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Mahmood N, Sefat E, Roberts D, Gilger BC, Gluck JM. Application of Noggin-Coated Electrospun Scaffold in Corneal Wound Healing. Transl Vis Sci Technol 2023; 12:15. [PMID: 37594449 PMCID: PMC10445176 DOI: 10.1167/tvst.12.8.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/16/2023] [Indexed: 08/19/2023] Open
Abstract
Purpose The objective of this study is to develop and characterize electrospun corneal bandage infused with Noggin protein and evaluate its therapeutic potential in the treatment of superficial nonhealing corneal ulceration. Methods Electrospun nanofibrous scaffolds were created with different blend ratios of polycaprolactone and gelatin and coated with different concentrations of Noggin protein. Morphologic, mechanical, degradation, and surface chemistry of the developed scaffold was assessed. Biocompatibility of the developed scaffold with corneal epithelial cells was evaluated by looking at cell viability, proliferation, and immunostaining. In vitro wound healing in the presence of Noggin-coated scaffold was evaluated by measuring wound closure rate after scratch. Results Uniform nanofibrous scaffolds coated with Noggin were constructed through optimization of electrospinning parameters and demonstrated mechanical properties better than or similar to commercially available contact lenses used in corneal wound healing. In the presence of Noggin-coated scaffold, corneal epithelial cells showed higher proliferation and wound-healing rate. Conclusions This Noggin-coated electrospun scaffold represents a step toward, expanding treatment options for patients with indolent corneal ulcers. Translational Relevance In this study, the feasibility of Noggin-coated electrospun scaffold as a therapeutic for indolent corneal ulcer was evaluated. This study also provides a better perspective for understanding electrospun scaffolds as a tunable platform to infuse topical therapeutics and use as a corneal bandage.
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Affiliation(s)
- Nasif Mahmood
- Department of Textile Engineering, Chemistry, and Science, Wilson College of Textiles, North Carolina State University, Raleigh, NC, USA
| | - Eelya Sefat
- Department of Textile Engineering, Chemistry, and Science, Wilson College of Textiles, North Carolina State University, Raleigh, NC, USA
| | - Darby Roberts
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Brian C. Gilger
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Jessica M. Gluck
- Department of Textile Engineering, Chemistry, and Science, Wilson College of Textiles, North Carolina State University, Raleigh, NC, USA
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Zhang Y, Lin L, Zhu Y, Yang S, Huang X. Long-Term Clinical Outcome of Low-Temperature Plasma Ablation Treatment for Recurrent Corneal Erosions. J Clin Med 2022; 11:jcm11216280. [PMID: 36362507 PMCID: PMC9654815 DOI: 10.3390/jcm11216280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose: To observe the therapeutic effect of low-temperature plasma ablation in treating patients with recurrent corneal erosions (RCEs). Materials and Methods: From 2020 to 2022, 35 participants with unilateral RCEs voluntarily enrolled. Here, 35 eyes of 35 patients were treated with low-temperature plasma ablation (coblation). All surgeries were performed by the same doctor (X.H.). The coblation went back and forth over the entire erosion area around five times for about five minutes. After the operation, patients were scheduled for follow-up visits at the outpatient clinic after 1 month, 3 months, 6 months, and 12 months, and at the end of the trial. During every visit, each patient underwent an evaluation of their ocular symptoms utilizing the following: pain score, intraocular pressure, slit lamp biomicroscopic examination, dry eye analysis, corneal topography, and corneal in vivo confocal microscopy (IVCM). Results: The mean follow-up time was 12.4 ± 6.1 months, ranging from 6 to 29 months. Of the 35 patients who had low-temperature plasma ablation, 32 eyes (91.43%) were completely symptom-free and three (8.57%) eyes had repeated episodes of recurrent corneal erosions after the surgery, at 3, 10, and 12 months, respectively. The typical RCE morphologic abnormalities observed in IVCM included the deformation and relaxation of the corneal epithelium, disorganized stromal fibers, reduced nerve fiber density, and disordered organization. After low-temperature plasma ablation, the loose cysts disappeared, and the epithelium became solid and tight. There was no obvious difference in the intraocular pressure (p = 0.090) or corneal astigmatism (p = 0.175) before and after treatment. The mean pain score decreased significantly, with a preoperative score of 7.7 ± 2.4 and postoperative score of 1.1 ± 1.8 (p < 0.001). The mean corneal thickness decreased from 562.6 ± 42.2 mm to 549.6 ± 26.9 mm (p = 0.031). The mean non-invasive keratograph tear meniscus height (NIKTMH) decreased from 0.210 ± 0.054 mm to 0.208 ± 0.045 mm (p = 0.001), and the mean TBUT decreased from 6.191 ± 2.811 s to 5.815 ± 2.802 s (p < 0.001), which manifested as a slight worsening of dry eyes. In one case, the patient’s corneal astigmatism became more severe, which may be related to the high instantaneous energy when the operation did not flush in a timely manner, and it was recovered after 6 months. Conclusions: Low-temperature plasma ablation is an effective and safe procedure to treat patients with recurrent corneal erosions.
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Yang Y, Mimouni M, Trinh T, Sorkin N, Cohen E, Santaella G, Rootman DS, Chan CC, Slomovic AR. Phototherapeutic keratectomy versus epithelial debridement combined with anterior stromal puncture or diamond-dusted burr for treatment of recurrent corneal erosions. CANADIAN JOURNAL OF OPHTHALMOLOGY 2022; 58:198-203. [PMID: 35216957 DOI: 10.1016/j.jcjo.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/11/2021] [Accepted: 01/26/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To 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. METHODS Patients 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. RESULTS A 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). CONCLUSION Compared 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.
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Affiliation(s)
- Yelin Yang
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ont
| | - Michael Mimouni
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ont
| | - Tanya Trinh
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ont
| | - Nir Sorkin
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ont.; Ophthalmology Department, Assaf Harofeh Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Cohen
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ont
| | - Gisella Santaella
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ont
| | - David S Rootman
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ont
| | - Clara C Chan
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ont..
| | - Allan R Slomovic
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ont
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Recurrent corneal erosion. OPHTHALMOLOGY JOURNAL 2021. [DOI: 10.17816/ov90921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Recurrent corneal erosion (RCE) is a common recurrent disease caused by abnormal adhesion of the corneal epithelium to the basement membrane. Previous corneal trauma is the most common cause of this disease. Corneal dystrophies, such as dystrophy of the epithelial basement membrane, Meesmann dystrophy, ReisBcklers dystrophy, lattice dystrophy and granular dystrophies, are also involved in the pathogenesis of recurrent corneal erosion. The main diagnostic methods for recurrent corneal erosion are slit-lamp examination and taking of medical history. Detectable RCE changes range from small corneal irregularities (such as epithelial microcysts) to large areas of loose epithelium or epithelial defects detecting by fluorescein staining. Areas of irregular epithelium with grayish inclusions or microcysts and a fingerprint pattern or a map-like defects are also revealed. The main goal of treatment is to relieve pain, stimulate re-epithelialization, and fully restore the adhesion of the basement membrane and epithelium. Lubricants and matrix proteinase inhibitors are prescribed as first-line therapy, and blood derivatives can be used as second-line therapy. When conservative therapy fails, surgical procedures are used (excimer laser phototherapeutic keratectomy, Bowmans membrane polishing with diamond drill, anterior stromal puncture, corneal collagen cross-linking).
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Teh BL, Chua PYS, Reddy AR. Three-year outcomes of alcohol delamination of corneal epithelium for recurrent corneal erosions of traumatic etiology. Indian J Ophthalmol 2021; 69:2437-2440. [PMID: 34427239 PMCID: PMC8544076 DOI: 10.4103/ijo.ijo_3796_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Boon Lin Teh
- Eye Clinic, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, United Kingdom
| | - Paul Y S Chua
- Eye Clinic, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, United Kingdom
| | - Aravind R Reddy
- Eye Clinic, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, United Kingdom
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Meurs KM, Montgomery K, Friedenberg SG, Williams B, Gilger BC. A defect in the NOG gene increases susceptibility to spontaneous superficial chronic corneal epithelial defects (SCCED) in boxer dogs. BMC Vet Res 2021; 17:254. [PMID: 34311726 PMCID: PMC8314488 DOI: 10.1186/s12917-021-02955-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 07/01/2021] [Indexed: 12/30/2022] Open
Abstract
Background Superficial chronic corneal epithelial defects (SCCEDs) are spontaneous corneal defects in dogs that share many clinical and pathologic characteristics to recurrent corneal erosions (RCE) in humans. Boxer dogs are predisposed to SCCEDs, therefore a search for a genetic defect was performed to explain this susceptibility. DNA was extracted from blood collected from Boxer dogs with and without SCCEDs followed by whole genome sequencing (WGS). RNA sequencing of corneal tissue and immunostaining of corneal sections from affected SCCED Boxer dogs with a deletion in the NOG gene and affected non-Boxer dogs without the deletion were performed. Results A 30 base pair deletion at a splice site in Noggin (NOG) (Chr 9:31453999) was identified by WGS and was significantly associated (P < 0.0001) with Boxer SCCEDs compared to unaffected non-Boxer dogs. NOG, BMP4, MMP13, and NCAM1 all had significant fold reductions in expression and SHH was significantly increased in Boxers with the NOG deletion as identified by RNA-Seq. Corneal IHC from NOG deletion dogs with SCCEDs had lower NOG and significantly higher scores of BMP2. Conclusions Many Boxer dogs with SCCED have a genetic defect in NOG. NOG is a constitutive protein in the cornea which is a potent inhibitor of BMP, which likely regulate limbal epithelial progenitor cells (LEPC). Dysregulation of LEPC may play a role in the pathogenesis of RCE. Supplementary Information The online version contains supplementary material available at 10.1186/s12917-021-02955-1.
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Affiliation(s)
- Kathryn M Meurs
- Clinical Sciences, North Carolina State University, 1060 William Moore Drive, Raleigh, North Carolina, 27613, USA.,Present address: Upstate Veterinary Specialties, Latham, NY, USA
| | - Keith Montgomery
- Clinical Sciences, North Carolina State University, 1060 William Moore Drive, Raleigh, North Carolina, 27613, USA.,Present address: Upstate Veterinary Specialties, Latham, NY, USA
| | | | - Brian Williams
- Clinical Sciences, North Carolina State University, 1060 William Moore Drive, Raleigh, North Carolina, 27613, USA.,Present address: Upstate Veterinary Specialties, Latham, NY, USA
| | - Brian C Gilger
- Clinical Sciences, North Carolina State University, 1060 William Moore Drive, Raleigh, North Carolina, 27613, USA. .,Present address: Upstate Veterinary Specialties, Latham, NY, USA.
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Li J, Ma Y, Huang X, Xu L, Tang S. Bandage Contact Lenses versus Deproteinized Calf Blood Extract Eye Gel for Recurrent Corneal Erosion Syndrome: A Case-Control Study. Ther Clin Risk Manag 2020; 16:1109-1115. [PMID: 33223832 PMCID: PMC7671461 DOI: 10.2147/tcrm.s277282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/21/2020] [Indexed: 11/23/2022] Open
Abstract
Background The clinical efficacy of eye drops in the treatment of recurrent corneal erosion syndrome (RCES) is not satisfactory. Many studies have confirmed the positive effect of the bandage contact lens (BCL) in corneal diseases, but not many in patients with RCES. The purpose of this study is to investigate the efficacy of the BCL compared with deproteinized calf blood extract eye gel in the initial treatment of RCES. Methods Forty-seven patients with RCES treated in our hospital from September 2010 to September 2018 were retrospectively analyzed, including 24 cases (26 eyes) in the bandage contact lenses (BCLs) group wearing bandage contact lens and 23 cases (24 eyes) in the drug group treated with deproteinized calf blood extract eye gel. The efficacy was evaluated after 3 months of treatment, with a mean follow-up time of 21.15 ± 1.71 months in the BCL group and 20.87 ± 1.89 months in the drug group. Corneal erosion resolution, pain relief, visual acuity recovery time, recurrence and complications were observed. Results After 3 months of treatment, 22 eyes (22/26, 84.6%) in the BCLs group achieved complete resolution, compared with 14 eyes (14/24, 58.3%) in the drug group (P <0.05). The corneal healing time in the BCLs group was 4.77 ± 4.51 weeks, which was significantly shorter than that in the drug group (9.83 ± 5.93 weeks (P <0.01)). At 1 and 2 months after treatment, the visual analogue score (VAS) in the BCLs group (3.28 ± 1.15 at 1 month and 1.90 ± 0.77 at 2 months) decreased more significantly than that in the drug group (4.54 ± 0.89 at 1 month and 2.43 ± 0.93 at 2months, P =0.000 at 1 month and P=0.034 at 2 months). At 3 months after treatment, the mean BCVA in the BCL group (logMAR 0.03±0.08) improved more significantly than that in the drug group (logMAR 0.14±0.12,P=0.001). The complete recovery time of visual acuity was 5.46 ± 4.43 weeks in the BCLs group, compared with 10.33 ± 6.12 weeks in the drug group (P =0.003). During further follow-up, recurrence was observed in 2 eyes (2/22, 9.1%) of the BCLs group and 6 eyes (6/14, 42.8%) of the drug group. No patient in both groups developed adverse side effects. Conclusion Bandage contact lenses are safe and effective in the initial treatment of RCES. Compared with topical deproteinized calf blood extract eye gel, the use of BCLs can provide a higher cure rate, better pain control, faster visual recovery and lower recurrence rate. Trial Registration Chinese Clinical Trial Registry, ChiCTR2000031241. Registered 25 March 2020- Retrospectively registered, http://www.chictr.org.cn/edit.aspx?pid=51309andhtm=4.
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Affiliation(s)
- Jing Li
- Department of Ophthalmology, Beijing Jishuitan Hospital, Beijing, People's Republic of China
| | - Yu Ma
- Department of Ophthalmology, Beijing Jishuitan Hospital, Beijing, People's Republic of China
| | - Xiaohan Huang
- Department of Ophthalmology, Beijing Jishuitan Hospital, Beijing, People's Republic of China
| | - Lanfang Xu
- Department of Ophthalmology, Beijing Jishuitan Hospital, Beijing, People's Republic of China
| | - Shaohua Tang
- Department of Ophthalmology, Beijing Jishuitan Hospital, Beijing, People's Republic of China
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Song MY, Chung JL, Kim KY, Hwang KY, Kwon YA, Song SW, Kim BY, Koh K. Combined Phototherapeutic Keratectomy and Peripheral Anterior Stromal Puncture for the Treatment of Recurrent Corneal Erosion Syndrome. KOREAN JOURNAL OF OPHTHALMOLOGY 2020; 34:297-303. [PMID: 32783422 PMCID: PMC7419241 DOI: 10.3341/kjo.2020.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/03/2020] [Accepted: 04/16/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To investigate the efficacy of the combined phototherapeutic keratectomy (PTK) and peripheral anterior stromal puncture (ASP) compared with that of PTK alone in patients with recurrent corneal erosion syndrome (RCES). METHODS The medical records of 25 patients (25 eyes) who underwent combined treatment of PTK and peripheral ASP for RCES from March 2016 to May 2017 were retrospectively reviewed. Twenty-three patients (23 eyes) treated with PTK alone from March 2015 to February 2016 served as a control group. All surgeries were performed by a single surgeon. This retrospective clinical study comprised 48 patients (48 eyes) who were followed up for more than 18 months. Clinical records of age, sex, laterality, etiology of RCES, and history of recurrence after treatment were evaluated. RESULTS Twenty-five eyes were treated with combined PTK and ASP, and 23 eyes were treated with PTK only. The mean follow-up period was 19.63 ± 2.97 and 19.75 ± 6.83 months, respectively. There were no differences in baseline parameters between the groups. In the combined treatment group, one patient experienced recurrence 6 months after the surgery. In the single treatment group, five patients showed recurrence at 4, 7, 8, 11, and 13 months after the surgery, respectively. Compared to the single treatment group, the combined treatment group showed significantly lower recurrence rate (p < 0.05). All recurred patients required no additional treatment except temporary therapeutic contact lenses and topical lubricants. CONCLUSIONS Our findings suggest that combined treatment of PTK and peripheral ASP is effective in alleviation of symptoms and prevention of recurrence in refractory RCES compared with treatment using PTK alone.
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Affiliation(s)
- Mi Yeon Song
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | | | - Kook Young Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Kyu Yeon Hwang
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Young A Kwon
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Sang Wroul Song
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Byung Yeop Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Kyungmin Koh
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea.
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Nanba H, Mimura T, Mizuno Y, Matsumoto K, Hamano S, Ubukata S, Yamamoto M, Watanabe E, Mizota A. Clinical course and risk factors of recurrent corneal erosion: Observational study. Medicine (Baltimore) 2019; 98:e14964. [PMID: 31008925 PMCID: PMC6494251 DOI: 10.1097/md.0000000000014964] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Recurrent corneal erosion (RCE) is a common disorder causing ocular pain, tearing, photophobia, and visual impairments. Various factors such as ocular trauma, ocular surgery, corneal dystrophy, contact lens wear, and diabetes mellitus (DM) can cause RCE. The purpose of this study was to determine the causative factors and clinical course of RCE.We retrospectively examined 21 eyes of 21 patients with RCE and investigated the patients' background, type of treatments, and clinical course after the treatments. All patients were treated with eye drops, ocular lubrication, or contact lens bandage for the RCE.Among the 21 patients with RCE, 9 were caused by trauma (Trauma group), 8 by DM (DM group), 1 by bacterial corneal ulcer, 1 by lagophthalmus and bacterial corneal ulcer, 1 by bandkeratopathy, and 1 by eyelid tumor (one eye). The mean age of the patients was 57.8 years with a range 34-91 years. The mean duration from the trauma to the onset of RCE was 5.2 ± 5.0 months (mean ± SD). The time required for a complete recovery of RCE was longer in the DM group (10.3 ± 3.1 weeks) than in the Trauma group (2.7 ± 1.1 weeks, P < .01). The presence of DM was significantly associated with the recovery duration of RCE (r = 0.72; P < .01). Multivariate analyses showed that the recovery duration of RCE was associated with the presence of DM (odds ratio = 139.8, P = .04). On the other hand, the type of treatments had no effect on the recovery duration of RCE.These findings suggest that trauma and DM are important causes of RCE. Wound recovery after RCE may be delayed in patients with DM.
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Affiliation(s)
- Hisataka Nanba
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo 173-8605
| | - Tatsuya Mimura
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo 173-8605
- Department of Ophthalmology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Yoshinobu Mizuno
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo 173-8605
| | - Koichi Matsumoto
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo 173-8605
| | - Shigeki Hamano
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo 173-8605
| | - Shoko Ubukata
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo 173-8605
| | - Megumi Yamamoto
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo 173-8605
| | - Emiko Watanabe
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo 173-8605
| | - Atsushi Mizota
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo 173-8605
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Lin SR, Aldave AJ, Chodosh J. Recurrent corneal erosion syndrome. Br J Ophthalmol 2019; 103:1204-1208. [DOI: 10.1136/bjophthalmol-2019-313835] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/25/2019] [Indexed: 12/28/2022]
Abstract
Recurrent corneal erosion syndrome (RCES) is a disorder characterised by a dysfunctional epithelial ecosystem. It often begins after trauma, or in the setting of epithelial basement membrane degeneration or dystrophy. Historically, RCES has been understood as a structural derangement of the anterior corneal architecture. More recently, studies have demonstrated the important role of neuropeptides in corneal homoeostasis. Thus, RCES may also be understood as a disorder of corneal epithelial cell biology. Management of RCES can be challenging, but newer therapies have demonstrated improved efficacy for this condition. This review examines the aetiology and pathogenesis of RCES, and provides an update on current and emerging treatment modalities for the management of this disorder.
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Abstract
Purpose To comprehensively review the literature regarding recurrent corneal erosion (RCE) and to present treatment options and recommendations for management. Overview RCE usually presents with sharp, unilateral pain upon awakening, in an eye with an underlying basement membrane dystrophy, prior ocular trauma, stromal dystrophy or degeneration, or prior surgery for refractive errors, cataracts, or corneal transplantation. Making the correct diagnosis requires a careful slit-lamp examination of both eyes coupled with a high degree of suspicion. Several treatments are commonly used for RCE but new therapies have been introduced recently. Conservative treatment consists of antibiotic and preservative-free lubricating drops, with topical cycloplegics and oral analgesics to control pain. Patients who are unresponsive to these therapies may benefit from therapeutic bandage contact lenses (BCL). Newer therapies include oral matrix metalloproteinase (MMP) inhibitors, blood-derived eye drops, amniotic membrane graft application, and judicious application of topical corticosteroids. Once the epithelium is healed, a course of hypertonic saline solution and/or ointment can be used. Surgical procedures may be performed in patients who fail conservative therapy. Punctal occlusion with plugs increases the tear film volume. Epithelial debridement with diamond burr polishing (DBP), anterior stromal puncture (ASP), or alcohol delamination should be considered in selected patients. DBP can be used for patients with basement membrane dystrophies and is the preferred treatment overall due to a low recurrence rate. ASP can be used for erosions outside the central visual axis. Excimer laser phototherapeutic keratectomy is an attractive option in eyes with central RCE since it precisely removes tissue while preserving corneal transparency. In patients with RCE who are also candidates for refractive surgery, photorefractive keratectomy can be considered. Summary Newly introduced therapies for RCE enable therapy to be individualized and lower the recurrence rate.
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Affiliation(s)
- Darby D Miller
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL 32224, USA,
| | - Syed A Hasan
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL 32224, USA,
| | - Nathaniel L Simmons
- Department of Ophthalmology, University of Rochester, Rochester, NY 14642, USA
| | - Michael W Stewart
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL 32224, USA,
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Lee JY, Choi JY, Jeong J. A Case of Corneal Chemical Injury by High-dose Ethanol during Orbital Wall Fracture Repair. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.4.374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jong Young Lee
- Department of Ophthalmology, Jeju National University School of Medicine, Jeju, Korea
| | - Jung Yeol Choi
- Department of Ophthalmology, Jeju National University School of Medicine, Jeju, Korea
| | - Jinho Jeong
- Department of Ophthalmology, Jeju National University School of Medicine, Jeju, Korea
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Bae SS, Chan CC. Superficial keratectomy: indications and outcomes. Can J Ophthalmol 2018; 53:553-559. [PMID: 30502977 DOI: 10.1016/j.jcjo.2018.01.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION To evaluate the indications and outcomes of manual blade superficial keratectomy STUDY DESIGN: Retrospective, nonrandomized, consecutive case series METHODS: Database search of patients from 2012-2017 who underwent superficial keratectomy was conducted at a tertiary care hospital cornea clinic. Charts of 121 patients (156 eyes) were reviewed who had at least 4 weeks of follow-up and both preoperative and postoperative measurements of best-corrected visual acuity or corneal cylinder. Outcome measures included: patient demographics, surgical indication, prior ocular history, best-corrected visual acuity (BCVA) changes, corneal and refractive astigmatism changes, recurrence of pathology, additional treatments required, and intraoperative and postoperative complications. RESULTS Mean patient age at time of operation was 63.3 (±14.8), 39% were male. Indications included epithelial basement membrane dystrophy, recurrent corneal erosion syndrome, Salzmann nodular degeneration, band keratopathy, and suspected ocular surface neoplasia. In eyes with epithelial basement membrane dystrophy, mean BCVA (20/47 to 20/40, P = 0.033), refractive astigmatism (1.76 ± 1.83 D to 1.15 ± 1.08 D, P = 0.010), and corneal astigmatism (1.44 ± 0.88 D to 1.06 ± 0.88 D, P = 0.022) significantly improved. Twenty-four percent (5/21) of eyes with recurrent erosions had symptoms return at a mean 6.5 months follow-up. No intraoperative complications were noted. The epithelium healed completely in all 156 eyes at final follow-up. CONCLUSION Superficial keratectomy is a simple, safe procedure that can be performed for a variety of conditions to improve visual acuity, reduce corneal astigmatism, and alleviate symptoms secondary to ocular surface pathology.
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Affiliation(s)
- Steven S Bae
- School of Medicine, Queen's University, Kingston, Ont
| | - Clara C Chan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont..
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Inducing fibrogenesis and new interfibrillary bonds in post-laser in situ keratomileusis keratectasia. J Cataract Refract Surg 2018; 44:1062-1065. [PMID: 30055956 DOI: 10.1016/j.jcrs.2018.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/28/2018] [Accepted: 05/20/2018] [Indexed: 11/20/2022]
Abstract
Flap creation weakens the cornea and is a risk factor for keratectasia after laser in situ keratomileusis (LASIK). We describe a new technique to halt the progression of keratectasia by mechanically reintegrating the flap into the residual stroma. Deep stromal vertical puncturing is performed in the 4.0 to 9.0 mm paracentral corneal zone at a depth of 350 to 420 μm. The puncturing is applied in circumferential rows using a 25-gauge needle or a diamond blade, with denser puncturing at the level of the cone. In 5 eyes with worsening post-LASIK keratectasia, improved uncorrected and corrected visual acuities, corneal flattening, and a hyperopic shift were observed. There was no progression of keratectasia on serial topographies. New collagen fibrogenesis was documented by optical coherence tomography. The technique seems to be promising to halt the progression of post-LASIK keratectasia. More clinical data and longer follow-up are needed for validation.
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Churashov SV, Kudryashova EV, Kulikov AN, Boiko EV, Chernysh VF, Maltsev DS. "Wet" transepithelial phototherapeutic keratectomy in the management of persistent epithelial defects in the graft. Clin Ophthalmol 2018; 12:895-901. [PMID: 29785085 PMCID: PMC5957060 DOI: 10.2147/opth.s161018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to evaluate the efficacy of “wet” transepithelial phototherapeutic keratectomy (TE-PTK) for treating persistent epithelial defects (PEDs) in the corneal graft following penetrating keratoplasty (PKP). Methods This study describes a noncomparative, prospective interventional case series. Patients with post-PKP graft epithelial defects lasting >3 months despite previous treatments with extensive wear soft contact lenses, amniotic membrane transplantation, and tarsorrhaphy were treated with wet TE-PTK. A wet TE-PTK procedure including a “wet ablation” step was performed using the EC-5000 excimer laser. Follow-up visits were at post-PTK days 3, 5, 10, and 30, and at each month thereafter. Results Eight patients (8 eyes; 5 men and 3 women; mean age, 51.3±14.3 years; mean follow-up period, 9.1±3.0 months) were included in this study. The mean best-corrected visual acuity was 1.76±0.28 log minimum angle of resolution (logMAR) at baseline and improved to 1.1±0.22 logMAR at 10 days postoperatively (p=0.0156; the improvement was significant). This effect remained stable throughout the remainder of the follow-up period. The mean time from wet TE-PTK to complete reepithelization was 4.3±1.3 days. Conclusion Wet TE-PTK appears to be effective for patients with post-PKP PEDs in the corneal graft who have failed conservative measures or previous surgical interventions.
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Affiliation(s)
- Sergei V Churashov
- Department of Ophthalmology, Military Medical Academy, St Petersburg, Russia
| | - Elena V Kudryashova
- Department of Ophthalmology, Military Medical Academy, St Petersburg, Russia
| | - Alexei N Kulikov
- Department of Ophthalmology, Military Medical Academy, St Petersburg, Russia
| | - Ernest V Boiko
- Department of Ophthalmology, Military Medical Academy, St Petersburg, Russia.,St Petersburg Branch, The S Fyodorov Eye Microsurgery Federal State Institution, St Petersburg, Russia.,Department of Ophthalmology, Mechnikov North-Western State Medical University, St Petersburg, Russia
| | - Valerii F Chernysh
- Department of Ophthalmology, Military Medical Academy, St Petersburg, Russia
| | - Dmitrii S Maltsev
- Department of Ophthalmology, Military Medical Academy, St Petersburg, Russia
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Oikonomakis K, Petrelli M, Petrovic A, Andreanos K, Droutsas K, Georgalas I, Kymionis G. Epithelial map-guided anterior stromal micropuncture for the treatment of recurrent corneal erosion syndrome. Int Ophthalmol 2018; 39:943-948. [DOI: 10.1007/s10792-018-0891-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 03/13/2018] [Indexed: 11/29/2022]
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Kim HJ, Koh JW. Effects of Diamond Burr in Patients with Recurrent Corneal Erosion. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.8.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hyun Ju Kim
- Department of Ophthalmology, Chosun University College of Medicine, Gwangju, Korea
| | - Jae Wong Koh
- Department of Ophthalmology, Chosun University College of Medicine, Gwangju, Korea
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Shin DY, Chung SH. Efficacy of Anterior Stromal Puncture Using 5% NaCl Eye Drops for Prolonged Time in Recurrent Corneal Erosion Syndrome. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.5.503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Da-Young Shin
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Hyang Chung
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Bae KH, Ahn M, Cho NC, You IC. Clinical Presentation and Treatment Outcomes of Recurrent Corneal Erosion. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.4.555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kyoung Hwa Bae
- Department of Ophthalmology, Chonbuk National University Medical School1, Jeonju, Korea
| | - Min Ahn
- Department of Ophthalmology, Chonbuk National University Medical School1, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
| | - Nam Chun Cho
- Department of Ophthalmology, Chonbuk National University Medical School1, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
| | - In Cheon You
- Department of Ophthalmology, Chonbuk National University Medical School1, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
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Abstract
PURPOSE To highlight the finding of occult areas of poor epithelial adhesion in the superior perilimbal cornea in a minority of patients with recalcitrant recurrent corneal erosion syndrome presenting with corneal erosion elsewhere on the corneal surface. PATIENT POPULATION Thirty-one eyes of 31 consecutive patients with corneal erosion undergoing mechanical debridement of the epithelium before diamond burr keratectomy for recurrent corneal erosion. METHODS Thirty-one eyes of 31 consecutive patients with recurrent corneal erosion were examined for poor epithelial adhesion determined by mechanical debridement with a dry microsponge. RESULTS During debridement, 8 of 31 eyes (25.8%) displayed a large arcuate area of occult dysfunction of adhesion in the superior perilimbal area. None of these eyes showed recurrence over a mean of 18 months after diamond burr keratectomy (95% confidence interval, 0%-36.9%). CONCLUSIONS Mechanical debridement with a microsponge identified a significant minority of patients with poor adhesion in the superior perilimbal cornea away from the area of obvious erosion and increased the target area for diamond burr keratectomy. This 2-pronged approach allowed successful management of this group.
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Choi M, Jung JW, Seo KY, Kim EK, Kim TI. Comparison of Nd:YAG Laser versus Conservative Management in the Treatment of Recurrent Corneal Erosion. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.5.687] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Moonjung Choi
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Won Jung
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Yul Seo
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Eung Kweon Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Im Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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