Treatment of grade IV diffuse lamellar keratitis with oral doxycycline and topical 10% sodium citrate

Air-Jet Spun Corn Zein Nanofibers and Thin Films with Topical Drug for Medical Applications

Diabetic patients are especially susceptible to chronic wounds of the skin, which can lead to serious complications. Sodium citrate is one potential therapeutic molecule for the topical treatment of diabetic ulcers, but its viability requires the assistance of a biomaterial matrix. In this study, nanofibers and thin films fabricated from natural corn zein protein are explored as a drug delivery vehicle for the topical drug delivery of sodium citrate. Corn zein is cheap and abundant in nature, and easily extracted with high purity, while nanofibers are frequently cited as ideal drug carriers due to their high surface area and high porosity. To further reduce costs, the 1-D nanofibers in this study were fabricated through an air jet-spinning method rather than the conventional electrospinning method. Thin films were also created as a comparative 2-D material. Corn zein composite nanofibers and thin films with different concentration of sodium citrate (1-30%) were analyzed through FTIR, DSC, TGA, and SEM. Results reveal that nanofibers are a much more effective vehicle than films, with the ability to interact with sodium citrate. Thermal analysis results show a stable material with low degradation, while FTIR reveals strong control over the protein secondary structures and hold of citrate. These tunable properties and morphologies allow the fibers to provide a sustained release of citrate and then revert to their structure prior to citrate loading. A statistical analysis via t-test confirmed a significant difference between fiber and film drug release. A biocompatibility study also confirms that cells are much more tolerant of the porous nanofiber structure than the nonporous protein films, and lower percentages of sodium citrate (1-5%) were outperformed to higher percentages (15-30%). This study demonstrated that protein-based nanofiber materials have high potential as vehicles for the delivery of topical diabetic drugs.

Diagnosis, Clinical Trend, and Treatment of Diffuse Lamellar Keratitis after Femtosecond Laser-Assisted in situ Keratomileusis: A Case Report

We report a severe case of diffuse lamellar keratitis (DLK) following femtosecond laser-assisted in situ keratomileusis (femto-LASIK). A 25-year-old man was submitted to 150 kHz iFS® IntraLase-assisted LASIK in both eyes for compound myopic astigmatism. The day after surgery, clinical examination showed a diffuse whitish granular cell reaction particularly in the right eye. High-dose dexamethasone eyedrops with topical antibiotic and artificial tears were prescribed. Five days after surgery, a central corneal opacity with convergent striae was detected at biomicroscopy. The suspicion of DLK was confirmed. Additional therapy based on hyperosmolar ophthalmological solution, oral doxycycline, and topical 10% sodium citrate was prescribed. Treatment was continued and tapered for over 3 months. Improvement in corneal transparency were obtained 2 weeks after the systemic therapy had been started. Uncorrected visual acuity improved from 20/32 to 20/20 at 1-year follow-up. DLK represents an infrequent complication after femto-LASIK. It should resolve without sequelae if promptly diagnosed and treated, without necessity of corneal flap lifting.