries.

Autologous serum eyedrops: literature review and implications for transfusion medicine specialists

Persistent corneal epithelial defects (CEDs) are caused by many diseases that are usually associated with decreased production of tears or reduced corneal sensitivity. Although surgical treatments are available for severe cases, CEDs are still difficult for ophthalmologists to treat. One treatment for CEDs that is uncommonly used in the United States is autologous serum eyedrops (ASEs). The first application of ASEs was described in 1984. This landmark report was followed by multiple studies that carefully evaluated the epithelial-promoting properties of ASEs and refined the means of ASE preparation. A number of clinical studies suggested the efficacy of ASEs in various ophthalmologic conditions. This article reviews the efficacy and complications of ASE use reported in these studies. Given that ophthalmologists may consult the blood bank to request ASEs, transfusion medicine physicians should be aware of the issues related to ASE preparation, storage, and potential utility.