Treatment Of Corneal Ulcers Research Articles

Applications of Amniotic Membrane in Ophthalmology – New Perspectives in the Treatment of Eye Diseases

Amniotic membrane, a natural protective barrier surrounding the fetus, possesses unique biological properties, making it a promising tool in regenerative medicine. It contains pluripotent cells, collagen, anti-inflammatory cytokines, and growth factors. This article aims to present the current state of knowledge regarding the potential applications of amniotic membrane in ophthalmology, as well as the benefits and challenges associated with this promising therapy. Amniotic membrane, used in the form of a graft or extract, exhibits anti-inflammatory effects, accelerates tissue healing, and regenerates corneal epithelium. In ophthalmology, amniotic membrane is used in the treatment of corneal ulcers, limbal stem cell deficiency, burns, strabismus, glaucoma, and neoplastic changes. It can also be used in the reconstruction of the ocular surface and in vitreoretinal surgery. Studies demonstrate its effectiveness in improving symptoms of dry eye syndrome. Additionally, new methods of combining amniotic membrane with the ocular surface are being introduced. Amniotic membrane is also used as a carrier in stem cell culture. The development of technology and research on amniotic membrane lead to the discovery of new applications and the improvement of surgical techniques, opening up prospects for even broader utilization of its potential in the future.

Application of conjunctival graft surgery in the treatment of corneal ulcers in dogs

The study of conjunctival graft surgery for treating corneal ulcers in dogs was conducted at Alpha Pet Veterinary Clinic and Bang Pham Veterinary Hospital from August 2021 to August 2022. Dogs were clinically examined with corneal ulcers and corneal perforations, corneal reflexes, and then fluorescein 2% reagent was used to examine and measure the diameter of the corneal damaged area by using Castroviejo calipers. The surgical method of conjunctival stem grafting was applied and evaluated effects of treatment on corneal ulcers in dogs. A total of 3,024 dogs were examined and treated during the study period. There were 195 dogs with eye diseases, accounting for 6.45% of the cases. The rate of corneal ulcers was 15.90% (31/195 cases). Among the corneal ulcer cases, conjunctival graft surgery was performed in 14 cases. The successful rate of conjunctival stem grafting was 71.43%. The complication rate of conjunctival stem grafting was 42.86%, in which 2 cases of mild complications were successfully treated. The average wound healing duration was 39.45 days. The occurrence of complications depended on the types of complication. Mild complications including suture detachment and corneal edema appeared after 2.5 to 5.5 days while corneal epithelial cysts and ocular edema occurred at 22 to 42 days after surgery. Therefore, this method could be used in treatment of corneal ulcers, particularly in cases of deep ulcers or corneal perforations that required to directly connect to blood vessels.

Rosuvastatin-laden nanofibrous patches for effective treatment of corneal ulcer in experimental animals

Corneal ulceration is a "silent epidemic" that impacts laborers’ lives, particularly in low-income countries, and calls for a unique ophthalmic drug delivery strategy that overcomes ocular barriers to promptly achieve therapeutic outcomes while remaining cost-effective. Rosuvastatin, a third-generation statin that significantly accelerates tissue regeneration and wound healing, could be proposed as a potential treatment for corneal ulcers. Based on these pillars, the current study aims to develop a nanofibers-based corneal patch laden with rosuvastatin, for the first time, as a novel approach for the treatment of corneal ulcers. Several characterizations were performed for the rosuvastatin-laden nanofibers (e.g., drug encapsulation efficiency, drug loading capacity, morphological analysis, elemental mapping, compatibility with other ingredients, and in vitro release studies) indicating the nanofibers' feasibility for the stated purpose. The therapeutic effects of rosuvastatin-laden nanofibers were examined on a surgically generated corneal ulcer rabbit model. The treatment outcomes were evaluated both macroscopically (e.g., corneal opacity degree and area of ulceration) and histologically demonstrating that the rosuvastatin-laden nanofibers heal corneal ulcers promptly. In light of this, the study emphasizes that rosuvastatin has a significant potential for healing corneal ulcers and that fast-release nanofibers may be an ideal drug delivery platform for treating corneal diseases topically.

Silicon-dried corneal graft crosslinking as a means to increase the effectiveness of urgent keratoplasty

Purpose: to evaluate the effectiveness of silicon-dried cornea, previously subjected to corneal collagen UVA crosslinking, for urgent keratoplasty.Material and methods. 28 patients (16 males, 12 females), diagnosed with perforating corneal ulcer of various etiologies, underwent penetrating keratoplasty for eye-preserving purposes. 14 patients (the main group) underwent transplantation of a silicon-dried cornea, previously subjected to corneal collagen crosslinking according to the standard (Dresden) protocol while the remaining 14 patients (comparison group) underwent penetrating keratoplasty with not pre-treated silicon-dried cornea. In the postoperative period, we measured the time of primary complete epithelization of the graft and assessed the presence/absence of ulcers and erosions of the corneal graft 1, 3, 6 and 12 months after the discharge from the hospital. For this purpose, all patients underwent corneal biomicroscopy with corneal surface preliminary stained with a 1% sodium fluorescein solution.Results. Complete epithelization in both the main group and the comparison group was found to take place, on average, at the same time after surgery. However, over the entire observation period, the main group showed fewer relapses of ulcers and corneal graft erosions than the comparison group.Conclusion. The use of silicon-dried cornea, subjected to corneal collagen cross-linking, increases the effectiveness of perforated corneal ulcer treatment in emergency surgical care.

Hydrodissection to create conjunctival flaps in dogs with corneal ulcers.

Hydrodissection is a liquid injection technique that is rarely used in animal ophthalmic procedures. The use of this technique in the creation of conjunctival flaps for the treatment of corneal ulcers in dogs can improve the outcome, task, and comfort for patients. This study aimed to evaluate the use of hydrodissection in the creation of conjunctival flaps in dogs with corneal ulcers. This study focused on a surgical procedure for creating conjunctival flaps in the eyes of 17 dogs with deep corneal ulcers. We divided the patients into two groups: Hydrodissection was performed in the first group (G1) and conventional divulsion without hydrodissection in the second group (G2). In G1, the conjunctival flap was created by subconjunctival injection of 1 mL of 0.9% sodium chloride, followed by flap construction. The flap was constructed through conventional divulsion using iris scissors in the G2. The operative time, degree of bleeding, and ease of conjunctival divulsion were evaluated during the procedure. Blepharospasm, hyperemia, edema, and scarring of the conjunctiva were evaluated during the post-operative period. Post-operative complications, notably suture dehiscence, were recorded in each group. Hydrodissection is an easy-to-perform maneuver that optimizes the construction of conjunctival flaps. There were no statistical differences in the parameters used to evaluate the trans- and post-operative period between the groups. The volume of sodium chloride administered in the conjunctiva ranged from 0.5 mL to 1 mL in G1. Dehiscence of the flap sutures was observed in four patients (two in G1 and two in G2), with no significant difference between the groups. Hydrodissection facilitates the construction of conjunctival flaps in dogs with corneal ulcers, affording greater comfort to patients and proving to be an excellent option for ophthalmologists.

Insulin eye drops for treating corneal ulcer in a non-diabetic patient: regarding a case

Corneal ulcers are included in a heterogeneous group of eye injuries. When patients do not respond to treatment, including even corneal transplant, other alternatives need to be explored.We present a case of a patient who suffered an accidental spillage from the contents of a car battery. This corneal lesion was refractory to both surgical and pharmacological treatment. After four years of a persistent ulcer, insulin topical treatment 50 IU/mL was started. Improvement began to be observed and currently the patient has completely recovered the corneal epithelium.Nowadays, evidence of the topical insulin use for the treatment of corneal ulcers is higher in diabetic patients. In non-diabetic patients, evidence is restricted to a series of cases of neurotrophic corneal ulcers and a case report of a patient who presented a persistent epithelial defect after resection of a neurinoma. This case presents the experience of using an insulin drop formulation with effectiveness and absence of toxicity in a patient non-diabetic with a post-caustic corneal ulcer.

Investigating the effect of eye drops based on iodine nanoparticles in the treatment of corneal ulcers in rabbit eyes

BackgroundVarious organisms, such as bacteria, viruses, and fungi, can cause corneal ulcers. One of the leading causes of vision loss and disability worldwide is corneal ulceration. Practical, accessible, and affordable treatment for this disease seems essential.Materials and methodsFifteen New Zealand rabbits infected with Staphylococcus aureus (ATCC 25923) corneal ulcers were randomly divided into three groups of five for the present study. (I, II, and III). Group I was used as the control group (without treatment). The second group received an iodine solution (1.25%) without a nanoparticle structure (betadine). The third group received an iodine solution with a nanoparticle structure used as eye drops. Drops in the corneal ulcer group were used five times daily for 14 days.Microbial counts and disease severity scores were measured on the first, second, fifth, and fourteenth days and compared between groups separately for each disease.ResultsThe results showed that the changes in microbial load were significant in the group that received betadine and nanoparticles. The microbial load was further reduced when using iodine nanoparticles than betadine. The betadine and nano-iodine groups significantly reduced the severity of the disease in rabbits with corneal ulcers (p < 0.05). The average changes in disease severity score were 4.8 ± 1.3, -2.6 ± 0.89, and -2.22 ± 1.22 in the untreated, nano iodine, and betadine groups, respectively. However, a significant increase in disease severity was observed in the untreated group (p = 0.001). It shows a significant difference (p < 0.001) between the nano iodine, betadine, and untreated groups. However, the difference in disease severity changes between nano iodine and non-nano iodine groups was insignificant.ConclusionNanoparticle iodine is more effective than non-nanoparticle iodine in reducing bacterial load. In reducing the severity of the disease, both types of iodine were superior to no treatment. But there was no apparent difference between the two groups treated with iodine.

Allogenic Lenticular Implantation for Correction of Refractive Error and Ectasia: Narrative Review.

Intrastromal lenticule implantation is a promising treatment option for corneal pathologies, from refractive error to ectasia. In this narrative review, we intend to feature up-to-date literature supporting the use of lenticular tissue, a compelling method that can be customized for a variety of applications, providing an additional source of donor tissue for treating corneal diseases. We searched databases PubMed, Mendeley, and Scopus last accessed 10 May 2023, for literature on stromal lenticules and narrowed based on relevance. Review articles, animal studies, ex vivo studies, and book chapters were excluded, while assessable and relevant articles published in English were included. Storage methods from using fresh lenticules to dehydration have proven successful, with cryopreservation maintaining structure and cellular viability for up to 10years. Successful use of lenticules for treatment of numerous pathologies including corneal ectasias, hyperopia, and presbyopia with additional insight into the treatment of corneal ulcers and perforations are highlighted in this narrative review. Lenticular implantation is an innovative and advantageous treatment for various ocular pathologies, offering increased bioavailability, flexibility, and customization for patients. They can treat previously untreatable diseases and serve as a replacement for synthetic implants, with promising outcomes worldwide. Lenticular implantation has the potential to become a leading approach in ophthalmologic surgery. Further studies should aim to provide evidentiary support for a standardization of lenticule banking.

Evaluation of Microbiological Culture and Antibiogram of the Patient with Corneal Ulcer due to Exposure Keratitis in the Intensive Care Unit in Sina Farshchian Hospital (2019-2020)

Background: Since patients admitted to the intensive care unit have a compromised immune system and are more prone to infection than other patients, timely diagnosis and treatment of corneal ulcers among this group of patients can prevent vision loss. Therefore, it is necessary to treat eye infections and corneal ulcers promptly and economize prohibitive costs. Objective: Appropriate treatment with the most effective antibiotic before the answer is available to prevent corneal ulcer complications and blindness. Methods: This study was conducted from November 2019 to November 2020 and after approval by the ethics committee of Hamedan University of Medical Sciences with the code of ethics: IR.UMSHA.REC.1398.716. First, the corneal secretions of 121 patients admitted to the intensive care unit of Sina Hospital are prepared by an ophthalmologist (after anesthetizing the cornea with tetracaine drops and sterile swabs) and culture in four growth mediums (blood agar, chocolate agar, thioglycolate, and EMB). Microbial cultures are examined after 48 hours and a fungal culture is examined one week later. Disc diffusions are placed in positive microbial cultures. Antibiotic susceptibility or resistance of the antibiogram was recorded. Other demographic data, including patients' age and sex, are extracted from ICU files. Also, test results and patient identifications are recorded in a checklist designed for this purpose. Results: Of all the antibiotics used against common bacteria, vancomycin (84%), colistin (80.43%), cefazolin (80%), and levofloxacin (60%) had the highest sensitivity and gentamicin (93.75%), ceftazidime (86.42%) Erythromycin (85%) had the highest resistance against isolated bacteria. Conclusion: The data obtained from this study showed that the most common microorganisms in the age group under the age of 30 years were Acinetobacter Baumannii, in the group of 30-60 years old was Klebsiella pneumonia, and age group over 61 years old was Staphylococcus aureus, and the most sensitive antibiotics in the age group under 30 years were vancomycin and levofloxacin and the age group30-60 were colistin and vancomycin and in the age group over 61 years were vancomycin and cefazolin.

A Novel Strategy as a Potential Rapid Therapy Modality in the Treatment of Corneal Ulcers: Fluconazole/Vancomycin Dual Drug‐Loaded Nanofibrous Patches

Front cover: In article 2200697 by Sumeyye Cesur, Ewa Kijeńska-Gawrońska, and co-workers, vancomycin and fluconazole dual-drug loaded dual-layered polyvinyl alcohol and gelatin nanofibrous corneal patches, produced by electrospinning, show significant antimicrobial activity against Candida albicans and Staphylococcus aureus and have a great potential to be used for the treatment of corneal ulcers.

A Novel Strategy as a Potential Rapid Therapy Modality in the Treatment of Corneal Ulcers: Fluconazole/Vancomycin Dual Drug‐Loaded Nanofibrous Patches

AbstractCorneal ulcer, which is brought on by a breach in the epithelial barrier, is a dangerous infection of the avascular corneal stroma. New treatment strategies are needed, suppressing the aggressive nature of the disease and including a combination of different drugs. In this study, vancomycin (VAN) and fluconazole (FLU) dual‐drug loaded dual‐layered polyvinyl alcohol and gelatin (PVA/GEL) nanofibrous patches are produced by electrospinning. Scanning electron microscopy (SEM) images show smooth surfaces are obtained for both pure and drug‐loaded nanofibrous patches. The tensile test results report that loading the FLU and VAN separately into the PVA/GEL patches decrease both the tensile strength and elongation at break and it is further reduced when combining two drug‐loaded layers in one patch. According to drug release results, the FLU and VAN‐loaded nanofibrous patches show a controlled release profile extending up to 96 h. Moreover, PVA/GEL/FLU, PVA/GEL/VAN, and PVA/GEL/FLU/VAN nanofibrous patches display significant antimicrobial activity against Candida albicans and Staphylococcus aureus. SEM, 4'‐6diamidynofenyloindol (DAPI) staining, and 3‐(4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyltetrazolium bromide (MTT) assay show that PVA/FLU and PVA/GEL/FLU/VAN nanofibrous patches have a superior effect on NIH3T3 cell spreading and proliferation. The novelty of this study lays in the development of a potential dual drug rapid treatment for corneal ulcers of aggressive nature.

Lactoferrin Influence on the Course of Suppurative Corneal Ulcer

Research justification. Corneal ulcer is a common corneal pathology dangerous because of its complications, which occur in 2.5–37.9 % of cases despite modern treatment. Thus, the development of novel methods improving the results of corneal ulcer treatment is very important.Research objective was to evaluate the efficacy of lactoferrin-based therapy for experimental suppurative corneal ulcer.Material and methods. The study was performed in male chinchilla rabbits. Three intact rabbits (6 eyes) were used as control animals. Staphylococcus suppurative corneal ulcer was modeled in both eyes of 63 experimental animals. These rabbits were randomized into three groups. The first group was administered placebo therapy, the second group received antibacterial therapy, and the third group — instillations of lactoferrin. The area of ulcerative lesion was used as the measure of the therapeutic efficacy of the treatment. Then, a histological study was performed, and microsamples were photographed with LOMO TC-500 digital camera (Russia).Results. Lactoferrin instillations resulted in reliable increase in the number of transfers from infiltration stage to epithelization stage, decrease in the percentage of ulcerations, and in the proportion of critical thinning of the cornea, as well as decrease in the proportion of perforations. However, it was noticed that lactoferrin treatment when continued after the end of epithelization process resulted in excessive formation of opaque scar tissue.Conclusion. Local administration of lactoferrin stimulates the epithelium regeneration and the formation of the connective tissue and thus prevents the development of complications of suppurative corneal ulcer. However, the identified excessive formation of opaque scar tissue in lactoferrin treatment lasting too long has to be taken into consideration when developing the optimal scheme for lactoferrin treatment.

Diagnosis and treatment of corneal ulcers in the course of systemic autoimmune diseases

Peripheral ulcerative keratitis is an inflammatory condition, usually crescent shaped and occurring in the corneal stromal region, where it is always associated with corneal stromal thinning. Peripheral ulcerative keratitis often occurs in the course of rheumatic diseases but is most commonly associated with rheumatoid arthritis. Peripheral ulcerative keratitis is also seen in granulomatosis with polyangiitis, polyarteritis nodosa, relapsing chondritis, and systemic lupus erythematosus. These diseases are analyzed in the article in relation to peripheral ulcerative keratitis with a discussion of individual treatment methods in specific cases.

Clinical Management of Corneal Ulcer by Chemical Cauterization using Silver Nitrate

The aim of this study was to devise the method of treatment of corneal ulcer in dogs which is very common in some breeds of dog. Earlier it was treated with some topical antibiotics but it was not successful as desired. In this study the cauterization of ulcer was done with silver nitrate, which was found to be very cheap and successful both in terms of financial and recovery parameters

Multi-component cord blood banking: a proof-of-concept international exercise.

Most public cord blood (CB) banks currently discard more than 80% of umbilical CB units not suitable for hemopoietic stem cell transplant due to low stem cell count. Although CB platelets, plasma, and red blood cells have been used for experimental allogeneic applications in wound healing, corneal ulcer treatment, and neonatal transfusion, no standard procedures for their preparation have been defined internationally. A network of 12 public CB banks in Spain, Italy, Greece, the UK, and Singapore developed a protocol to validate a procedure for the routine production of CB platelet concentrate (CB-PC), CB platelet-poor plasma (CB-PPP), and CB leukoreduced red blood cells (CB-LR-RBC) using locally available equipment and the commercial BioNest ABC and EF medical devices. CB units with >50 mL volume (excluding anticoagulant) and ≥150×109/L platelets were double centrifuged to obtain CB-PC, CB-PPP, and CB-RBC. The CB-RBC were diluted with saline-adenine-glucose-mannitol (SAGM), leukoreduced by filtration, stored at 2-6°C, and tested for hemolysis and potassium (K+) release over 15 days, with gamma irradiation performed on day 14. A set of acceptance criteria was pre-defined. This was for CB-PC: volume ≥5 mL and platelet count 800-1,200×109/L; for CB-PPP: platelet count <50×109/L; and for CB-LR-RBC: volume ≥20 mL, hematocrit 55-65%, residual leukocytes <0.2×106/unit, and hemolysis ≤0.8%. Eight CB banks completed the validation exercise. Compliance with acceptance criteria was 99% for minimum volume and 86.1% for platelet count in CB-PC, and 90% for platelet count in CB-PPP. Compliance in CB-LR-RBC was 85.7% for minimum volume, 98.9% for residual leukocytes, and 90% for hematocrit. Compliance for hemolysis ≤0.8% decreased from 89.0 to 63.2% from day 0 to 15. K+ release increased from 3.0±1.8 to 25.0±7.0 mmol/L from day 0 to 15, respectively. The MultiCord12 protocol was a useful tool to develop preliminary standardization of CB-PC, CB-PPP, and CB-LR-RBC.

Characterization of Infectious Keratitis in Opioid Users in a County Hospital Setting.

To determine risk factors and clinical course of corneal ulcers in the setting of opioid use. A retrospective cohort study was performed of patients presenting with bacterial or fungal keratitis at a county hospital from 2010-2021. Subjects were separated into three groups: opioid drug users (heroin, methadone, fentanyl), non-opioid drug users, and non-drug users. 24 opioid users, 77 non-opioid drug users, and 38 non-drug users were included in the study. Chi-square and t-tests were used to compare hospitalization for corneal ulcer treatment; length of hospitalization; loss to follow-up; final best corrected visual acuity (BCVA); medication noncompliance; time to ulcer resolution; and visual disability (defined either by the legal limit for driving in California or the federal limit for blindness). Opioid users had higher rates of unemployment (p=0.002), homelessness (p=0.018), and psychiatric conditions (p=0.024) compared with non-opioid and non-drug users. They had more severe presentations, with worse initial BCVA of the affected eye (p=0.003), larger ulcer size (p=0.023), and higher rates of individuals below the legal vision thresholds for driving (p=0.009) and blindness (p=0.033) at initial presentation. Opioid use was associated with increased rate of hospitalization (p<0.001), higher fortified antibiotic use (p=0.009), worse final BCVA of the affected eye (p=0.020), and increased rates of BCVA worse than the legal vision thresholds for driving (p=0.043) and blindness (p<0.001) on final presentation. Infectious keratitis associated with opioid use is associated with more severe presentations and poorer outcomes, including higher rates of visual disability.

CONTRIBUTION OF DEHYDRATED AMNIOTIC MEMBRANE IN THE TREATMENT OF RECURRENT IMMUNOLOGICAL CORNEAL ULCER: CASE REPORT

The dehydrated amniotic membrane allowing easy and safe handling is an allogeneic tissue derived from amniotic membrane of human origin.It is used in the treatment of corneal ulcers, pterygiums, symblepharons, and others. in our patient suffering from dermatomyositis under corticosteroids and presenting an immunological corneal ulcer, the use of the dehydrated amniotic membrane was beneficial with a functional improvement. this technique is easy, accessible and has many therapeutic indications in order to improve the therapeutic management of this type of patient.

Corneal stromal lenticule transplantation for the treatment of corneal ulcers.

To evaluate the safety and efficacy of using corneal stromal lenticules (CSLs) obtained during refractive surgery Refractive Lenticule Extraction (ReLEx) with the Small Incision Lenticule Extraction (SMILE) procedure for the treatment of corneal ulcers. This retrospective study included 12 eyes of 12 patients, 7 men and 5 women with varying degrees of corneal ulcer. The mean age was 64 ± 18 (range 34 to 95 years). The monitoring included corrected distance visual acuity (CDVA), slit-lamp biomicroscopy examination, a Seidel test, stability of the graft and anterior segment optical coherence tomography (AS-OCT) inspection. Patients were closely monitored for possible postoperative complications for at least 6 months. In 7/12 (58%) eyes, the corneal ulcer was successfully sealed with CSL and amniotic membrane (AM) without the need for any additional surgical intervention. In 3 eyes, penetrating keratoplasty (PK) was needed in addition to CSL transplantation and in 2 eyes the scleral patch was used to fully seal after CSL transplantation. During the follow-up period no signs of rejection or infection were detected in any patient. The use of CSLs from ReLEx SMILE may be considered as an alternative method for the treatment of corneal ulcers before a more extensive and definitive solution - PK - is used. Our preliminary findings suggest that properly performed CSL transplantation using cryopreserved lenticules is a safe and effective method to temporarily cover the corneal partial-thickness defect or even perforation.

Antibiotic susceptibility pattern of bacterial isolates from microbial keratitis in North and Central India: A multi centric study.

This study was conducted to examine microbiological profile with their antibiotic sensitivity in cases of bacterial keratitis in north and central India to ensure appropriate use of antibiotics. The microbiology laboratory records of 228 patients with culture-proven bacterial keratitis from 1st January to 31st December 2019 were analyzed. Cultured bacterial isolates were subjected to antimicrobial susceptibility testing to antibiotics commonly used in the treatment of corneal ulcer. Chi-squared or Fisher's exact test were applied to check the significance of difference between the susceptibility levels of antibiotics. The prevalence of Staphylococcus aureus and Pseudomonas aeruginosa-induced keratitis was higher in northern India, whereas that by Streptococcus pneumoniae was more prevalent in central India. In central India, 100% of S. pneumoniae isolates were found to be sensitive to ceftriaxone compared to 79% in northern India (P = 0.017). In comparison to 67% of isolates from north India, 15% of S. aureus isolates from central India were found to be sensitive to ofloxacin (P = 0.009). Similarly, 23% of isolates from central India were found sensitive to amikacin compared to 65% of isolates from north India (P = 0.012). P. aeruginosa isolates from central India were found to be sensitive to ceftazidime in 63% of cases compared to 21% of isolates from north India (P = 0.034). Prevalence of bacteria and their susceptibility to antibiotics are not uniform across geography. Vancomycin remained the most effective drug in all gram-positive coccal infections. S. aureus susceptibility to amikacin was significantly greater in north India. P. aeruginosa showed less susceptibility as compared to previous reports.

Использование аутологичной кондиционированной плазмы (ACP) в лечении перфоративной язвы роговицы (клинический случай)

Purpose. To evaluate the effectiveness of a combined approach in the treatment of perforated corneal ulcers using autologous conditioned plasma (ACP). Material and methods. In the Republican Clinical Ophthalmological Hospital, 3 patients with a corneal ulcer were treated using ACP. Two patients with corneal ulcer without perforation, one patient with corneal ulcer with perforation. Two patients with a corneal ulcer without perforation, in addition to the standard conservative treatment, received a single application of ACP in the area of the corneal ulcer in several layers, a single subconjunctival injection of ACP. In both cases, the ulcerative process was stopped successfully. A technique for a combined approach to the closure of perforated corneal ulcers has been developed, including primary suturing of the corneal defect in the ulcer area in order to reduce the risk of fluid perfusion; restoration of the anterior chamber with sterile air; multilayer applications of autologous conditioned plasma into the ulcer area and, as it is filled with ACP, the coverage area is expanded to the entire cornea. On average, the coating consists of 5–7 layers with 20–30 sec. polymerization. It is important to remove excess autoplasma with a tupfer and prevent excesses from entering the conjunctival fornix, which minimizes the risk of displacement of the ACP film. Surgery is performed against the background of active antibacterial, antiinflammatory and keratoprotective therapy. Additionally, a soft contact lens was applied at the end of the operation. Results. During surgery, the closure of the perforation of the cornea with an ACP composite was achieved, a stable anterior chamber of the eyeball was noted, and there was no external filtration of the cornea. These results remained stable over the entire follow-up period of 1 month. Conclusions. A positive preliminary clinical result was demonstrated using a combined approach in the treatment of corneal ulcer complicated by perforation using autologous conditioned plasma. Application of ACP to the cornea contributed to the creation of a durable composite to block the perforation. After expanding the number of patients treated by this technique, we assume that this technique can be considered as an alternative for urgent treatment of perforated corneal ulcers without penetrating keratoplasty. Keywords: corneal ulcer with perforation, autologous conditioned plasma, platelet-rich plasma