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Xu G, Qi H, He Q, Chen M, Fu J, Wang Q, Chen B, Yang QH, Huang Y, Wei S, Wang L. Predicting visual outcomes in keratoprosthesis surgery with critical flicker fusion frequency, B-scan, visual electrophysiology and endoscopy. Br J Ophthalmol 2024:bjo-2024-325719. [PMID: 39153832 DOI: 10.1136/bjo-2024-325719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/20/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE This study evaluates the predictive power of the critical flicker fusion frequency (CFF) test for visual outcomes in keratoprosthesis (KPro) candidates, comparing its accuracy with B-scan ultrasound, flash visual evoked potentials (fVEP) and endoscopy. METHODS The study included 42 patients (42 eyes) scheduled for KPro surgery with a median follow-up period of 6 months. The receiver operating characteristic curve identified the cut-off threshold for CFF in the model development study (17 eyes). All patients in the comparison study (25 eyes) underwent preoperative assessments including trichromatic CFF (red, green and yellow), B-scan ultrasound, fVEP and perioperative endoscopy. Results were classified as either favourable or unfavourable predictors of visual outcomes based on predefined criteria. Sensitivity and specificity of each assessment were calculated based on postoperative best-corrected visual acuity (BCVA)≥20/200. The Bland-Altman test assessed the consistency between CFF-predicted BCVA and actual BCVA. RESULTS Among the trichromatic CFF tests, the yellow-CFF (yCFF) exhibited the highest area under the curve value of 0.97 and a cut-off threshold at 10 Hz for predicting postoperative BCVA≥20/200 (p<0.05). yCFF achieved 90% sensitivity and 80% specificity in predicting satisfactory postoperative outcomes. Endoscopy had 80% sensitivity and 80% specificity, B-scan showed 70% sensitivity and 60% specificity, and fVEP had 75% sensitivity and 40% specificity. yCFF showed a mean bias of 0.091 logarithm of the minimum angle of resolution (logMAR) in postoperative prediction. CONCLUSIONS The CFF test provides robust visual function evaluation in KPro candidates. It demonstrates superior predictive accuracy for visual prognosis compared with routine ophthalmologic examinations, such as B-scan ultrasonography, fVEP and endoscopy.
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Affiliation(s)
- Guangcan Xu
- School of Medicine, Nankai University, Tianjin, China
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Haolan Qi
- School of Medicine, Nankai University, Tianjin, China
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qianwei He
- School of Medicine, Nankai University, Tianjin, China
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Mingxiong Chen
- School of Medicine, Nankai University, Tianjin, China
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Junxia Fu
- Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qun Wang
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Biyue Chen
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Qing Hua Yang
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yifei Huang
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Shihui Wei
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Liqiang Wang
- School of Medicine, Nankai University, Tianjin, China
- Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
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Paschalis EI, Zhou C, Sharma J, Dohlman TH, Kim S, Lei F, Chodosh J, Vavvas D, Urtti A, Papaliodis G, Dohlman CH. The prophylactic value of TNF-α inhibitors against retinal cell apoptosis and optic nerve axon loss after corneal surgery or trauma. Acta Ophthalmol 2024; 102:e381-e394. [PMID: 37803488 PMCID: PMC10997738 DOI: 10.1111/aos.15786] [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: 03/13/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND AND PURPOSE Late secondary glaucoma is an often-severe complication after acute events like anterior segment surgery, trauma and infection. TNF-α is a major mediator that is rapidly upregulated, diffusing also to the retina and causes apoptosis of the ganglion cells and degeneration of their optic nerve axons (mediating steps to glaucomatous damage). Anti-TNF-α antibodies are in animals very effective in protecting the retinal cells and the optic nerve-and might therefore be useful prophylactically against secondary glaucoma in future such patients. Here we evaluate (1) toxicity and (2) efficacy of two TNF-α inhibitors (adalimumab and infliximab), in rabbits by subconjunctival administration. METHODS For drug toxicity, animals with normal, unburned corneas were injected with adalimumab (0.4, 4, or 40 mg), or infliximab (1, 10, or 100 mg). For drug efficacy, other animals were subjected to alkali burn before such injection, or steroids (for control). The rabbits were evaluated clinically with slit lamp and photography, electroretinography, optical coherence tomography, and intraocular pressure manometry. A sub-set of eyes were stained ex vivo after 3 days for retinal cell apoptosis (TUNEL). In other experiments the optic nerves were evaluated by paraphenylenediamine staining after 50 or 90 days. Loss of retinal cells and optic nerve degeneration were quantified. RESULTS Subconjunctival administration of 0.4 mg or 4.0 mg adalimumab were well tolerated, whereas 40.0 mg was toxic to the retina. 1, 10, or 100 mg infliximab were also well tolerated. Analysis of the optic nerve axons after 50 days confirmed the safety of 4.0 mg adalimumab and of 100 mg infliximab. For efficacy, 4.0 mg adalimumab subconjunctivally in 0.08 mL provided practically full protection against retinal cell apoptosis 3 days following alkali burn, and infliximab 100 mg only slightly less. At 90 days following burn injury, control optic nerves showed about 50% axon loss as compared to 8% in the adalimumab treatment group. CONCLUSIONS Subconjunctival injection of 4.0 mg adalimumab in rabbits shows no eye toxicity and provides excellent neuroprotection, both short (3 days) and long-term (90 days). Our total. accumulated data from several of our studies, combined with the present paper, suggest that corneal injuries, including surgery, might benefit from routine administration of anti-TNF-α biologics to reduce inflammation and future secondary glaucoma.
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Affiliation(s)
- Eleftherios I. Paschalis
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Chengxin Zhou
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jyoti Sharma
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas H. Dohlman
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Kim
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Fengyang Lei
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - James Chodosh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Demetrios Vavvas
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Angiogenesis Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Arto Urtti
- Division of Pharmaceutical Biosciences, University of Helsinki, Finland and School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - George Papaliodis
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Claes H. Dohlman
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Liu Z, Liu K, Shi S, Chen X, Gu X, Wang W, Mao K, Yibulayi R, Wu W, Zeng L, Zhou W, Lin X, Zhang F, Lou B. Alkali injury-induced pathological lymphangiogenesis in the iris facilitates the infiltration of T cells and ocular inflammation. JCI Insight 2024; 9:e175479. [PMID: 38587075 PMCID: PMC11128208 DOI: 10.1172/jci.insight.175479] [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: 09/05/2023] [Accepted: 02/14/2024] [Indexed: 04/09/2024] Open
Abstract
Inflammatory lymphangiogenesis is intimately linked to immune regulation and tissue homeostasis. However, current evidence has suggested that classic lymphatic vessels are physiologically absent in intraocular structures. Here, we show that neolymphatic vessels were induced in the iris after corneal alkali injury (CAI) in a VEGFR3-dependent manner. Cre-loxP-based lineage tracing revealed that these lymphatic endothelial cells (LECs) originate from existing Prox1+ lymphatic vessels. Notably, the ablation of iridial lymphangiogenesis via conditional deletion of VEGFR3 alleviated the ocular inflammatory response and pathological T cell infiltration. Our findings demonstrate that iridial neolymphatics actively participate in pathological immune responses following injury and suggest intraocular lymphangiogenesis as a valuable therapeutic target for the treatment of ocular inflammation.
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Affiliation(s)
- Zheng Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Keli Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Shunhua Shi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xun Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xinyu Gu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Weifa Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Keli Mao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Rukeye Yibulayi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Wanwen Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Lei Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Weibin Zhou
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaofeng Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Feng Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Bingsheng Lou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
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Orive Bañuelos A, Fideliz de la Paz M, Feijóo Lera R, Santamaría Carro A, Martínez Grau A, Andollo Victoriano N, Etxebarria Ecenarro J. Transmucosal Boston Keratoprosthesis Type II in a Case of Severe Bilateral Chemical Burn. Cornea 2024; 43:261-264. [PMID: 37906002 DOI: 10.1097/ico.0000000000003426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/08/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE The purpose of this report was to describe a new alternative surgical technique combining oral mucosa and the Boston Keratoprosthesis type II (BKPro II) in a patient with severe chemical burn. METHODS We present a case of a 37-year-old man who suffered a severe bilateral chemical burn. Visual acuity was light perception and projection in both eyes. After many surgeries, including eyelid reconstruction, eyelashes electrolysis, and amniotic membrane transplants, he presented a corneal thinning in his right eye that was managed with an autologous oral mucosa graft. Considering the limited function of the eyelids, mild symblepharon, and dry ocular surface, we proposed the implantation of a BKPro II. The patient voiced his desire of avoiding complete tarsorrhaphy for better cosmesis. Osteo-odonto-keratoprosthesis or tibial bone keratoprothesis was also discarded at the patient's express wish. A year and a half later, the oral mucosa was transplanted, and once the ocular surface was stabilized, we lift the mucosa 270 degrees and performed the implantation of the BKPro II covering this device with the mucosa trephined avoiding the complete tarsorrhaphy and theraby modifying the standard procedure. RESULTS After 34 months of follow-up, the patient did not develop any complications, his visual acuity is stable (0.3 decimal), and funduscopic examination showed a pale optic disk, vascular tortuosity, and an epiretinal membrane that remains stable up to this period. CONCLUSIONS Transmucosal BKPro II may be considered as an alternative surgical technique for implant support in BKPro II carriers who want to improve their cosmesis avoiding, avoid complete tarsorrhaphy, and do not want to be exposed to dental or bone surgeries.
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Affiliation(s)
- Ana Orive Bañuelos
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, University Hospital of Cruces, Barakaldo, Spain
| | - María Fideliz de la Paz
- Centro de Oftalmología Barraquer, Universitat Internacional de Catalunya, Barcelona, Spain
- Institut Universitari Barraquer, Universitat Autónoma de Barcelona, Barcelona, Spain; and
| | - Raquel Feijóo Lera
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, University Hospital of Cruces, Barakaldo, Spain
| | - Alaitz Santamaría Carro
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, University Hospital of Cruces, Barakaldo, Spain
| | - Ainhoa Martínez Grau
- Centro de Oftalmología Barraquer, Universitat Internacional de Catalunya, Barcelona, Spain
- Institut Universitari Barraquer, Universitat Autónoma de Barcelona, Barcelona, Spain; and
| | - Noelia Andollo Victoriano
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, University Hospital of Cruces, Barakaldo, Spain
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country (UPV/ EHU), Leioa, Spain
| | - Jaime Etxebarria Ecenarro
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, University Hospital of Cruces, Barakaldo, Spain
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country (UPV/ EHU), Leioa, Spain
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Cao X, Wang C, Deng Z, Zhong Y, Chen H. Efficient ocular delivery of siRNA via pH-sensitive vehicles for corneal neovascularization inhibition. Int J Pharm X 2023; 5:100183. [PMID: 37234133 PMCID: PMC10206438 DOI: 10.1016/j.ijpx.2023.100183] [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: 02/15/2023] [Revised: 04/05/2023] [Accepted: 04/28/2023] [Indexed: 05/27/2023] Open
Abstract
Corneal neovascularization (CoNV)-induced blindness is an enduring and challenging condition with limited management options. Small interfering RNA (siRNA) is a promising strategy for preventing CoNV. This study reported a new strategy using siVEGFA to silence vascular endothelial growth factor A (VEGFA) for CoNV treatment. To improve the efficacy of siVEGFA delivery, a pH-sensitive polycationic mPEG2k-PAMA30-P(DEA29-D5A29) (TPPA) was fabricated. TPPA/siVEGFA polyplexes enter cells via clathrin-mediated endocytosis, resulting in higher cellular uptake efficiency and comparable silencing efficiency than that of Lipofectamine 2000 in vitro. Hemolytic assays verified that TPPA safe in normal physiological environments (pH 7.4) but can easily destroy membranes in acidic mature endosomes (pH 4.0). Studies on the distribution of TPPA in vivo showed that it could prolong the retention time of siVEGFA and promote its penetration in the cornea. In a mouse model induced by alkali burn, TPPA efficiently delivered siVEGFA to the lesion site and achieved VEGFA silencing efficiency. Importantly, the inhibitory effect of TPPA/siVEGFA on CoNV was comparable to that of the anti-VEGF drug ranibizumab. Delivering siRNA using pH-sensitive polycations to the ocular environment provides a new strategy to efficiently inhibit CoNV.
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Affiliation(s)
- Xiaowen Cao
- School of Ophthalmology and Optometry/School of Biomedical Engineering, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Changrong Wang
- Engineering Research Center of Molecular & Neuroimaging, Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Zhennv Deng
- School of Ophthalmology and Optometry/School of Biomedical Engineering, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Yiming Zhong
- School of Ophthalmology and Optometry/School of Biomedical Engineering, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Hao Chen
- School of Ophthalmology and Optometry/School of Biomedical Engineering, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
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Zhou C, Lei F, Mittermaier M, Ksander B, Dana R, Dohlman CH, Vavvas DG, Chodosh J, Paschalis EI. Opposing Roles of Blood-Borne Monocytes and Tissue-Resident Macrophages in Limbal Stem Cell Damage after Ocular Injury. Cells 2023; 12:2089. [PMID: 37626899 PMCID: PMC10453077 DOI: 10.3390/cells12162089] [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: 07/04/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Limbal stem cell (LSC) deficiency is a frequent and severe complication after chemical injury to the eye. Previous studies have assumed this is mediated directly by the caustic agent. Here we show that LSC damage occurs through immune cell mediators, even without direct injury to LSCs. In particular, pH elevation in the anterior chamber (AC) causes acute uveal stress, the release of inflammatory cytokines at the basal limbal tissue, and subsequent LSC damage and death. Peripheral C-C chemokine receptor type 2 positive/CX3C motif chemokine receptor 1 negative (CCR2+ CX3CR1-) monocytes are the key mediators of LSC damage through the upregulation of tumor necrosis factor-alpha (TNF-α) at the limbus. In contrast to peripherally derived monocytes, CX3CR1+ CCR2- tissue-resident macrophages have a protective role, and their depletion prior to injury exacerbates LSC loss and increases LSC vulnerability to TNF-α-mediated apoptosis independently of CCR2+ cell infiltration into the tissue. Consistently, repopulation of the tissue by new resident macrophages not only restores the protective M2-like phenotype of macrophages but also suppresses LSC loss after exposure to inflammatory signals. These findings may have clinical implications in patients with LSC loss after chemical burns or due to other inflammatory conditions.
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Affiliation(s)
- Chengxin Zhou
- Department of Ophthalmology, Massachusetts Eye and Ear and Schepens Eye Research Institute, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA; (C.Z.); (F.L.); (M.M.); (B.K.); (R.D.); (C.H.D.); (J.C.)
- Boston Keratoprosthesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA
- Disruptive Technology Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - Fengyang Lei
- Department of Ophthalmology, Massachusetts Eye and Ear and Schepens Eye Research Institute, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA; (C.Z.); (F.L.); (M.M.); (B.K.); (R.D.); (C.H.D.); (J.C.)
- Boston Keratoprosthesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA
- Disruptive Technology Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - Mirja Mittermaier
- Department of Ophthalmology, Massachusetts Eye and Ear and Schepens Eye Research Institute, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA; (C.Z.); (F.L.); (M.M.); (B.K.); (R.D.); (C.H.D.); (J.C.)
| | - Bruce Ksander
- Department of Ophthalmology, Massachusetts Eye and Ear and Schepens Eye Research Institute, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA; (C.Z.); (F.L.); (M.M.); (B.K.); (R.D.); (C.H.D.); (J.C.)
| | - Reza Dana
- Department of Ophthalmology, Massachusetts Eye and Ear and Schepens Eye Research Institute, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA; (C.Z.); (F.L.); (M.M.); (B.K.); (R.D.); (C.H.D.); (J.C.)
| | - Claes H. Dohlman
- Department of Ophthalmology, Massachusetts Eye and Ear and Schepens Eye Research Institute, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA; (C.Z.); (F.L.); (M.M.); (B.K.); (R.D.); (C.H.D.); (J.C.)
- Boston Keratoprosthesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA
| | - Demetrios G. Vavvas
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA;
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear and Schepens Eye Research Institute, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA; (C.Z.); (F.L.); (M.M.); (B.K.); (R.D.); (C.H.D.); (J.C.)
- Boston Keratoprosthesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA
- Disruptive Technology Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
- Department of Ophthalmology and Visual Sciences, University of New Mexico School of Medicine, Albuquerque, NM 87108, USA
| | - Eleftherios I. Paschalis
- Department of Ophthalmology, Massachusetts Eye and Ear and Schepens Eye Research Institute, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA; (C.Z.); (F.L.); (M.M.); (B.K.); (R.D.); (C.H.D.); (J.C.)
- Boston Keratoprosthesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear, Mass General Brigham, Harvard Medical School, Boston, MA 02114, USA
- Disruptive Technology Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
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Graca M, Sarantopoulos K, Horn DB. Chemical toxic exposures and chronic ocular pain. FRONTIERS IN TOXICOLOGY 2023; 5:1188152. [PMID: 37637478 PMCID: PMC10448520 DOI: 10.3389/ftox.2023.1188152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/18/2023] [Indexed: 08/29/2023] Open
Abstract
Chronic ocular pain is a common, debilitating chronic pain condition with significant morbidity and negative impact in patients' quality of life. Several, diverse types of insults to the ocular surface can lead to acute, and under certain conditions to chronic ocular pain, and these include toxic irritants. Exposure of ocular surface to toxic irritants, in addition to direct tissue injury, carries the capacity to generated intense immune and neuronal responses with hyper-excitability, sensitization and chronic pain. Because, chronic ocular pain subsequent to toxic exposures is relatively unrecognized clinical entity, this brief review highlights pertinent concepts of its epidemiology, pathogenesis/pathophysiology, clinical progression, with recommendations for its clinical management that clinicians may find helpful. Suppression of pain signaling, generating neuronal sensitization, and prevention of chronicity of neuropathic pain is particularly emphasized in this respect.
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Affiliation(s)
- Mateusz Graca
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, United States
| | - Konstantinos Sarantopoulos
- Department of Anesthesiology, Perioperative Medicine and Pain Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Danielle Bodzin Horn
- Department of Anesthesiology, Perioperative Medicine and Pain Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
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Zhou C, Lei F, Sharma J, Hui PC, Wolkow N, Dohlman CH, Vavvas DG, Chodosh J, Paschalis EI. Sustained Inhibition of VEGF and TNF-α Achieves Multi-Ocular Protection and Prevents Formation of Blood Vessels after Severe Ocular Trauma. Pharmaceutics 2023; 15:2059. [PMID: 37631272 PMCID: PMC10458495 DOI: 10.3390/pharmaceutics15082059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE This study aimed to develop a clinically feasible and practical therapy for multi-ocular protection following ocular injury by using a thermosensitive drug delivery system (DDS) for sustained delivery of TNF-α and VEGF inhibitors to the eye. METHODS A thermosensitive, biodegradable hydrogel DDS (PLGA-PEG-PLGA triblock polymer) loaded with 0.7 mg of adalimumab and 1.4 mg of aflibercept was injected subconjunctivally into Dutch-belted pigmented rabbits after corneal alkali injury. Control rabbits received 2 mg of IgG-loaded DDS or 1.4 mg of aflibercept-loaded DDS. Animals were followed for 3 months and assessed for tolerability and prevention of corneal neovascularization (NV), improvement of corneal re-epithelialization, inhibition of retinal ganglion cell (RGC) and optic nerve axon loss, and inhibition of immune cell infiltration into the cornea. Drug-release kinetics was assessed in vivo using an aqueous humor protein analysis. RESULTS A single subconjunctival administration of dual anti-TNF-α/anti-VEGF DDS achieved a sustained 3-month delivery of antibodies to the anterior chamber, iris, ciliary body, and retina. Administration after corneal alkali burn suppressed CD45+ immune cell infiltration into the cornea, completely inhibited cornea NV for 3 months, accelerated corneal re-epithelialization and wound healing, and prevented RGC and optic nerve axon loss at 3 months. In contrast, anti-VEGF alone or IgG DDS treatment led to persistent corneal epithelial defect (combined: <1%; anti-VEGF: 15%; IgG: 10%, of cornea area), increased infiltration of CD45+ immune cells into the cornea (combined: 28 ± 20; anti-VEGF: 730 ± 178; anti-IgG: 360 ± 186, cells/section), and significant loss of RGCs (combined: 2.7%; anti-VEGF: 63%; IgG: 45%) and optic nerve axons at 3 months. The aqueous humor protein analysis showed first-order release kinetics without adverse effects at the injection site. CONCLUSIONS Concomitant inhibition of TNF-α and VEGF prevents corneal neovascularization and ameliorates subsequent irreversible damage to the retina and optic nerve after severe ocular injury. A single subconjunctival administration of this therapy, using a biodegradable, slow-release thermosensitive DDS, achieved the sustained elution of therapeutic levels of antibodies to all ocular tissues for 3 months. This therapeutic approach has the potential to dramatically improve the outcomes of severe ocular injuries in patients and improve the therapeutic outcomes in patients with retinal vascular diseases.
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Affiliation(s)
- Chengxin Zhou
- Department of Ophthalmology, Harvard Medical School, Boston, MA 02115, USA; (C.Z.); (F.L.); (P.-C.H.); (N.W.); (C.H.D.); (D.G.V.)
- Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear, Boston, MA 02114, USA
| | - Fengyang Lei
- Department of Ophthalmology, Harvard Medical School, Boston, MA 02115, USA; (C.Z.); (F.L.); (P.-C.H.); (N.W.); (C.H.D.); (D.G.V.)
- Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear, Boston, MA 02114, USA
| | - Jyoti Sharma
- Department of Ophthalmology, Harvard Medical School, Boston, MA 02115, USA; (C.Z.); (F.L.); (P.-C.H.); (N.W.); (C.H.D.); (D.G.V.)
- Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear, Boston, MA 02114, USA
| | - Pui-Chuen Hui
- Department of Ophthalmology, Harvard Medical School, Boston, MA 02115, USA; (C.Z.); (F.L.); (P.-C.H.); (N.W.); (C.H.D.); (D.G.V.)
- Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear, Boston, MA 02114, USA
| | - Natalie Wolkow
- Department of Ophthalmology, Harvard Medical School, Boston, MA 02115, USA; (C.Z.); (F.L.); (P.-C.H.); (N.W.); (C.H.D.); (D.G.V.)
- David G. Cogan Laboratory of Eye Pathology and Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Boston, MA 02114, USA
| | - Claes H. Dohlman
- Department of Ophthalmology, Harvard Medical School, Boston, MA 02115, USA; (C.Z.); (F.L.); (P.-C.H.); (N.W.); (C.H.D.); (D.G.V.)
- Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear, Boston, MA 02114, USA
| | - Demetrios G. Vavvas
- Department of Ophthalmology, Harvard Medical School, Boston, MA 02115, USA; (C.Z.); (F.L.); (P.-C.H.); (N.W.); (C.H.D.); (D.G.V.)
- Angiogenesis Laboratory, Massachusetts Eye and Ear, Boston, MA 02114, USA
| | - James Chodosh
- Department of Ophthalmology, Harvard Medical School, Boston, MA 02115, USA; (C.Z.); (F.L.); (P.-C.H.); (N.W.); (C.H.D.); (D.G.V.)
- Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear, Boston, MA 02114, USA
- Disruptive Technology Laboratory, Massachusetts Eye and Ear, Boston, MA 02114, USA
- Department of Ophthalmology and Visual Sciences, University of New Mexico School of Medicine, Albuquerque, NM 87108, USA
| | - Eleftherios I. Paschalis
- Department of Ophthalmology, Harvard Medical School, Boston, MA 02115, USA; (C.Z.); (F.L.); (P.-C.H.); (N.W.); (C.H.D.); (D.G.V.)
- Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear, Boston, MA 02114, USA
- Disruptive Technology Laboratory, Massachusetts Eye and Ear, Boston, MA 02114, USA
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9
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Yu J, Shen Y, Luo J, Jin J, Li P, Feng P, Guan H. Upadacitinib inhibits corneal inflammation and neovascularization by suppressing M1 macrophage infiltration in the corneal alkali burn model. Int Immunopharmacol 2023; 116:109680. [PMID: 36739832 DOI: 10.1016/j.intimp.2023.109680] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/21/2022] [Accepted: 12/31/2022] [Indexed: 02/05/2023]
Abstract
Alkali burn-induced corneal inflammation and subsequent corneal neovascularization (CNV) are major causes of corneal opacity and vision loss. M1 macrophages play a central role in inflammation and CNV. Therefore, modulation of M1 macrophage polarization is a promising strategy for corneal alkali burns. Here, we illustrate the effect and underlying mechanisms of upadacitinib on corneal inflammation and CNV induced by alkali burns in mice. The corneas of BALB/c mice were administered with 1 M NaOH for 30 s and randomly assigned to the vehicle group and the upadacitinib-treated group. Corneal opacity and corneal epithelial defects were assessed clinically. Quantitative real-time PCR (qRT-PCR), immunohistochemistry, and western blot analysis were performed to detect M1 macrophage polarization and CD31+ corneal blood vessels. The results showed that upadacitinib notably decreased corneal opacity, and promoted corneal wound healing. On day 7 and 14 after alkali burns, upadacitinib significantly suppressed CNV. Corneal alkali injury caused M1 macrophage recruitment in the cornea. In contrast to the vehicle, upadacitinib suppressed M1 macrophage infiltration and decreased the mRNA expression levels of inducible nitric oxide synthase (iNOS), monocyte chemotactic protein-1 (MCP-1), tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, IL-1β, and vascular endothelial growth factor A (VEGF-A) in alkali-injured corneas. Moreover, upadacitinib dose-dependently inhibited M1 macrophage polarization by suppressing interferon (IFN)-γ-/lipopolysaccharide-stimulated STAT1 activation in vitro. Our findings reveal that upadacitinib can efficiently alleviate alkali-induced corneal inflammation and neovascularization by inhibiting M1 macrophage infiltration. These data demonstrate that upadacitinib is an effective drug for the treatment of corneal alkali burns.
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Affiliation(s)
- Jianfeng Yu
- Eye Institute, Affiliated Hospital of Nantong University, Nantong 226001, China; Medical School of Nantong University, Nantong 226001, China
| | - Yao Shen
- Eye Institute, Affiliated Hospital of Nantong University, Nantong 226001, China; Medical School of Nantong University, Nantong 226001, China
| | - Jiawei Luo
- Eye Institute, Affiliated Hospital of Nantong University, Nantong 226001, China; Medical School of Nantong University, Nantong 226001, China
| | - Juan Jin
- Nantong Hospital of Traditional Chinese Medicine, Nantong 226001, China
| | - Pengfei Li
- Eye Institute, Affiliated Hospital of Nantong University, Nantong 226001, China; Medical School of Nantong University, Nantong 226001, China
| | - Peida Feng
- Medical School of Nantong University, Nantong 226001, China
| | - Huaijin Guan
- Eye Institute, Affiliated Hospital of Nantong University, Nantong 226001, China; Medical School of Nantong University, Nantong 226001, China.
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10
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Balla A, Tran B, Valtari A, Steven P, Scarpellini C, Augustyns K, Urtti A, Vellonen KS, Ruponen M. A Novel Ferroptosis Inhibitor UAMC-3203, a Potential Treatment for Corneal Epithelial Wound. Pharmaceutics 2022; 15:pharmaceutics15010118. [PMID: 36678747 PMCID: PMC9863691 DOI: 10.3390/pharmaceutics15010118] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 01/01/2023] Open
Abstract
Corneal wound, associated with pain, impaired vision, and even blindness, is the most common ocular injury. In this study, we investigated the effect of a novel ferroptosis inhibitor, UAMC-3203 (10 nM-50 µM), in corneal epithelial wound healing in vitro in human corneal epithelial (HCE) cells and ex vivo using alkali-induced corneal wounded mice eye model. We evaluated in vivo acute tolerability of the compound by visual inspection, optical coherence tomography (OCT), and stereomicroscope imaging in rats after its application (100 µM drug solution in phosphate buffer pH 7.4) twice a day for 5 days. In addition, we studied the partitioning of UAMC-3203 in corneal epithelium and corneal stroma using excised porcine cornea. Our study demonstrated that UAMC-3203 had a positive corneal epithelial wound healing effect at the optimal concentration of 10 nM (IC50 value for ferroptosis) in vitro and at 10 µM in the ex vivo study. UAMC-3203 solution (100 µM) was well tolerated after topical administration with no signs of toxicity and inflammation in rats. Ex-vivo distribution study revealed significantly higher concentration (~12-38-fold) and partition coefficient (Kp) (~52 times) in corneal epithelium than corneal stroma. The UAMC-3203 solution (100 µM) was stable for up to 30 days at 4 °C, 37 °C, and room temperature. Overall, UAMC-3203 provides a new prospect for safe and effective therapy for corneal wounds.
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Affiliation(s)
- Anusha Balla
- School of Pharmacy, University of Eastern Finland, Yliopistonranta 1, 70211 Kuopio, Finland
- Correspondence:
| | - Bao Tran
- Division of Dry-Eye and Ocular GVHD, Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50923 Cologne, Germany
| | - Annika Valtari
- School of Pharmacy, University of Eastern Finland, Yliopistonranta 1, 70211 Kuopio, Finland
| | - Philipp Steven
- Division of Dry-Eye and Ocular GVHD, Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50923 Cologne, Germany
| | - Camilla Scarpellini
- Laboratory of Medicinal Chemistry, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, Campus Drie Eiken, University of Antwerp, Universiteitsplein 1, B-2160 Antwerp, Belgium
| | - Koen Augustyns
- Laboratory of Medicinal Chemistry, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, Campus Drie Eiken, University of Antwerp, Universiteitsplein 1, B-2160 Antwerp, Belgium
| | - Arto Urtti
- School of Pharmacy, University of Eastern Finland, Yliopistonranta 1, 70211 Kuopio, Finland
- Faculty of Pharmacy, University of Helsinki, 00014 Helsinki, Finland
| | - Kati-Sisko Vellonen
- School of Pharmacy, University of Eastern Finland, Yliopistonranta 1, 70211 Kuopio, Finland
| | - Marika Ruponen
- School of Pharmacy, University of Eastern Finland, Yliopistonranta 1, 70211 Kuopio, Finland
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11
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Li S, Pang K, Zhu S, Pate K, Yin J. Perfluorodecalin-based oxygenated emulsion as a topical treatment for chemical burn to the eye. Nat Commun 2022; 13:7371. [PMID: 36450767 PMCID: PMC9712419 DOI: 10.1038/s41467-022-35241-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Chemical injuries to the eye are emergencies with limited acute treatment options other than prompt irrigation and can cause permanent vision loss. We developed a perfluorodecalin-based supersaturated oxygen emulsion (SSOE) to topically deliver high concentration of oxygen to the eye. SSOE is manufactured in hyperbaric conditions and stored in a ready-to-use canister. Upon dispensation, SSOE rapidly raises partial oxygen pressure 3 times over atmospheric level. SSOE is biocompatible with human corneal cells and safe on mouse eyes in vivo. A single topical application of SSOE to the eye after alkali injury significantly promotes corneal epithelial wound healing, decreases anterior chamber exudation, and reduces optical opacity and cataract formation in mice. SSOE treatment reduces intraocular hypoxia, cell death, leukocyte infiltration, production of inflammatory mediators, and hypoxia-inducible factor 1-alpha signaling, thus hastening recovery of normal tissue integrity during the wound healing process. Here, we show that SSOE is an effective topical therapeutic in the acute treatment of ocular chemical injuries.
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Affiliation(s)
- Sanming Li
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
| | - Kunpeng Pang
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
| | - Shuyan Zhu
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
| | | | - Jia Yin
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Department of Ophthalmology, Boston, MA, USA.
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12
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Effect of Tauroursodeoxycholic Acid on Inflammation after Ocular Alkali Burn. Int J Mol Sci 2022; 23:ijms231911717. [PMID: 36233018 PMCID: PMC9570278 DOI: 10.3390/ijms231911717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/25/2022] Open
Abstract
Inflammation is the main cause of corneal and retinal damage in an ocular alkali burn (OAB). The aim of this study was to investigate the effect of tauroursodeoxycholic acid (TUDCA) on ocular inflammation in a mouse model of an OAB. An OAB was induced in C57BL/6j mouse corneas by using 1 M NaOH. TUDCA (400 mg/kg) or PBS was injected intraperitoneally (IP) once a day for 3 days prior to establishing the OAB model. A single injection of Infliximab (6.25 mg/kg) was administered IP immediately after the OAB. The TUDCA suppressed the infiltration of the CD45-positive cells and decreased the mRNA and protein levels of the upregulated TNF-α and IL-1β in the cornea and retina of the OAB. Furthermore, the TUDCA treatment inhibited the retinal glial activation after an OAB. The TUDCA treatment not only ameliorated CNV and promoted corneal re-epithelization but also attenuated the RGC apoptosis and preserved the retinal structure after the OAB. Finally, the TUDCA reduced the expression of the endoplasmic reticulum (ER) stress molecules, IRE1, GRP78 and CHOP, in the retinal tissues of the OAB mice. The present study demonstrated that the TUDCA inhibits ocular inflammation and protects the cornea and retina from injury in an OAB mouse model. These results provide a potential therapeutic intervention for the treatment of an OAB.
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13
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Li Z, Wang Q, Zhang SF, Huang YF, Wang LQ. Timing of glaucoma treatment in patients with MICOF: A retrospective clinical study. Front Med (Lausanne) 2022; 9:986176. [PMID: 36250075 PMCID: PMC9562139 DOI: 10.3389/fmed.2022.986176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To summarize and discuss the treatment and timing of glaucoma in patients with MICOF keratoprosthesis implantation to guide follow-up clinical treatment. Methods The data of 39 eyes (39 patients) with the Moscow Eye Microsurgery Complex in Russia (MICOF) keratoprosthesis implantation in our hospital from 1 January 2002 to 31 December 2017 were collected, including patients with preexisting glaucoma and those who developed glaucoma de novo after MICOF. The sex, age, preoperative diagnosis, glaucoma surgery, keratoplasty, times of keratoplasty, best corrected visual acuity (BCVA) and final follow-up corrected visual acuity, visual field (VF) defect, and cup-to-disk ratio (CDR) were statistically analyzed. Results Among 16 eyes with preexisting glaucoma, eight eyes underwent glaucoma surgery before MICOF, 4 eyes underwent glaucoma surgery combined with MICOF, and four eyes were managed medically. Among 23 eyes with de novo glaucoma, seven eyes were treated with surgery and 16 eyes were treated with medication only. A total of 9 (56.3%) eyes had corneal transplants with preexisting glaucoma, which was a higher percentage than that in the patients with de novo glaucoma (n = 5, 21.7%, P = 0.043). In both the preexisting glaucoma group and the de novo glaucoma group, the most common causes were alkali burns (56.3% of preexisting glaucoma and 43.5% of de novo glaucoma). There was no significant difference between the operation and initial visual acuity, postoperative visual acuity, BCVA, CDR, or VF defect. In the de novo glaucoma group, the final follow-up visual acuity of the glaucoma surgery group (1.56 ± 1.07) was worse than that of the mediation group (0.44 ± 0.53) (P < 0.017). Among the complications, the incidence of cornea melting in the patients treated with medications only (n=10) was significantly higher than that in the patients treated with glaucoma surgery (n = 0, P = 0.007), but there was no significant difference in the other complications. Conclusion Among patients with MICOF, those patients who have undergone keratoplasty are more likely to develop glaucoma before surgery and glaucoma needs to be prevented. Surgical treatment can be selected according to the ocular surface condition in the patients with de novo glaucoma to reduce the occurrence of complications.
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Affiliation(s)
- Zhao Li
- Department of Ophthalmology, The Chinese People's Liberation Army of China (PLA) General Hospital, Beijing, China
- Department of Medical School, Nankai University, Tianjin, China
| | - Qun Wang
- Department of Ophthalmology, The Chinese People's Liberation Army of China (PLA) General Hospital, Beijing, China
| | - Shi-Feng Zhang
- Department of Ophthalmology, The Chinese People's Liberation Army of China (PLA) General Hospital, Beijing, China
- Department of Medical School, Nankai University, Tianjin, China
| | - Yi-Fei Huang
- Department of Ophthalmology, The Chinese People's Liberation Army of China (PLA) General Hospital, Beijing, China
- Yi-Fei Huang
| | - Li-Qiang Wang
- Department of Ophthalmology, The Chinese People's Liberation Army of China (PLA) General Hospital, Beijing, China
- *Correspondence: Li-Qiang Wang
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Abstract
Millions of people worldwide are bilaterally blind due to corneal diseases including infectious etiologies, trauma, and chemical injuries. While corneal transplantation can successfully restore sight in many, corneal graft survival decreases in eyes with chronic inflammation and corneal vascularization. Additionally, the availability of donor cornea material can be limited, especially in underdeveloped countries where corneal blindness may also be highly prevalent. Development of methods to create and implant an artificial cornea (keratoprosthesis)may be the only option for patients whose eye disease is not suitable for corneal transplantation or who live in regions where corneal transplantation is not possible. The Boston keratoprosthesis (B-KPro) is the most commonly implanted keratoprosthesis worldwide, having restored vision in thousands of patients. This article describes the initial design of the B-KPro and the modifications that have been made over many years. Additionally, some of the complications of surgical implantation and long-term care challenges, particularly complicating inflammation and glaucoma, are discussed. Expected final online publication date for the Annual Review of Vision Science, Volume 8 is September 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Claes Dohlman
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA;
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15
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Neuroprotection for Age-Related Macular Degeneration. OPHTHALMOLOGY SCIENCE 2022; 2:100192. [PMID: 36570623 PMCID: PMC9767822 DOI: 10.1016/j.xops.2022.100192] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 12/27/2022]
Abstract
Age-related macular degeneration (AMD) is a leading cause of blindness worldwide. Early to intermediate AMD is characterized by the accumulation of lipid- and protein-rich drusen. Late stages of the disease are characterized by the development of choroidal neovascularization, termed "exudative" or "neovascular AMD," or retinal pigment epithelium (RPE) cell and photoreceptor death, termed "geographic atrophy" (GA) in advanced nonexudative AMD. Although we have effective treatments for exudative AMD in the form of anti-VEGF agents, they have no role for patients with GA. Neuroprotection strategies have emerged as a possible way to slow photoreceptor degeneration and vision loss in patients with GA. These approaches include reduction of oxidative stress, modulation of the visual cycle, reduction of toxic molecules, inhibition of pathologic protein activity, prevention of cellular apoptosis or programmed necrosis (necroptosis), inhibition of inflammation, direct activation of neurotrophic factors, delivery of umbilical tissue-derived cells, and RPE replacement. Despite active investigation in this area and significant promise based on preclinical studies, many clinical studies have not yielded successful results. We discuss selected past and current neuroprotection trials for AMD, highlight the lessons learned from these past studies, and discuss our perspective regarding remaining questions that must be answered before neuroprotection can be successfully applied in the field of AMD research.
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Key Words
- AD, Alzheimer disease
- ALA, alpha lipoic acid
- AMD, age-related macular degeneration
- AREDS, Age-Related Eye Disease Study
- AREDS2, Age-Related Eye Disease Study 2
- Age-related macular degeneration
- CFH, complement factor H
- CNTF, ciliary neurotrophic factor
- GA, geographic atrophy
- HTRA1, high-temperature requirement A1
- IOP, intraocular pressure
- Neuroprotection
- RBP, retinol-binding protein
- RGC, retinal ganglion cell
- RIPK3, receptor-interacting serine/threonine-protein kinase 3
- ROS, reactive oxygen species
- RPE, retinal pigment epithelium
- Retinal degeneration
- VA, visual acuity
- iPSC, induced pluripotent stem cell
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Yuan M, Qian X, Huang Y, Ma X, Duan F, Yang Y, Lou B, Lin X. Th17 Activation and Th17/Treg Imbalance in Prolonged Anterior Intraocular Inflammation after Ocular Alkali Burn. Int J Mol Sci 2022; 23:7075. [PMID: 35806082 PMCID: PMC9266712 DOI: 10.3390/ijms23137075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 12/12/2022] Open
Abstract
Ocular alkali burn (OAB) is a sight-threatening disease with refractory ocular inflammation causing various blinding complications. Th17 lymphocytes account for the pathogeneses of the autoimmune disease and chronic inflammation, but their role in prolonged anterior intraocular inflammation after OAB is still unknown. A rat OAB model was established for this purpose. Anterior intraocular inflammation was observed in both the acute and late phases of OAB, and histological examination confirmed the presence of inflammatory cell infiltration and fibrin exudation in the anterior segment. Luminex xMAP technology and qPCR were used to evaluate the intraocular levels of cytokines. The levels of IL-1β, IL-6, and TNF-α were significantly elevated during the acute phase. The expression of IL-17A gradually increased from day 7 onwards and remained at a relatively high level. Immunofluorescence was performed to identify Th17 cells. CD4 and IL-17A double positive cells were detected in the anterior chamber from days 7 to 28. Flow cytometry showed that the frequency of Th17 cells increased in both lymph nodes and spleen, while the frequency of Treg cells remained unchanged, resulting in an elevated Th17/Treg ratio. The present study suggests that Th17 activation and Th17/Treg imbalance account for prolonged anterior intraocular inflammation after OAB.
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Affiliation(s)
| | | | | | | | | | | | | | - Xiaofeng Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 Xianlie Road, Guangzhou 510060, China; (M.Y.); (X.Q.); (Y.H.); (X.M.); (F.D.); (Y.Y.); (B.L.)
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Huang Y, Yuan M, Duan F, Yang Y, Lou B, Lin X. Inhibition of endoplasmic reticulum stress by 4-phenylbutyrate alleviates retinal inflammation and the apoptosis of retinal ganglion cells after ocular alkali burn in mice. Inflamm Res 2022; 71:577-590. [PMID: 35415762 DOI: 10.1007/s00011-022-01565-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/28/2022] [Accepted: 03/19/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Retinal ganglion cell (RGC) apoptosis is one of the most severe complications that causes permanent visual impairment following ocular alkali burn (OAB). Currently, very few treatment options exist for this condition. This study was conducted to determine the effect of 4-phenylbutyric acid (4-PBA) on endoplasmic reticulum (ER) stress after OAB using a well-established OAB mouse model. METHODS Ocular alkali burn was induced in C57BL/6 mouse corneas using 1 M NaOH. 4-PBA (10 mg/kg; 250 μL per injection) or saline (250 μL per injection) was injected intraperitoneally once per day for 3 days before the establishment of the OAB model. The apoptosis of retinal ganglion cells (RGCs) was assessed by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay, and the histological damage was examined by hematoxylin and eosin and immunofluorescence assay on retinal flat mounts. The key inflammatory response and the expression of ER stress-related markers in the retinal tissues were assessed by real-time PCR, western blotting and histologic analyses. RESULTS 4-PBA significantly alleviated the apoptosis of RGCs and prevented the structural damage of the retina, as determined by the evaluation of RGC density and retinal thickness. Inhibition of ER stress by 4-PBA decreased the expression of vital proinflammatory cytokines, tumor necrosis factor alpha, and interleukin-1 beta; and suppressed the activation of retinal microglial cells and nuclear factor-kappa B (NF-κB). 4-PBA reduced the expression of the ER stress molecules, glucose-regulated protein 78, activated transcription factor 6, inositol-requiring enzyme-1 (IRE1), X-box-binding protein 1 splicing, and CCAAT/enhancer-binding protein homologous protein, in the retinal tissues and RGCs of OAB mice. CONCLUSIONS The present study demonstrated that the inhibition of ER stress by 4-PBA alleviates the inflammatory response via the IRE1/NF-κB signaling pathway and protects the retina and RGCs from injury in an OAB mouse model. Such findings further suggest that 4-PBA might have potential therapeutic implications for OAB treatment.
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Affiliation(s)
- Yanqiao Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Miner Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Fang Duan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Yao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Bingsheng Lou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Xiaofeng Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China.
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Tarff A, E.Drew-Bear L, Di Meglio L, Yee R, Adelita Vizcaino M, Gupta P, Annadanam A, Cano M, Behrens A. Effect of topical bovine colostrum in wound healing of corneal surface after acute ocular alkali burn in mice. Exp Eye Res 2022; 220:109093. [DOI: 10.1016/j.exer.2022.109093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/30/2022] [Accepted: 04/22/2022] [Indexed: 12/18/2022]
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19
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Funatsu J, Murakami Y, Shimokawa S, Nakatake S, Fujiwara K, Okita A, Fukushima M, Shibata K, Yoshida N, Koyanagi Y, Akiyama M, Notomi S, Nakao S, Hisatomi T, Takeda A, Paschalis EI, Vavvas DG, Ikeda Y, Sonoda KH. Circulating inflammatory monocytes oppose microglia and contribute to cone cell death in retinitis pigmentosa. PNAS NEXUS 2022; 1. [PMID: 35529318 DOI: 10.1093/pnasnexus/pgac003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Retinitis pigmentosa (RP) is an intractable inherited disease that primarily affects the rods through gene mutations followed by secondary cone degeneration. This cone-related dysfunction can lead to impairment of daily life activities, and ultimately blindness in patients with RP. Paradoxically, microglial neuroinflammation contributes to both protection against and progression of RP, but it is unclear which population(s) - tissue-resident microglia and/or peripheral monocyte-derived macrophages (mφ) - are implicated in the progression of the disease. Here we show that circulating blood inflammatory monocytes (IMo) are key effector cells that mediate cone cell death in RP. Attenuation of IMo and peripherally engrafted mφ by Ccl2 deficiency or immune modulation via intravenous nano-particle treatment suppressed cone cell death in rd10 mice, an animal model of RP. In contrast, the depletion of resident microglia by a colony-stimulating factor 1 receptor inhibitor exacerbated cone cell death in the same model. In human patients with RP, IMo was increased and correlated with disease progression. These results suggest that peripheral IMo is a potential target to delay cone cell death and prevent blindness in RP.
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Affiliation(s)
- Jun Funatsu
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Yusuke Murakami
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Shotaro Shimokawa
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Shunji Nakatake
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Kohta Fujiwara
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Ayako Okita
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Masatoshi Fukushima
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Kensuke Shibata
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan.,Department of Genomics and Molecular Analysis, Yamaguchi University School of Medicine, Yamaguchi 755-8505, Japan
| | - Noriko Yoshida
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan.,Department of Ophthalmology, Fukuoka Dental College Medical and Dental Hospital, Fukuoka 814-0193, Japan
| | - Yoshito Koyanagi
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Masato Akiyama
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan.,Department of Ocular Pathology and Imaging Science, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Shoji Notomi
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Shintaro Nakao
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Toshio Hisatomi
- Department of Ophthalmology, Chikushi Hospital, Fukuoka University, Fukuoka 818-8502, Japan
| | - Atsunobu Takeda
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Eleftherios I Paschalis
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.,Boston Keratoprosthesis Laboratory, Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.,Disruptive Technology Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
| | - Demetrios G Vavvas
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.,Angiogenesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
| | - Yasuhiro Ikeda
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan.,Department of Ophthalmology, Faculty of Medicine, University of Miyazaki, Miyazaki, 889-1692, Japan
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
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20
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Knockdown of LncRNA SNHG1 Suppresses Corneal Angiogenesis by the Regulation of miR-195-5p/VEGF-A. J Ophthalmol 2021; 2021:6646512. [PMID: 34712495 PMCID: PMC8548121 DOI: 10.1155/2021/6646512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 12/13/2022] Open
Abstract
LncRNA SNHG1 (SNHG1) has been widely studied as the causative factor of angiogenesis and proliferative agent in gastric, lung, cervical, and hepatocellular carcinomas. However, its significance of angiogenesis and progression of corneal neovascularization (CRNV) is least understood. This study focuses on the molecular mechanisms followed by SNHG1 to establish CRNV and its angiogenesis. Bioinformatics analysis to identify potential miRNA targets of SNHG1 and vascular endothelial growth factor A (VEGF-A) was conducted using StarBase and was subsequently confirmed by the luciferase reporter assay. Relative quantitative expression of SNHG1 in human umbilical vein endothelial cells (HUVECs) was detected through qRT-PCR and western blot analysis. Cell proliferation was detected through CCK-8 assay, whereas migratory abilities of the cells were determined with transwell assay. A capillary-like tube formation assay was performed to detect the tube formation ability of the cells. Following this, relative expression of miR-195-5p and VEGF-A was determined through qRT-PCR and western blot analysis. Results from the experiments manifested upregulated levels of SNHG1 and VEGF-A in HUVECs and CRNV tissues as compared with the control group, whereas downregulated levels of miR-195-5p were measured in the CRNV tissues and HUVECs, suggesting the negative correlation between lncRNA and miRNA. Overexpressed vascular endothelial growth factor promoted cell proliferation and tube formation; however, its silencing leads to inhibition in angiogenesis and proliferation. Potential binding sites of SNHG1 showed miR-195-5p as its direct target and SNHG1 as a sponge for this miRNA. Knockdown and downregulated levels of SNHG1 showed a notable decrease and inhibition in angiogenesis and migration of CRNV cells. The study showed that SNHG1 inhibition significantly reduced cell proliferation, migration, and tube formation in HUVECs transfect with lncRNA SNHG1. Mechanistic insights into the SNHG1 showed that SNHG1 acts as a sponge for miR-195-5p and upregulates the levels of VEGF-A.
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21
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Begum G, Leigh T, Stanley D, Logan A, Blanch RJ. Determining the effect of ocular chemical injuries on topical drug delivery. Drug Deliv 2021; 28:2044-2050. [PMID: 34595979 PMCID: PMC8491719 DOI: 10.1080/10717544.2021.1979124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Ocular chemical injuries (OCIs) commonly cause ocular damage and visual loss and treatment uses topical therapies to facilitate healing and limit complications. However, the impact of chemical injury on corneal barrier function and treatment penetration is unknown. Therefore, the aim of this study was to determine the effect of OCI on drug penetration and absorption. Porcine corneal explants were used to assess histological damage, electrical resistance, and the trans-corneal penetration/corneal adsorption of reference compounds (sodium fluorescein and rhodamine B) and dexamethasone. Corneal explants were injured with either 1 M sulfuric acid, or 1 M sodium hydroxide. Dexamethasone penetration was measured using high-performance liquid chromatography (HPLC) and that of fluorescein and rhodamine using fluorescence. Dexamethasone corneal adsorption was measured using enzyme-linked immunoabsorbant assay (ELISA). Both acid and alkaline injuries reduced trans-corneal electrical resistance. NaOH injury increased hydrophilic fluorescein penetration (NaOH 8.59 ± 1.50E–05 cm.min−1 vs. Hanks' Balanced Salt Solution (HBSS) 1.64 ± 1.01E–06 cm.min−1) with little impact on hydrophobic rhodamine B (1 M NaOH 6.55 ± 2.45E–04 cm.min−1 vs. HBSS 4.60 ± 0.972E–04 cm.min−1) and dexamethasone penetration (1 M NaOH 3.00 ± 0.853E–04 cm.min−1 vs. HBSS 2.69 ± 0.439E–04 cm.min−1). By contrast, H2SO4 decreased trans-corneal penetration of hydrophilic fluorescein (H2SO4 1.16 ± 14.2E–07 cm.min−1) and of hydrophobic dexamethasone (H2SO4 1.88 ± 0.646E–04 cm.min−1) and rhodamine B (H2SO4 4.60 ± 1.42E–05 cm.min−1). Acid and alkaline OCI differentially disrupted the corneal epithelial barrier function. Acid injury reduced penetration of hydrophobic dexamethasone and rhodamine B as well as hydrophilic fluorescein, which may translate clinically into reduced drug penetration after OCI, while alkaline injury increased fluorescein penetration, with minimal effect on dexamethasone and rhodamine B penetration.
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Affiliation(s)
- Ghazala Begum
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
| | - Thomas Leigh
- School of Chemistry, University of Birmingham, Birmingham, UK
| | - David Stanley
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Ann Logan
- Axolotl Consulting Ltd, Droitwich, UK.,Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Richard James Blanch
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK.,Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.,Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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22
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Wang L, He X, Wang Q, Wu T, Liu A, Huang Y. Long-term outcomes of the MICOF keratoprosthesis surgery. Ocul Surf 2021; 21:178-185. [PMID: 34118425 DOI: 10.1016/j.jtos.2021.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE To evaluate long-term anatomical and functional outcomes of the MICOF keratoprosthesis to treat end-stage corneal blindness. DESIGN Retrospective review of consecutive clinical case series. PARTICIPANTS Between October 2000 and October 2015, at the Department of Ophthalmology of Chinese PLA General Hospital (PLAGH), a total of 132 eyes of 131 patients had undergone a MICOF keratoprosthesis implantation. Of those, 91 eyes of 90 patients were included in this study. METHODS Preoperative information, surgical procedures, and postoperative data were collected for each included eye. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA), keratoprosthesis retention, and significant postoperative complications were reported. RESULTS The most common indications for surgery were chemical or thermal burns (68.1%, 62 of 91 eyes) and explosive injury (12.1%, 11 of 91 eyes), followed by Stevens-Johnson Syndrome (10.0%, 9 of 91 eyes), Sjögren's syndrome (4.4%, 4 of 91 eyes), mucous membrane pemphigoid (3.3%, 3 of 91 eyes) and multi-penetrating keratoplasty failure (2.2%, 2 of 91 eyes). The mean follow-up duration was 8.38 ± 3.22 years (range: 5-17.25 years, median: 7.67 years). All patbients had a preoperative visual acuity of hand motions or worse. A MICOF keratoprosthesis significantly improved patients' visual function with bilateral end-stage corneal blindness. Postoperative visual acuity improved to 20/200 or better in 41 eyes (45.1%, of 91 eyes) and to 20/100 or better in 32 eyes (35.2% of 91 eyes) at the last follow-up visit. Preexisting glaucoma was present in 17 (18.7% of 91 eyes). The most common postoperative complications were overgrowth of the surface mucosa (31.9%, 29 of 91 eyes), glaucoma (25.3%, 23 of 91 eyes), retro-prosthetic membrane (15.4%, 14 of 91 eyes), keratoprosthesis device extrusion (15.4%, 14 of 91 eyes), superficial tissue thinning (14.3%, 13 of 91 eyes), endophthalmitis (13.2%, 12 of 91 eyes), titanium frame exposure (13.2%, 12 of 91 eyes), optical cylinder ante-displacement (13.2%, 12 of 91 eyes), cornea melting (7.7%, 7 of 91 eyes), retinal detachment (6.6%, 6 of 91 eyes) and aqueous humour leakage (2.2%, 2 of 91 eyes). 84.6% (77 of 91 eyes) of the eyes retained their initial keratoprosthesis at the latest follow-up. CONCLUSIONS A MICOF keratoprosthesis is a reliable approach to rescue vision in end-stage corneal blinded patients and has better retention than a Boston Kpro TypeⅡ.
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Affiliation(s)
- Liqiang Wang
- Department of Ophthalmology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China.
| | - Xiezhou He
- Department of Ophthalmology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China; Medical College, Nankai University, Tianjin, China
| | - Qun Wang
- Department of Ophthalmology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Tengyun Wu
- Air Force Medical Center of PLA, Beijing, China
| | - Anqi Liu
- Department of Ophthalmology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Yifei Huang
- Department of Ophthalmology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China.
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23
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Geoffrion D, Robert MC, Chodosh J, Di Polo A, Harissi-Dagher M. Perspectives for preclinical mouse models of glaucoma after Boston keratoprosthesis type 1. Exp Eye Res 2021; 208:108615. [PMID: 33971222 DOI: 10.1016/j.exer.2021.108615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/15/2021] [Accepted: 05/04/2021] [Indexed: 12/01/2022]
Abstract
Animal models of the Boston keratoprosthesis type 1 (KPro) are needed to study glaucoma damage after KPro implantation to control for confounding comorbidities common in human KPro recipients. The purpose of this study was to determine the feasibility of establishing a reproducible mouse model of glaucoma after KPro surgery, specifically that of a miniaturized mouse model of KPro (mKPro). In the present study, a total of 20 corneas of donor C57BL/6 mice (n = 10) were implanted in one eye of each recipient BALB/C mouse (n = 20), assembled as part of the mKPro, either with or without intraoperative lensectomy. Main feasibility outcomes consisted in incidence rates of loss of tone, capsule nicking, and lens extrusion, as well as acquisition of posterior segment optical coherence tomography (OCT) images. With lensectomy (n = 10), loss of ocular tone and retinal detachment occurred in 100% of mice. Without lensectomy (n = 10), capsule nicking and opening, as well as lens extrusion, occurred in 80% of mice. Causes of these complications included the large proportion of intraocular volume occupied by the lens, the shallow anterior chamber, and thus the lack of available intraocular volume to implant the KPro if the lens remains present. Successful mouse KPro surgery may require a great deal of practice to be useful as a reproducible model. Animal KPro models ought to be pursued further by research teams in future studies.
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Affiliation(s)
- Dominique Geoffrion
- Department of Ophthalmology, Centre hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet, D.01.2273, Montreal, Quebec, H2X 3E4, Canada; Department of Experimental Surgery, Faculty of Medicine, McGill University, 3655 Promenade Sir William Osler, Montreal, Quebec, H3G 0B1, Canada
| | - Marie-Claude Robert
- Department of Ophthalmology, Centre hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet, D.01.2273, Montreal, Quebec, H2X 3E4, Canada
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA, 02114 - 3002, United States
| | - Adriana Di Polo
- Department of Ophthalmology, Centre hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet, D.01.2273, Montreal, Quebec, H2X 3E4, Canada; Department of Neurosciences, Université de Montréal, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis, R09.720, Montreal, Quebec, H2X 0A9, Canada
| | - Mona Harissi-Dagher
- Department of Ophthalmology, Centre hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet, D.01.2273, Montreal, Quebec, H2X 3E4, Canada.
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24
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Geoffrion D, Robert MC, Di Polo A, Koenekoop RK, Agoumi Y, Harissi-Dagher M. Tear Film Cytokine Profile of Patients With the Boston Keratoprosthesis Type 1: Comparing Patients With and Without Glaucoma. Invest Ophthalmol Vis Sci 2021; 62:20. [PMID: 33856415 PMCID: PMC8054627 DOI: 10.1167/iovs.62.4.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose Inflammatory cytokines are involved in glaucoma pathogenesis. The purpose is to compare cytokine levels in the tear film of Boston keratoprosthesis (KPro) patients with and without glaucoma, relative to controls, and correlate levels with clinical parameters. Methods This cross-sectional study enrolled 58 eyes (58 patients): 41 KPro eyes with glaucoma, 7 KPro eyes without glaucoma, and 10 healthy controls. Twenty-seven cytokines were measured by multiplex bead immunoassay. Intraocular pressure (IOP), cup-to-disk ratio (CDR), retinal nerve fiber layer, visual acuity, topical medications, and angle closure were assessed in all KPro eyes. Cytokine levels between groups were analyzed by nonparametric tests, and correlations with clinical parameters by Spearman's test. Results Levels of TNF-ɑ, IL-1β, FGF-basic, and IFN-ɣ were significantly higher in KPro with glaucoma compared to KPro without (P = 0.020; 0.008; 0.043; 0.018, respectively). KPro groups had similar characteristics and topical antibiotic/steroid regimen. Levels of IL-1Ra, IL-15, VEGF, and RANTES were significantly higher in KPro with glaucoma compared to controls (P < 0.001; = 0.034; < 0.001; = 0.001, respectively). IL-1β and IFN-ɣ levels were positively correlated with CDR (r = 0.309, P = 0.039 and r = 0.452, P = 0.006, respectively) and IOP (r = 0.292, P = 0.047 and r = 0.368, P = 0.023, respectively). TNF-α and FGF-basic levels were positively correlated with CDR (r = 0.348, P = 0.022 and r = 0.344, P = 0.021, respectively). Conclusions TNF-α, IL-1β, FGF-basic, IFN-ɣ are elevated in tears of KPro patients with glaucoma and correlate with CDR and IOP. These results show, for the first time in humans, concordance with documented elevations of TNF-α and IL-1β in the murine KPro model. Ocular surface inflammation may reflect inflammatory processes of KPro glaucoma.
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Affiliation(s)
- Dominique Geoffrion
- Department of Ophthalmology, Université de Montréal, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Department of Experimental Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Marie-Claude Robert
- Department of Ophthalmology, Université de Montréal, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Adriana Di Polo
- Department of Ophthalmology, Université de Montréal, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Department of Neurosciences, Université de Montréal, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Robert K Koenekoop
- Departments of Experimental Surgery, Paediatric Surgery, Adult Ophthalmology, and Human Genetics, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Younes Agoumi
- Department of Ophthalmology, Université de Montréal, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Mona Harissi-Dagher
- Department of Ophthalmology, Université de Montréal, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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25
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Wang LQ, Wu TY, Chen XN, Xu ZQ, Yang M, Xiang R, Ma X, Zhang S, Huang YF. Long-term outcomes of Boston keratoprosthesis type I: the Chinese People's Liberation Army General Hospital experience. Br J Ophthalmol 2021; 106:781-785. [PMID: 33674425 DOI: 10.1136/bjophthalmol-2019-315617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 10/22/2020] [Accepted: 01/19/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE To report the long-term outcomes of Boston keratoprosthesis type I (B-KPro type I) implantation in the management of severe ocular surface disorders. METHODS Retrospective case series. Patients who underwent B-KPro type I implantation at the People's Liberation Army General Hospital were enrolled between March 2011 and September 2019. Data regarding visual acuity (VA), B-KPro type I retention and postoperative complications were recorded and analysed. RESULTS A total of 103 eyes of 100 patients who underwent B-KPro type I implantation were included. The main indications were chemical burn (59.2%), ocular trauma (25.2%), herpetic keratitis (11.7%) and autoimmune diseases (3.9%). The percentage of eyes with postoperative VA of 10/200 or better was 82.7% at 6 months, 82.8% at 12 months, 77.9% at 2 years, 72.4% at 3 years, 71.1% at 4 years, 69.4% at 5 years, 58.9% at 6 years, 56.8% at 7 years and 42.9% at 8 years. Preoperatively, 8.7% eyes were diagnosed with new-onset glaucoma. Retroprosthetic membrane formation occurred in 19.4% eye. Corneal melting occurred in 18.4% eyes. Sterile vitritis was diagnosed in 4.9% eyes and infectious endophthalmitis in 2.9% eyes. Retinal detachment occurred in 0.9% eyes. CONCLUSIONS In a Chinese patient group, B-KPro type I is a viable option for treating severe ocular surface disorders in eyes where conventional keratoplasty would have a poor prognosis, especially in patients with chemical and thermal burns. Improved visual outcomes and high retention rate can be achieved and maintained in most cases.
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Affiliation(s)
- Li-Qiang Wang
- Department of Ophthalmology, General Hospital of People's Liberation Army, Beijing, China
| | - Teng-Yun Wu
- Department of Ophthalmology, General Hospital of People's Liberation Army, Beijing, China.,Department of Ophthalmology, Air Force Medical Center, Beijing, China
| | - Xiao-Niao Chen
- Department of Ophthalmology, General Hospital of People's Liberation Army, Beijing, China
| | - Ze-Quan Xu
- Department of Ophthalmology, General Hospital of People's Liberation Army, Beijing, China
| | - Min Yang
- Department of Ophthalmology, Chinese PLA 251 Hospital, Zhangjiakou, China
| | - Ran Xiang
- Department of Ophthalmology, General Hospital of People's Liberation Army, Beijing, China
| | - Xiao Ma
- Department of Ophthalmology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Shan Zhang
- Department of Ophthalmology, General Hospital of People's Liberation Army, Beijing, China
| | - Yi-Fei Huang
- Department of Ophthalmology, General Hospital of People's Liberation Army, Beijing, China
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26
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Hui PC, Pereira LA, Dore R, Chen S, Taniguchi E, Chodosh J, Dohlman CH, Paschalis EI. Intrinsic Optical Properties of Boston Keratoprosthesis. Transl Vis Sci Technol 2020; 9:10. [PMID: 33200051 PMCID: PMC7645245 DOI: 10.1167/tvst.9.12.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/07/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose To benchmark the optical performance of Boston Keratoprosthesis (B-KPro). Methods Back focal lengths (BFL) of B-KPros for various eye axial lengths were measured using an optical bench, International Organization for Standardization–certified for intraocular lens characterization, and compared against manufacturer's specification. The modulation transfer function (MTF) and the resolution efficiencies were measured. The theoretical geometry-dependent higher-order aberrations (HOA) were calculated. The devices were characterized with optical profilometry for estimating the surface scattering. Aberration correction and subsequent image quality improvement were simulated in CODE-V. Natural scene-imaging was performed in a mock ocular environment. Retrospective analysis of 15 B-KPro recipient eyes were presented to evaluate the possibility of achieving 20/20 best-corrected visual acuity (BCVA). Results BFL measurements were in excellent agreement with the manufacturer-reported values (r = 0.999). The MTF specification exceeded what is required for achieving 20/20 visual acuity. Astigmatism and field curvature, correctable in simulations, were the primary aberrations limiting imaging performance. Profilometry of the anterior surface revealed nanoscale roughness (root-mean-square amplitude, 30–50 nm), contributing negligibly to optical scattering. Images of natural scenes obtained with a simulated B-KPro eye demonstrated good central vision, with 10/10 visual acuity (equivalent to 20/20). Full restoration of 20/20 BCVA was obtainable for over 9 years in some patients. Conclusions Theoretical and experimental considerations demonstrate that B-KPro has the optical capacity to restore 20/20 BCVA in patients. Further image quality improvement can be anticipated through correction of HOAs. Translational Relevance We establish an objective benchmark to characterize the optics of the B-KPro and other keratoprosthesis and propose design changes to allow improved vision in B-KPro patients.
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Affiliation(s)
- Pui-Chuen Hui
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.,Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Leonardo A Pereira
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.,CAPES Foundation, Ministry of Education of Brazil, Brasilia, Brazil
| | - Renald Dore
- University of Rochester, Institute of Optics, Rochester, NY, USA
| | - Shengtong Chen
- University of Rochester, Institute of Optics, Rochester, NY, USA
| | - Elise Taniguchi
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.,Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Claes H Dohlman
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.,Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Eleftherios I Paschalis
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.,Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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27
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Hancox Z, Heidari Keshel S, Yousaf S, Saeinasab M, Shahbazi MA, Sefat F. The progress in corneal translational medicine. Biomater Sci 2020; 8:6469-6504. [PMID: 33174878 DOI: 10.1039/d0bm01209b] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cornea tissue is in high demand by tissue donation centres globally, and thus tissue engineering cornea, which is the main topic of corneal translational medicine, can serve as a limitless alternative to a donated human cornea tissue. Tissue engineering aims to produce solutions to the challenges associated with conventional cornea tissue, including transplantation and use of human amniotic membrane (HAM), which have issues with storage and immune rejection in patients. Accordingly, by carefully selecting biomaterials and fabrication methods to produce these therapeutic tissues, the demand for cornea tissue can be met, with an improved healing outcome for recipients with less associated harmful risks. In this review paper, we aim to present the recent advancements in the research and clinical applications of cornea tissue, applications including biomaterial selection, fabrication methods, scaffold structure, cellular response to these scaffolds, and future advancements of these techniques.
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Affiliation(s)
- Zoe Hancox
- Department of Biomedical and Electronics Engineering, School of Engineering, University of Bradford, Bradford, UK.
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Dua HS, Ting DSJ, Al Saadi A, Said DG. Chemical eye injury: pathophysiology, assessment and management. Eye (Lond) 2020; 34:2001-2019. [PMID: 32572184 PMCID: PMC7784957 DOI: 10.1038/s41433-020-1026-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 11/09/2022] Open
Abstract
Chemical eye injury (CEI) is an acute emergency which can threaten sight and life. These commonly occur at home or the workplace with the former being generally mild and the latter more severe and bilateral. Major workplace accidents involve other parts of the body and can be associated with inhalation or ingestion of the chemical. Alkali injuries cause damage by saponification of tissue and deeper penetration as a consequence. Acid injuries cause rapid coagulation of tissue, which impedes penetration and limits damage. Irritants such as alcohols, cause superficial epithelial denudation. Severe chemical insult can affect all anterior segment structures causing iris, pupil and lens abnormalities. Eye pressure is variably affected and can be low or high or start as one and rapidly change to the other. Chorioretinal changes in the form of vasculopathy are seen and ascribed to be secondary to anterior segment inflammation rather than due to the direct effect of CEI. Final outcome related to structure and function is determined by the injurious agent, duration of exposure, nature of treatment and the rapidity with which it is instituted. Prevention of further damage by profuse and prolonged eye wash, after ascertaining pH of both eyes, together with exploration and removal of all particulate matter, is the key. Other management principles include a complete and thorough assessment, control of inflammation, facilitation of healing and prevention and management of sequelae and complications. Intraocular pressure is often forgotten and must be assessed and managed. Management often requires a multidisciplinary approach.
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Affiliation(s)
- Harminder S Dua
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK.
| | - Darren Shu Jeng Ting
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Ahmed Al Saadi
- Department of Ophthalmology, Zayed Military Hospital, Abu Dhabi, UAE
| | - Dalia G Said
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
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Ray HC, Corliss BA, Bruce AC, Kesting S, Dey P, Mansour J, Seaman SA, Smolko CM, Mathews C, Dey BK, Owens GK, Peirce SM, Yates PA. Myh11+ microvascular mural cells and derived mesenchymal stem cells promote retinal fibrosis. Sci Rep 2020; 10:15808. [PMID: 32978500 PMCID: PMC7519078 DOI: 10.1038/s41598-020-72875-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 08/10/2020] [Indexed: 12/29/2022] Open
Abstract
Retinal diseases are frequently characterized by the accumulation of excessive scar tissue found throughout the neural retina. However, the pathophysiology of retinal fibrosis remains poorly understood, and the cell types that contribute to the fibrotic response are incompletely defined. Here, we show that myofibroblast differentiation of mural cells contributes directly to retinal fibrosis. Using lineage tracing technology, we demonstrate that after chemical ocular injury, Myh11+ mural cells detach from the retinal microvasculature and differentiate into myofibroblasts to form an epiretinal membrane. Inhibition of TGFβR attenuates Myh11+ retinal mural cell myofibroblast differentiation, and diminishes the subsequent formation of scar tissue on the surface of the retina. We demonstrate retinal fibrosis within a murine model of oxygen-induced retinopathy resulting from the intravitreal injection of adipose Myh11-derived mesenchymal stem cells, with ensuing myofibroblast differentiation. In this model, inhibiting TGFβR signaling does not significantly alter myofibroblast differentiation and collagen secretion within the retina. This work shows the complexity of retinal fibrosis, where scar formation is regulated both by TGFβR and non-TGFβR dependent processes involving mural cells and derived mesenchymal stem cells. It also offers a cautionary note on the potential deleterious, pro-fibrotic effects of exogenous MSCs once intravitreally injected into clinical patients.
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Affiliation(s)
- H Clifton Ray
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Bruce A Corliss
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Anthony C Bruce
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Sam Kesting
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Paromita Dey
- The RNA Institute, University at Albany, State University of New York, Albany, NY, USA
| | - Jennifer Mansour
- Department of Biology, University of Virginia, Charlottesville, VA, USA
| | - Scott A Seaman
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Christian M Smolko
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Corbin Mathews
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Bijan K Dey
- The RNA Institute, University at Albany, State University of New York, Albany, NY, USA
| | - Gary K Owens
- Robert M. Berne Cardiovascular Research Center, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Molecular Physiology and Biological Physics, University of Virginia, Charlottesville, VA, USA
| | - Shayn M Peirce
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Paul A Yates
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA.
- Department of Ophthalmology, University of Virginia, PO Box 800715, Charlottesville, VA, 22908, USA.
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Chen X, Lei F, Zhou C, Chodosh J, Wang L, Huang Y, Dohlman CH, Paschalis EI. Glaucoma after Ocular Surgery or Trauma: The Role of Infiltrating Monocytes and Their Response to Cytokine Inhibitors. THE AMERICAN JOURNAL OF PATHOLOGY 2020; 190:2056-2066. [PMID: 32693061 DOI: 10.1016/j.ajpath.2020.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/21/2020] [Accepted: 07/07/2020] [Indexed: 12/11/2022]
Abstract
Glaucoma is a frequent and devastating long-term complication following ocular trauma, including corneal surgery, open globe injury, chemical burn, and infection. Postevent inflammation and neuroglial remodeling play a key role in subsequent ganglion cell apoptosis and glaucoma. To this end, this study was designed to investigate the amplifying role of monocyte infiltration into the retina. By using three different ocular injury mouse models (corneal suture, penetrating keratoplasty, and globe injury) and monocyte fate mapping techniques, we show that ocular trauma or surgery can cause robust infiltration of bone marrow-derived monocytes into the retina and subsequent neuroinflammation by up-regulation of Tnf, Il1b, and Il6 mRNA within 24 hours. This is accompanied by ganglion cell apoptosis and neurodegeneration. Prompt inhibition of tumor necrosis factor-α or IL-1β markedly suppresses monocyte infiltration and ganglion cell loss. Thus, acute ocular injury (surgical or trauma) can lead to rapid neuroretinal inflammation and subsequent ganglion cell loss, the hallmark of glaucoma. Infiltrating monocytes play a central role in this process, likely amplifying the inflammatory cascade, aiding in the activation of retinal microglia. Prompt administration of cytokine inhibitors after ocular injury prevents this infiltration and ameliorates the damage to the retina-suggesting that it may be used prophylactically for neuroprotection against post-traumatic glaucoma.
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Affiliation(s)
- Xiaoniao Chen
- Boston Keratoprosthesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Fengyang Lei
- Boston Keratoprosthesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Chengxin Zhou
- Boston Keratoprosthesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - James Chodosh
- Boston Keratoprosthesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Liqiang Wang
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Yifei Huang
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Claes H Dohlman
- Boston Keratoprosthesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
| | - Eleftherios I Paschalis
- Boston Keratoprosthesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
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31
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Zhou C, Singh A, Qian G, Wolkow N, Dohlman CH, Vavvas DG, Chodosh J, Paschalis EI. Microporous Drug Delivery System for Sustained Anti-VEGF Delivery to the Eye. Transl Vis Sci Technol 2020; 9:5. [PMID: 32855852 PMCID: PMC7422759 DOI: 10.1167/tvst.9.8.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/04/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To describe a novel microporous drug delivery system (DDS) for sustained anti- vascular endothelial growth factor (VEGF) delivery to the eye and to evaluate its efficacy in a corneal injury model. Methods A macro-porous DDS (1.5 × 1.5 × 4 mm) loaded with 2 mg of bevacizumab was implanted subconjunctivally in three Dutch-belted pigmented rabbits after corneal alkali injury (2N NaOH). Three rabbits received sham DDS. Animals were followed for three months and assessed in vivo and ex vivo for corneal neovascularization (NV), epithelial defect, stromal scarring, endothelial cell loss, and expression of angiogenic and inflammatory markers in the cornea and retina. Results Anti-VEGF DDS treatment led to complete inhibition of superior cornea NV and complete corneal re-epithelialization by day 58 whereas sham DDS resulted in severe cornea NV and persistent epithelial defect (9%∼12% of total cornea area) through the end of the study. Histologically, anti-VEGF DDS significantly reduced CD45+ and F4/80 CD11b+ cell accumulation (79%, P < 0.05) in the cornea, ameliorated tumor necrosis factor–α expression (90%, P < 0.05), reduced corneal stromal scarring and prevented corneal endothelial cell loss, as compared to sham DDS. Moreover, anti-VEGF DDS achieved retinal penetration and reduction in retinal VEGF levels at 3 months. Conclusions Use of subconjunctival anti-VEGF DDS suppresses cornea NV, inflammation, stromal scarring, prevents endothelial cell loss, and abrogates retinal VEGF upregulation in a rabbit corneal alkali burn model. Moreover, it delivers anti-VEGF antibodies to the retina for three months. This delivery platform could enable antibody therapy of other corneal and retinal vascular pathologies. Translational Relevance We describe a method for sustained anti-VEGF delivery to the eye for the treatment of ocular injuries.
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Affiliation(s)
- Chengxin Zhou
- Boston Keratoprosthesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear and Schepens Eye Research Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Arushi Singh
- Boston Keratoprosthesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear and Schepens Eye Research Institute, Boston, MA, USA
| | - Grace Qian
- Boston Keratoprosthesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear and Schepens Eye Research Institute, Boston, MA, USA
| | - Natalie Wolkow
- Harvard Medical School, Boston, MA, USA.,David G. Cogan Laboratory of Eye Pathology and Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Claes H Dohlman
- Boston Keratoprosthesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear and Schepens Eye Research Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Demetrios G Vavvas
- Angiogenesis Laboratory, Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - James Chodosh
- Boston Keratoprosthesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear and Schepens Eye Research Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Disruptive Technology Laboratory (D.T.L.), Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Eleftherios I Paschalis
- Boston Keratoprosthesis Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear and Schepens Eye Research Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Disruptive Technology Laboratory (D.T.L.), Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Treatment of Oculoplastic and Ocular Surface Disease in Eyes Implanted with a Type I Boston Keratoprosthesis in Southern China: A Retrospective Study. Adv Ther 2020; 37:3206-3222. [PMID: 32436025 DOI: 10.1007/s12325-020-01381-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION This study aimed to describe the clinical features, surgical management of the eyelid and ocular surface, and outcomes of 16 patients implanted with a Boston type I keratoprosthesis (KPro). METHODS A retrospective, single-center, consecutive case series of 16 patients with Stevens-Johnson syndrome (1), ocular chemical burns (12), and ocular thermal burns (3) implanted with KPro was studied. All subjects were men aged 27-51 years. Surgical treatment and outcomes for eyelid malposition, symblepharon, and glaucoma were assessed. RESULTS From September 2010 to February 2019, 29 patients were admitted to Zhongshan Ophthalmic Center for KPro implantation, of whom 16 (55%) required eyelid or ocular surface surgeries to maintain hydration and protect the corneal tissue, which is vulnerable to epithelial defects. Forty-one adnexal surgical procedures were performed. The most common indication for surgery was symblepharon, and the most frequent procedures were symblepharon lysis with ocular mucous membrane grafts and amniotic membranes (7) and full-thickness skin grafts to the eyelids (7). Preoperative conjunctival injection and corneal staining were documented in 9 (56%) and 8 (50%) eyes, respectively, and at up to 4 months postoperative follow-up (the last adnexal surgery before KPro) were recorded in 3 (19%, p = 0.03) and 2 (12%, p = 0.02) eyes, respectively. Glaucoma drainage devices were inserted in six patients. One patient with Stevens-Johnson syndrome underwent FP7 Ahmed glaucoma valve (AGV) implantation inferotemporally and developed plate exposure 2 months postoperatively. Five patients underwent FP8 AGV implantation with tube insertion into the vitreous cavity due to the scarred conjunctiva and limited subconjunctival space. In the study period, intraocular pressure (IOP) was in the normal range, and no tube or plate exposure was observed. CONCLUSION The ocular environment is critical for successful KPro surgery. A multidisciplinary approach for any lid and ocular surface abnormality in ocular burns or Stevens-Johnson syndrome is important to improve the quality of the ocular surface and accommodate KPro and AGV, which is vital for maintaining vision after KPro surgery. FP8 AGV may be feasible for IOP control in adult KPro cases with restricted subconjunctival space.
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Hui PC, Shtyrkova K, Zhou C, Chen X, Chodosh J, Dohlman CH, Paschalis EI. Implantable self-aligning fiber-optic optomechanical devices for in vivo intraocular pressure-sensing in artificial cornea. JOURNAL OF BIOPHOTONICS 2020; 13:e202000031. [PMID: 32246524 DOI: 10.1002/jbio.202000031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 06/11/2023]
Abstract
Artificial cornea is an effective treatment of corneal blindness. Yet, intraocular pressure (IOP) measurements for glaucoma monitoring remain an urgent unmet need. Here, we present the integration of a fiber-optic Fabry-Perot pressure sensor with an FDA-approved keratoprosthesis for real-time IOP measurements using a novel strategy based on optical-path self-alignment with micromagnets. Additionally, an alternative noncontact sensor-interrogation approach is demonstrated using a bench-top optical coherence tomography system. We show stable pressure readings with low baseline drift (<2.8 mm Hg) for >4.5 years in vitro and efficacy in IOP interrogation in vivo using fiber-optic self-alignment, with good initial agreement with the actual IOP. Subsequently, IOP drift in vivo was due to retroprosthetic membrane (RPM) formation on the sensor secondary to surgical inflammation (more severe in the current pro-fibrotic rabbit model). This study paves the way for clinical adaptation of optical pressure sensors with ocular implants, highlighting the importance of controlling RPM in clinical adaptation.
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Affiliation(s)
- Pui-Chuen Hui
- Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear, Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Katia Shtyrkova
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States
| | - Chengxin Zhou
- Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear, Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Xiaoniao Chen
- Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear, Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - James Chodosh
- Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear, Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
- Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Claes H Dohlman
- Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear, Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Eleftherios I Paschalis
- Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear, Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
- Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
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The Therapeutic Effects and Possible Mechanism of Pranoprofen in Mouse Model of Corneal Alkali Burns. J Ophthalmol 2020; 2020:7485912. [PMID: 32322412 PMCID: PMC7166258 DOI: 10.1155/2020/7485912] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/12/2020] [Accepted: 03/09/2020] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate therapeutic effects and possible mechanism of pranoprofen in a mouse model of corneal alkali burns and provide new evidence for the clinical treatment of corneal alkali burns. Methods A unilateral alkali burn was created in the central cornea by placing a piece of 2 mm diameter filter paper soaked in 1N NaOH on the right eye for 30 seconds. After the model was performed, C57BL/6J mice received topical treatment with saline eye drops or pranoprofen eye drops and were, respectively, categorized as saline group and pranoprofen group, whereas the remaining normal mice that were not subjected to alkali burns served as control, each group containing 15 mice (n = 45). On the 5th day after model establishment, the corneal fluorescein sodium staining score was evaluated in order to assess corneal epithelial damage. Tissue HE stain was used to observe the pathological changes of corneal tissue in each group. Real-time RT-PCR and western blot were also performed to detect the mRNA and protein expression of NLRP3, IL-1β/p17, and matrix metallopeptidase MMP-13. Results 5 days after burns, microscopic observations of the pranoprofen group showed less corneal opacity and neovascularization development than the saline group. Sodium fluorescein staining showed obvious corneal structure disorders, poor corneal epithelium continuity, and a larger corneal epithelial defect area in the saline group (10.33±+−0.57) as opposed to the pranoprofen group (8.33 ± 0.57) (p < 0.05). HE stain results showed the saline group had obvious corneal structure disorder and the corneal epithelial layer was incomplete as opposed to the pranoprofen group. PCR and western blot results suggested that the pranoprofen group expressed less NLRP3, IL-1β, and MMP-13 mRNA and protein expression in corneal tissue than the saline group (p < 0.05). Conclusion Pranoprofen may alleviate inflammatory response by inhibiting the expression levels of NLRP3 and IL-1β at the early stage of corneal alkali injury, lowering the expression of MMP-13 and ultimately reducing corneal epithelial damage.
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Abstract
To review clinical aspects and cellular and molecular steps in the development of long-term glaucoma after corneal surgery or acute trauma—especially the pivotal role of tumor necrosis factor alpha (TNF-α), the rapidity of the secondary damage to the retinal ganglion cells, and the clinical promise of early antiinflammatory intervention.
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Choi SH, Kim MK, Oh JY. Glaucoma after ocular chemical burns: Incidence, risk factors, and outcome. Sci Rep 2020; 10:4763. [PMID: 32179804 PMCID: PMC7076008 DOI: 10.1038/s41598-020-61822-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/04/2020] [Indexed: 11/29/2022] Open
Abstract
Effects of chemical injuries on the cornea and limbus have been widely studied; however, little is known about glaucoma after ocular chemical injuries. We herein investigated the incidence, risk factors, and outcome of glaucoma in patients with ocular chemical burns. Medical records were reviewed of patients who visited our clinic for chemical injuries to the ocular surface. Patients were divided into glaucoma and non-glaucoma groups based on high intraocular pressure (IOP) readings. Clinical characteristics, treatment method, and therapeutic and visual outcomes were compared between the two groups. Of 29 patients (40 eyes), 9 patients (15 eyes, 37.5%) were diagnosed with glaucoma at 2.64 ± 2.92 months after injury. Factors associated with glaucoma included male gender (p = 0.0114), bilateral ocular involvement (p = 0.0478), severe ocular surface involvement (Dua grades IV-VI, p = 0.0180), poor initial visual acuity (p = 0.0136), high initial IOP (p < 0.0001), pupil involvement at initial examination (p = 0.0051), and the need for amniotic membrane transplantation in the acute stage (p = 0.0079). At final follow-up, IOP was uncontrolled in 3 eyes (20.0%), and visual acuity was worse in the glaucoma group than in the non-glaucoma group (logMAR 2.94 ± 1.86 vs 0.34 ± 0.69, p < 0.0001). These findings suggest that careful evaluation and intensive treatment for glaucoma are essential in patients with severe ocular burns.
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Affiliation(s)
- Se Hyun Choi
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Mee Kum Kim
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Youn Oh
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea. .,Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
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Shaw P, Sharma AK, Kalonia A, Shukla SK. Vascular perfusion: A predictive tool for thermal burn injury. J Tissue Viability 2020; 29:48-50. [DOI: 10.1016/j.jtv.2019.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023]
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Li T, Jiang B, Zhou X. Clinical characteristics of patients hospitalized for ocular chemical injuries in Shanghai from 2012 to 2017. Int Ophthalmol 2020; 40:909-916. [DOI: 10.1007/s10792-019-01263-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 12/28/2019] [Indexed: 01/07/2023]
Abstract
Abstract
Purpose
To summarize the clinical characteristics of patients with ocular chemical injuries and evaluate their potential relationship with the visual outcome by analyzing the medical records of these patients from January 1, 2012, to December 31, 2017.
Methods
This is a retrospective case series study. Patient data included age, gender, occupational classification, location of ocular chemical injury, initial and final best-corrected distance visual acuity (BCDVA), intraocular pressure (IOP), nature and chemical phase, distribution and severity of chemical injury, management methods, and complications. All variables were evaluated for their potential relationship with visual outcome.
Results
A total of 160 patients were hospitalized with ocular chemical injuries. Majority of the patients were factory workers and arrived at the consultation room less than 24 h after injury. The most common ocular injury setting, classification of severity, causative chemical, chemical phase, and complications were workplace, grade II, unknown and mixed substance, liquid, and elevated IOP, respectively. The risk factors for poor final BCDVA were identified as older age, poor initial BCDVA, and irrigation 24 h after injury (P < 0.001, P < 0.001, and P = 0.011, respectively).
Conclusions
We elaborate the clinical characteristics and outcomes of patients with ocular chemical injuries in Jinshan District, Shanghai. A comprehensive education program should be established and the use of protective eyewear should be promoted to prevent occupation-related ocular chemical injuries.
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Bizrah M, Yusuf A, Ahmad S. An update on chemical eye burns. Eye (Lond) 2019; 33:1362-1377. [PMID: 31086244 PMCID: PMC7002428 DOI: 10.1038/s41433-019-0456-5] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/06/2019] [Accepted: 04/02/2019] [Indexed: 01/20/2023] Open
Abstract
Ocular chemical injuries vary in severity, with the more severe end of the spectrum having profound visual consequences and medicolegal implications. Grading of ocular injuries is critical for determining acute treatment and visual prognosis. Poor immediate management results in more challenging treatment of acute disease. Similarly, poorly controlled acute disease results in more treatment-resistant chronic ocular disease. Despite several decades of research and public health initiatives, simple and effective interventions such as wearing protective eyewear and immediate irrigation of eyes remain as key challenges. Education and prevention are therefore important public health messages. Hurdles in the acute management of disease include poor evidence-base for commonly used treatments (e.g. based on experimental animal studies), reduced treatment adherence rates and high clinic non-attendance rates. The evolution of treatment strategies, particularly limbal stem cell transplantation, has revolutionised the visual and cosmetic outcomes in chronic phases of disease. It is therefore increasingly important to consider tertiary referral for patients with limbal stem cell failure or vision-limiting corneal scarring.
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Affiliation(s)
- Mukhtar Bizrah
- Imperial College Healthcare NHS Trust, Western Eye Hospital, 153-173 Marylebone Road, London, NW1 5QH, UK.
| | - Ammar Yusuf
- UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, UK
| | - Sajjad Ahmad
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
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40
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Heise CW, Agarwal S. Ocular Exposures Reported to Poison Control Centers From 2011 to 2015. Am J Ophthalmol 2019; 204:46-50. [PMID: 30851268 DOI: 10.1016/j.ajo.2019.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/25/2019] [Accepted: 02/27/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To identify and characterize the ocular exposures reported to poison control centers over a 5-year period from 2011 to 2015 in the United States. DESIGN Pooled cross-sectional study. SUBJECTS Callers to poison control centers. METHODS We retrospectively analyzed data from 477 274 calls for ocular exposure to the National Poison Data System. Major medical outcomes, reason for exposure, location of exposure, and causative xenobiotic were evaluated. RESULTS A mean volume of 95 454 calls per year were reported to poison control centers, with most exposures occurring unintentionally, at home, and predominantly in children under 5 years of age. Most serious adult exposures occurred at work owing to alkali exposures. There was an increasing incidence in exposures in those over 64 years old. The most common treatment provided was irrigation and wash for the affected eye. CONCLUSIONS Children under 5 are most susceptible; they may have permanent disability owing to laundry detergent exposure; and concerted intervention is needed in this age group. Many serious adult exposures occurred at work owing to alkali exposures.
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Affiliation(s)
- Craig William Heise
- Division of Medical Toxicology and Precision Medicine, Division of Clinical Data Analytics and Decision Support, Department of Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA.
| | - Sumit Agarwal
- Division of Care Transformation, Banner-University Medical Center Phoenix, Phoenix, Arizona, USA
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Cho J, Bell N, Botzet G, Vora P, Fowler BJ, Donahue R, Bush H, Taylor BK, Albuquerque RJC. Latent Sensitization in a Mouse Model of Ocular Neuropathic Pain. Transl Vis Sci Technol 2019; 8:6. [PMID: 30937216 PMCID: PMC6436610 DOI: 10.1167/tvst.8.2.6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/16/2018] [Indexed: 12/12/2022] Open
Abstract
Purpose Chronic ocular pain is poorly understood and difficult to manage. We developed a murine model of corneal surface injury (CSI)-induced chronic ocular neuropathic pain. The study focuses on changes in corneal nerve morphology and associated short- and long-term pain-like behavior after CSI. Methods CSI was induced in mice by local application of an alkali solution (0.75 N NaOH). Corneal nerve architecture, morphology, density, and length were studied. Eye-wiping was evaluated before and after CSI in response to hypertonic saline (2 M NaCl). Naltrexone (NTX) or Naloxone-methiodide (NLX-me), opioid receptor antagonists, were given subcutaneously (s.c., 3 mg/kg) or topically (eye drop, 100 μM), and then an eye-wiping test was performed. Results CSI caused partial corneal deinnervation followed by gradual reinnervation. Regenerated nerves displayed increased tortuosity, beading, and branching. CSI enhanced hypertonic saline-induced eye-wiping behavior compared to baseline or sham-injury (P < 0.01). This hypersensitivity peaked at 10 days and subsided 14 days after CSI. Administration of NTX, or NLX-me, a selective peripheral opioid antagonist, reinstated eye-wiping behavior in the injury group, but not in the sham groups (P < 0.05). Conclusions This study introduces a model of chronic ocular pain and corneal neuropathy following CSI. CSI induces central and peripheral opioid receptor-dependent latent sensitization (LS) that is unmasked by systemic or topical administration of opioid antagonists. Translational Relevance This model of chronic ocular pain establishes LS as a new inhibitory mechanism in the oculotrigeminal system and may be used for potential diagnostic and therapeutic interventions for ocular neuropathy.
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Affiliation(s)
- Jooyoung Cho
- Department of Ophthalmology, University of Kentucky, Lexington, KY, USA
| | - Nicholas Bell
- Department of Ophthalmology, University of Kentucky, Lexington, KY, USA
| | - Gregory Botzet
- Department of Ophthalmology, University of Kentucky, Lexington, KY, USA
| | - Paras Vora
- Department of Ophthalmology, University of Kentucky, Lexington, KY, USA
| | - Benjamin J Fowler
- Bascom Palmer Eye Institute, University of Miami Miller, Miami, FL, USA
| | - Renee Donahue
- Department of Physiology, University of Kentucky, Lexington, KY, USA
| | - Heather Bush
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Bradley K Taylor
- Department of Physiology, University of Kentucky, Lexington, KY, USA.,Department of Anesthesiology, University of Pittsburgh, PA, USA
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Bai Y, Wang W, Zhang Y, Zhang F, Zhang H. lncRNA MIAT suppression alleviates corneal angiogenesis through regulating miR-1246/ACE. Cell Cycle 2019; 18:661-669. [PMID: 30782069 DOI: 10.1080/15384101.2019.1578143] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Corneal neovascularization (CRNV) is a prevalence eye disorder that affects the transparency and refraction properties of eyes. To explore the correlation between the level of Angiotensin II (Ang II) and corneal angiogenesis, the rat model of CRNV was established using alkali-burn, while the human umbilical vein endothelial cells (HUVECs) were stimulated using VEGF to induce the CRNV cells in vitro. RNA immunoprecipitation (RIP) and RNA pull-down were performed to validate the relationship between MIAT and miR-1246. The expression of MIAT and Ang II was increased, while miR-1246 was decreased in CRNV rat model. VEGF stimulation significantly promoted cell proliferation and migration of HUVECs, knockdown of MIAT dramatically reversed the effects of VEGF, while cells co-transfected with miR-1246 inhibitor obviously abolished the effect of VEGF+si-MIAT, however, enalaprilat abolished the effects of VEGF+si-MIAT+miR-1246 inhibitor. MIAT directly regulated the expression of miR-1246. In conclusion, VEGF stimulation promoted cell proliferation and migration of HUVECs mainly through regulating MIAT/miR-1246/ACE.
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Affiliation(s)
- Yanhui Bai
- a Department of Ophthalmology , First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Weiqun Wang
- a Department of Ophthalmology , First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Youmei Zhang
- a Department of Ophthalmology , First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Fengyan Zhang
- a Department of Ophthalmology , First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Haohao Zhang
- b Division of Endocrinology, Department of Internal Medicine , First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
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Paschalis EI, Taniguchi EV, Chodosh J, Pasquale LR, Colby K, Dohlman CH, Shen LQ. Blood Levels of Tumor Necrosis Factor Alpha and Its Type 2 Receptor Are Elevated in Patients with Boston Type I Keratoprosthesis. Curr Eye Res 2019; 44:599-606. [PMID: 30632412 DOI: 10.1080/02713683.2019.1568500] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Purpose: Boston keratoprosthesis (KPro) patients are prone to glaucoma even with well-controlled intraocular pressure (IOP). Recent experimental data have shown that soluble tumor necrosis factor alpha (TNF-α) after ocular injury may contribute to progressive retinal damage and subsequent glaucoma. This study evaluates the blood plasma levels of soluble TNF-α, TNF receptors 1 (TNFR1) and 2 (TNFR2), and leptin in patients with Boston type I KPro. Methods: Venous blood samples were collected from KPro patients with glaucoma (KPro G, n = 19), KPro patients without glaucoma (KPro NoG, n = 12), primary angle closure glaucoma without KPro (PACG, n = 13), and narrow angles without glaucoma or KPro (NA, n = 21). TNF-α, TNFR1, TNFR2, and leptin levels were quantified using the enzyme-linked immunosorbent assay. Erythrocyte sedimentation rate (ESR) was assessed using the Westergren test. Patients with underlying autoimmune conditions or diabetes were excluded from the study. Results: All groups had similar age, body mass index (BMI), IOP, and ESR (p ≥ 0.11). The mean time from KPro surgery to blood draw was 5.3 ± 3.7 years. Compared to NA patients (0.72 ± 0.3 pg/ml), KPro G and KPro NoG patients had higher blood plasma levels of TNF-α (1.18 ± 0.58 pg/ml, p = 0.006; 1.16 ± 0.50 pg/ml, p = 0.04, respectively). Similarly, KPro G patients had higher blood plasma levels of TNFR2 (2768 ± 1368 pg/ml) than NA patients (2020 ± 435 pg/ml, p = 0.048). In multivariate analysis, KPro status remained positively associated with TNF-α levels (β = 0.36; 95% confidence intervals [CI]: 0.14-0.58; p = 0.002) and TNFR2 levels (β = 458.3; 95% CI: 32.8-883.7; p = 0.035) after adjusting for age, gender, BMI, glaucoma status, and ESR. TNFR1 and leptin levels were not significantly different in the study groups. Conclusions: We detected elevated serum levels of TNF-α and TNFR2 in KPro patients. Longitudinal studies are needed to establish TNF-α and TNFR2 as serum biomarkers related to KPro surgery. Abbreviations: BCVA: best corrected visual acuity; BMI: body mass index; CDR: cup-to-disc ratio; EDTA: ethylenediaminetetraacetic acid; ELISA: enzyme-linked immunosorbent assay; ESR: erythrocyte sedimentation rate; HVF: Humphrey visual field; IOP: intraocular pressure; KPro G: keratoprosthesis with glaucoma; KPro NoG: keratoprosthesis without glaucoma; KPro: keratoprosthesis; MD: mean deviation; NA: narrow angle; non-KPro: without keratoprosthesis; PACG: primary angle closure glaucoma; RNFL: retinal nerve fiber layer; TNF-α: tumor necrosis factor alpha; TNFR1: tumor necrosis factor receptor 1; TNFR2: tumor necrosis factor receptor 2.
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Affiliation(s)
- Eleftherios I Paschalis
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear , Boston , MA , USA.,b Boston Keratoprosthesis Laboratory , Massachusetts Eye and Ear - Schepens Eye Research Institute, Harvard Medical School , Boston , MA , USA.,c Disruptive Technology Laboratory, Department of Ophthalmology , Massachusetts Eye and Ear, Harvard Medical School , Boston , MA , USA
| | - Elise V Taniguchi
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear , Boston , MA , USA.,b Boston Keratoprosthesis Laboratory , Massachusetts Eye and Ear - Schepens Eye Research Institute, Harvard Medical School , Boston , MA , USA.,d Department of Ophthalmology , Universidade Federal de Sao Paulo , Sao Paulo , Brazil
| | - James Chodosh
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear , Boston , MA , USA.,b Boston Keratoprosthesis Laboratory , Massachusetts Eye and Ear - Schepens Eye Research Institute, Harvard Medical School , Boston , MA , USA.,c Disruptive Technology Laboratory, Department of Ophthalmology , Massachusetts Eye and Ear, Harvard Medical School , Boston , MA , USA
| | - Louis R Pasquale
- e Department of Ophthalmology , Icahn School of Medicine, Mount Sinai Hospital , New York , NY , USA
| | - Kathryn Colby
- f Department of Ophthalmology , University of Chicago , Chicago , IL , USA
| | - Claes H Dohlman
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear , Boston , MA , USA.,b Boston Keratoprosthesis Laboratory , Massachusetts Eye and Ear - Schepens Eye Research Institute, Harvard Medical School , Boston , MA , USA
| | - Lucy Q Shen
- a Department of Ophthalmology , Harvard Medical School, Massachusetts Eye and Ear , Boston , MA , USA
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Paschalis EI, Lei F, Zhou C, Chen XN, Kapoulea V, Hui PC, Dana R, Chodosh J, Vavvas DG, Dohlman CH. Microglia Regulate Neuroglia Remodeling in Various Ocular and Retinal Injuries. THE JOURNAL OF IMMUNOLOGY 2018; 202:539-549. [PMID: 30541880 DOI: 10.4049/jimmunol.1800982] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/04/2018] [Indexed: 11/19/2022]
Abstract
Reactive microglia and infiltrating peripheral monocytes have been implicated in many neurodegenerative diseases of the retina and CNS. However, their specific contribution in retinal degeneration remains unclear. We recently showed that peripheral monocytes that infiltrate the retina after ocular injury in mice become permanently engrafted into the tissue, establishing a proinflammatory phenotype that promotes neurodegeneration. In this study, we show that microglia regulate the process of neuroglia remodeling during ocular injury, and their depletion results in marked upregulation of inflammatory markers, such as Il17f, Tnfsf11, Ccl4, Il1a, Ccr2, Il4, Il5, and Csf2 in the retina, and abnormal engraftment of peripheral CCR2+ CX3CR1+ monocytes into the retina, which is associated with increased retinal ganglion cell loss, retinal nerve fiber layer thinning, and pigmentation onto the retinal surface. Furthermore, we show that other types of ocular injuries, such as penetrating corneal trauma and ocular hypertension also cause similar changes. However, optic nerve crush injury-mediated retinal ganglion cell loss evokes neither peripheral monocyte response in the retina nor pigmentation, although peripheral CX3CR1+ and CCR2+ monocytes infiltrate the optic nerve injury site and remain present for months. Our study suggests that microglia are key regulators of peripheral monocyte infiltration and retinal pigment epithelium migration, and their depletion results in abnormal neuroglia remodeling that exacerbates neuroretinal tissue damage. This mechanism of retinal damage through neuroglia remodeling may be clinically important for the treatment of patients with ocular injuries, including surgical traumas.
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Affiliation(s)
- Eleftherios I Paschalis
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114; .,Massachusetts Eye and Ear/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, MA 02114.,Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114; and
| | - Fengyang Lei
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114.,Massachusetts Eye and Ear/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, MA 02114.,Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114; and
| | - Chengxin Zhou
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114.,Massachusetts Eye and Ear/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, MA 02114.,Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114; and
| | - Xiaohong Nancy Chen
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114.,Angiogenesis Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114
| | - Vassiliki Kapoulea
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114.,Massachusetts Eye and Ear/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, MA 02114
| | - Pui-Chuen Hui
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114.,Massachusetts Eye and Ear/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, MA 02114.,Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114; and
| | - Reza Dana
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114.,Massachusetts Eye and Ear/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, MA 02114
| | - James Chodosh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114.,Massachusetts Eye and Ear/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, MA 02114.,Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114; and
| | - Demetrios G Vavvas
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114.,Angiogenesis Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114
| | - Claes H Dohlman
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114.,Massachusetts Eye and Ear/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, MA 02114
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45
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Permanent neuroglial remodeling of the retina following infiltration of CSF1R inhibition-resistant peripheral monocytes. Proc Natl Acad Sci U S A 2018; 115:E11359-E11368. [PMID: 30442669 PMCID: PMC6275537 DOI: 10.1073/pnas.1807123115] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This work contributes to the understanding of the enigmatic progressive retinal damage following acute ocular surface injury. Clinical findings in patients suggest that such injuries can adversely affect the retina. This study demonstrates that corneal injury leads to rapid infiltration of blood-derived monocytes into the retina and to subsequent remodeling of the neuroglial system. In contrast to previously held belief, this study shows that the blood-derived monocytes engraft permanently into the retina and differentiate into microglia-like cells. Although these cells are morphologically indistinguishable from native microglia, they retain a distinct signature and insensitivity to CSF1R inhibition and exhibit a reactive phenotype which persists long after the noxious stimuli is removed, ultimately contributing to progressive neuroretinal degeneration. Previous studies have demonstrated that ocular injury can lead to prompt infiltration of bone-marrow–derived peripheral monocytes into the retina. However, the ability of these cells to integrate into the tissue and become microglia has not been investigated. Here we show that such peripheral monocytes that infiltrate into the retina after ocular injury engraft permanently, migrate to the three distinct microglia strata, and adopt a microglia-like morphology. In the absence of ocular injury, peripheral monocytes that repopulate the retina after depletion with colony-stimulating factor 1 receptor (CSF1R) inhibitor remain sensitive to CSF1R inhibition and can be redepleted. Strikingly, consequent to ocular injury, the engrafted peripheral monocytes are resistant to depletion by CSF1R inhibitor and likely express low CSF1R. Moreover, these engrafted monocytes remain proinflammatory, expressing high levels of MHC-II, IL-1β, and TNF-α over the long term. The observed permanent neuroglia remodeling after injury constitutes a major immunological change that may contribute to progressive retinal degeneration. These findings may also be relevant to other degenerative conditions of the retina and the central nervous system.
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46
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Wang Y, Yu X, Qian W, Zhou D, Yang T, Wang S, He W, Luo G. Epidemiologic Investigation of Chemical Burns in Southwestern China from 2005 to 2016. J Burn Care Res 2018; 39:1006-1016. [PMID: 29939259 DOI: 10.1093/jbcr/iry032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The epidemiological characteristics of chemical burns vary in different regions of the world. This study aims to survey the epidemiology, outcomes, and costs of chemical burns in southwest China, to determine associated risk factors and to obtain data for developing an effective approach to prevent and treat chemical burns. This retrospective study includes 410 cases with chemical burns admitted to the Institute of Burn Research of Southwest Hospital from 2005 to 2016. Data, including demographic, etiology, outcomes, and costs, were collected and analyzed. A total of 410 cases admitted to our burn center were included. The average age of the burn patients was 38.58 ± 14.66 years. The incidence of chemical burns peaked in autumn. The most common etiology were acids. Limbs were the most common burn sites (59.51%). Average total body surface area (TBSA) was 12.37 ± 18.67%. The percentage of patients who underwent procedures and the number of procedures were significantly greater for TBSA and full-thickness burns. The mortality of chemical burns was 1.22%. The median length of stay (LOS) and cost were 21 days and 65,852 CNY, respectively. The major risk factors for cost were the number of procedures, TBSA and full-thickness burns, the major risk factors for LOS were the number of procedures and outcome. Chemical burns mainly occurred in adult males with occupational exposures to chemical agents due to inappropriate operation. Emphasis on safety education for the public and professional pre-employment training for workers should become key preventive targets to reduce the incidence of chemical burns.
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Affiliation(s)
- Yangping Wang
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University, China
| | - Xunzhou Yu
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University, China
| | - Wei Qian
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University, China
| | - Daijun Zhou
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University, China
| | - Tao Yang
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University, China
| | - Song Wang
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University, China
| | - Weifeng He
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University, China
| | - Gaoxing Luo
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Army Medical University, China
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Guzmán M, Miglio MS, Zgajnar NR, Colado A, Almejún MB, Keitelman IA, Sabbione F, Fuentes F, Trevani AS, Giordano MN, Galletti JG. The mucosal surfaces of both eyes are immunologically linked by a neurogenic inflammatory reflex involving TRPV1 and substance P. Mucosal Immunol 2018; 11:1441-1453. [PMID: 29867077 DOI: 10.1038/s41385-018-0040-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/08/2018] [Accepted: 04/15/2018] [Indexed: 02/04/2023]
Abstract
Immunological interdependence between the two eyes has been reported for the cornea and the retina but not for the ocular mucosal surface. Intriguingly, patients frequently report ocular surface-related symptoms in the other eye after unilateral ocular surgery. Here we show how unilateral eye injuries in mice affect the mucosal immune response of the opposite ocular surface. We report that, despite the lack of lymphatic cross-drainage, a neurogenic inflammatory reflex in the contralateral conjunctiva is sufficient to increase, first, epithelial nuclear factor kappa B signaling, then, dendritic cell maturation, and finally, expansion of effector, instead of regulatory, T cells in the draining lymph node, leading to disrupted ocular mucosal tolerance. We also show that damage to ocular surface nerves is required. Using pharmacological inhibitors and agonists, we identified transient receptor potential vanilloid 1 (TRPV1) channel as the receptor sensing tissue damage in the injured eye and substance P released in the opposite ocular surface as the effector of the sympathetic response. Finally, blocking either step prevented subsequent ocular allergic reactions in the opposite eye in a unilateral corneal alkali burn model. This study demonstrates that both ocular surfaces are immunologically linked and suggests potential therapeutic targets for intervention.
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Affiliation(s)
- Mauricio Guzmán
- Immunology Laboratory, Institute of Experimental Medicine (IMEX), National Academy of Medicine/CONICET, Buenos Aires, Argentina
| | - Maximiliano S Miglio
- Immunology Laboratory, Institute of Experimental Medicine (IMEX), National Academy of Medicine/CONICET, Buenos Aires, Argentina
| | - Nadia R Zgajnar
- Nuclear Receptors Laboratory, Institute of Experimental Biology & Medicine (IBYME)-CONICET, Buenos Aires, Argentina
| | - Ana Colado
- Immunology Laboratory, Institute of Experimental Medicine (IMEX), National Academy of Medicine/CONICET, Buenos Aires, Argentina
| | - María B Almejún
- Immunology Laboratory, Institute of Experimental Medicine (IMEX), National Academy of Medicine/CONICET, Buenos Aires, Argentina
| | - Irene A Keitelman
- Immunology Laboratory, Institute of Experimental Medicine (IMEX), National Academy of Medicine/CONICET, Buenos Aires, Argentina
| | - Florencia Sabbione
- Immunology Laboratory, Institute of Experimental Medicine (IMEX), National Academy of Medicine/CONICET, Buenos Aires, Argentina
| | - Federico Fuentes
- Immunology Laboratory, Institute of Experimental Medicine (IMEX), National Academy of Medicine/CONICET, Buenos Aires, Argentina
| | - Analía S Trevani
- Immunology Laboratory, Institute of Experimental Medicine (IMEX), National Academy of Medicine/CONICET, Buenos Aires, Argentina.,Microbiology, Parasitology & Immunology Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Mirta N Giordano
- Immunology Laboratory, Institute of Experimental Medicine (IMEX), National Academy of Medicine/CONICET, Buenos Aires, Argentina.,Microbiology, Parasitology & Immunology Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Jeremías G Galletti
- Immunology Laboratory, Institute of Experimental Medicine (IMEX), National Academy of Medicine/CONICET, Buenos Aires, Argentina.
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Paschalis EI, Lei F, Zhou C, Kapoulea V, Thanos A, Dana R, Vavvas DG, Chodosh J, Dohlman CH. The Role of Microglia and Peripheral Monocytes in Retinal Damage after Corneal Chemical Injury. THE AMERICAN JOURNAL OF PATHOLOGY 2018; 188:1580-1596. [PMID: 29630857 DOI: 10.1016/j.ajpath.2018.03.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/04/2018] [Accepted: 03/26/2018] [Indexed: 12/17/2022]
Abstract
Eyes that have experienced alkali burn to the surface are excessively susceptible to subsequent severe glaucoma and retinal ganglion cell loss, despite maximal efforts to prevent or slow down the disease. Recently, we have shown, in mice and rabbits, that such retinal damage is neither mediated by the alkali itself reaching the retina nor by intraocular pressure elevation. Rather, it is caused by the up-regulation of tumor necrosis factor-α (TNF-α), which rapidly diffuses posteriorly, causing retinal ganglion cell apoptosis and CD45+ cell activation. Herein, we investigated the involvement of peripheral blood monocytes and microglia in retinal damage. Using CX3CR1+/EGFP::CCR2+/RFP reporter mice and bone marrow chimeras, we show that peripheral CX3CR1+CD45hiCD11b+MHC-II+ monocytes infiltrate into the retina from the optic nerve at 24 hours after the burn and release further TNF-α. A secondary source of peripheral monocyte response originates from a rare population of patrolling myeloid CCR2+ cells of the retina that differentiate into CX3CR1+ macrophages within hours after the injury. As a result, CX3CR1+CD45loCD11b+ microglia become reactive at 7 days, causing further TNF-α release. Prompt TNF-α inhibition after corneal burn suppresses monocyte infiltration and microglia activation, and protects the retina. This study may prove relevant to other injuries of the central nervous system.
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Affiliation(s)
- Eleftherios I Paschalis
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Massachusetts Eye and Ear/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, Massachusetts; Disruptive Technology Laboratory, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
| | - Fengyang Lei
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Massachusetts Eye and Ear/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, Massachusetts; Disruptive Technology Laboratory, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Chengxin Zhou
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Massachusetts Eye and Ear/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, Massachusetts; Disruptive Technology Laboratory, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Vassiliki Kapoulea
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Massachusetts Eye and Ear/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, Massachusetts; Disruptive Technology Laboratory, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Aristomenis Thanos
- Angiogenesis Laboratory, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Reza Dana
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Demetrios G Vavvas
- Angiogenesis Laboratory, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Disruptive Technology Laboratory, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Claes H Dohlman
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Massachusetts Eye and Ear/Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory, Harvard Medical School, Boston, Massachusetts
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49
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Shanbhag SS, Saeed HN, Paschalis EI, Chodosh J. Boston keratoprosthesis type 1 for limbal stem cell deficiency after severe chemical corneal injury: A systematic review. Ocul Surf 2018; 16:272-281. [PMID: 29597010 DOI: 10.1016/j.jtos.2018.03.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/23/2018] [Accepted: 03/21/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE To systematically review the published literature on outcomes of Boston keratoprosthesis type 1 for the treatment of limbal stem cell deficiency secondary to severe chemical corneal injury. METHODS Literature searches were conducted in MEDLINE (Ovid), Embase, Web of Science, and the Cochrane Central Register. The main outcome measures assessed were the proportion of eyes with best-corrected visual acuity (BCVA) ≥ 20/200 and the proportion retaining their original keratoprosthesis, both at the last recorded visit. RESULTS We identified 9 reports in which outcomes of Boston keratoprosthesis type I implantation after severe chemical injury could be determined, encompassing a total of 106 eyes of 100 patients. There were no randomized controlled studies. The median pre-operative BCVA was hand motion. Vision improved to ≥20/200 in 99/106 (93.4%) eyes after implantation. With a mean follow-up of 24.99 ± 14 months, 68/106 (64.1%) eyes retained BCVA ≥ 20/200 at the last examination. Therefore, 68/99 (68.7%) of those who improved to > 20/200 maintained at least this acuity. The originally implanted device was retained in 88/99 (88.9%) recipients for whom retention was reported. The mean time to failure was 22.36 ± 17.2 months. Glaucomatous optic neuropathy was the most common cause for BCVA <20/200 in eyes that retained the keratoprosthesis (18/27, 66.7%).. CONCLUSIONS Implantation of a Boston keratoprosthesis type I in eyes with corneal blindness after severe chemical ocular injury leads to functional vision in the majority of recipients. Evidence was limited by variability in outcome reporting and an absence of controlled studies..
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Affiliation(s)
- Swapna S Shanbhag
- Disruptive Technology Laboratory, Mass. Eye & Ear, 243 Charles Street, Boston, MA 02114, USA
| | - Hajirah N Saeed
- Disruptive Technology Laboratory, Mass. Eye & Ear, 243 Charles Street, Boston, MA 02114, USA
| | - Eleftherios I Paschalis
- Disruptive Technology Laboratory, Mass. Eye & Ear, 243 Charles Street, Boston, MA 02114, USA
| | - James Chodosh
- Disruptive Technology Laboratory, Mass. Eye & Ear, 243 Charles Street, Boston, MA 02114, USA.
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