In vivo and ex vivo evaluation of cell–cell interactions, adhesion and migration in ocular surface of patients undergone excimer laser refractive surgery after topical therapy with different lubricant eyedrops

Hyaluronic acid hydrogels crosslinked via blue light-induced thiol-ene reaction for the treatment of rat corneal alkali burn

To assess corneal inflammation from alkali chemical burns, we examined the therapeutic effects of in situ-forming hyaluronic acid (HA) hydrogels crosslinked via blue light-induced thiol-ene reaction on a rat corneal alkali burn model. Animals were divided into three groups (n = 7 rats per group): untreated, treated with 0.1% HA eye drops, and treated with crosslinked HA hydrogels. Crosslinking of HA hydrogel followed by the administration of HA eye drops and crosslinked HA hydrogels were carried out once a day from days 0–4. Corneal re-epithelialization, opacity, neovascularization, thickness, and histology were evaluated to compare the therapeutic effects of the three groups. Further investigation was conducted on the transparency of HA hydrogels to acquire the practical capabilities of hydrogel as a reservoir for drug delivery. Compared to untreated animals, animals treated with crosslinked HA hydrogels exhibited greater corneal re-epithelialization on days 1, 2, 4, and 7 post-injury (p = 0.004, p = 0.007, p = 0.008, and p = 0.034, respectively) and the least corneal neovascularization (p = 0.008). Histological analysis revealed lower infiltration of stromal inflammatory cells and compact collagen structure in crosslinked HA hydrogel-treated animals than in untreated animals. These findings corresponded with immunohistochemical analyses indicating that the expression of inflammatory markers such as α-SMA, MMP9, and IL1-β was lower in animals treated with crosslinked HA hydrogels than untreated animals and animals treated only with 0.1% HA eye drops. With beneficial pharmacological effects such as re-epithelization and anti-inflammation, in situ-forming hyaluronic acid (HA) hydrogels may be a promising approach to effective drug delivery in cases of corneal burn injuries.

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Corneal chemical injuries can induce corneal opacification, limbal ischemia, and loss of vision.

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Limitations for using topical eye drops includes maintaining the optimal concentration of the drug on the ocular surface.

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Crosslinked HA hydrogels achieved rapid corneal re-epithelialization and low-grade neovascularization after chemical injury.

Clinical Applications of In Vivo Confocal Microscopy in Keratorefractive Surgery

PURPOSE

To review the contribution of in vivo confocal microscopy (IVCM) to the understanding of corneal wound healing following refractive surgery, and its role in the diagnosis and management of complications arising from keratorefractive procedures.

METHODS

Review of the basic science and clinical literature relating to the study of keratorefractive surgical procedures using IVCM.

RESULTS

Extensive research using IVCM has generated a comprehensive understanding of tissue responses after corneal refractive surgery. Epithelial thickness and stromal keratocyte density can be quantified postoperatively and studied longitudinally. Corneal nerve loss and subsequent reinnervation has been characterized and differs significantly between laser refractive techniques. IVCM has also been used to study complications arising from postoperative inflammation (diffuse lamellar keratitis, central toxic keratopathy, ring keratitis, and ectasia), infection (microbial keratitis), and neuropathy (dry eye and neuralgia). This imaging technique can have a critical role in the diagnosis of these complications and subsequent monitoring of treatment response. Manual processing of IVCM images is time-consuming and there may be significant interobserver and intraobserver variability with poor repeatability. However, increasing automation and the use of artificial intelligence is improving the speed and accuracy of image analysis.

CONCLUSIONS

IVCM has historically been confined to a research setting because image capture and subsequent processing was extremely labor intensive. However, advances in both hardware and software capabilities promise to allow the use of IVCM in routine clinical practice. Real-time evaluation of the cornea at a cellular level will be particularly useful in patients with inflammatory, infectious, or neuropathic complications of keratorefractive surgery. [J Refract Surg. 2021;37(7):493-503.].

Hyaluronic Acid Combined with Serum Rich in Growth Factors in Corneal Epithelial Defects

The aim of this study is to assess if an adhesive biopolymer, sodium hyaluronate (NaHA), has synergistic effects with s-PRGF (a serum derived from plasma rich in growth factors and a blood derivative that has already shown efficacy in corneal epithelial wound healing), to reduce time of healing or posology. In vitro proliferation and migration studies, both in human corneal epithelial (HCE) cells and in rabbit primary corneal epithelial (RPCE) cultures, were carried out. In addition, we performed studies of corneal wound healing in vivo in rabbits treated with s-PRGF, NaHA, or the combination of both. We performed immunohistochemistry techniques (CK3, CK15, Ki67, ß4 integrin, ZO-1, α-SMA) in rabbit corneas 7 and 30 days after a surgically induced epithelial defect. In vitro results show that the combination of NaHA and s-PRGF offers the worst proliferation rates in both HCE and RPCE cells. Addition of NaHA to s-PRGF diminishes the re-epithelializing capability of s-PRGF. In vivo, all treatments, given twice a day, showed equivalent efficacy in corneal epithelial healing. We conclude that the combined use of s-PRGF and HaNA as an adhesive biopolymer does not improve the efficacy of s-PRGF alone in the wound healing of corneal epithelial defects.