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Zhou C, Yin Y, Wang J, Ren Z, Jiao L, Zhong L, Yang Z. Corneal wound healing following infrared laser irradiation at the wavelengths of 1.319 and 10.6 μm. Lasers Surg Med 2024; 56:218-225. [PMID: 38105476 DOI: 10.1002/lsm.23749] [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: 08/30/2023] [Revised: 11/17/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES To investigate the wound healing of rabbit cornea following infrared laser irradiations at the wavelengths of 1.319 and 10.6 μm. MATERIALS AND METHODS Twelve New Zealand rabbits were selected to establish a corneal injury model. The right and left eyes were irradiated with a neodymium-doped yttrium aluminum garnet laser at the wavelength of 1.319 μm (140 J/cm2 ) for 0.7 s and a CO2 laser at the wavelength of 10.6 μm (5.94 J/cm2 ) for 0.14 s, respectively. The incident spot diameter was 3 mm. Optical coherence tomography (OCT) was used to monitor injuries at 0 h, 0.5 h, 1 h, 3 h, 6 h, 12 h, 18 h, 24 h, 30 h, 36 h, 42 h, 48 h, 54 h, 60 h, 66 h, 3 d, 7 d, 14 d, 28 d, 3 m, and 6 m postexposure. Meanwhile, slit-lamp microscopy and histopathology were performed at 6 h, 24 h, 3 d, 7 d, 14 d, 28 d, 3 m, and 6 m postexposure. RESULTS After the two types of infrared laser injuries, distinct white circular lesions on the corneal surface were directly observed. Deeper corneal injury, more severe edema, and faster migration of new epithelium were found for the wavelength of 1.319 μm, compared to the wavelength of 10.6 μm. CONCLUSIONS OCT combined with histopathology and slit-lamp microscopy can clearly observe the dynamic process of corneal wound healing after infrared laser irradiation. The damage characteristics for the two different wavelengths were visibly different, but the whole wound healing process was similar. The obtained results may provide references for the diagnosis, treatment, and evaluation of laser-induced damages.
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Affiliation(s)
- Congling Zhou
- Beijing Institute of Radiation Medicine, Beijing, China
- School of Life Sciences, Hebei University, Baoding, China
| | - Yixue Yin
- Beijing Institute of Radiation Medicine, Beijing, China
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jiarui Wang
- Beijing Institute of Radiation Medicine, Beijing, China
| | - Ziqi Ren
- School of Management, Hebei University, Baoding, China
| | - Luguang Jiao
- Beijing Institute of Radiation Medicine, Beijing, China
| | - Li Zhong
- School of Life Sciences, Hebei University, Baoding, China
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California, USA
| | - Zaifu Yang
- Beijing Institute of Radiation Medicine, Beijing, China
- School of Life Sciences, Hebei University, Baoding, China
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Ra’oh NA, Man RC, Fauzi MB, Ghafar NA, Buyong MR, Hwei NM, Halim WHWA. Recent Approaches to the Modification of Collagen Biomatrix as a Corneal Biomatrix and Its Cellular Interaction. Polymers (Basel) 2023; 15:polym15071766. [PMID: 37050380 PMCID: PMC10097332 DOI: 10.3390/polym15071766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/21/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Over the last several decades, numerous modifications and advancements have been made to design the optimal corneal biomatrix for corneal epithelial cell (CECs) or limbal epithelial stem cell (LESC) carriers. However, researchers have yet to discover the ideal optimization strategies for corneal biomatrix design and its effects on cultured CECs or LESCs. This review discusses and summarizes recent optimization strategies for developing an ideal collagen biomatrix and its interactions with CECs and LESCs. Using PRISMA guidelines, articles published from June 2012 to June 2022 were systematically searched using Web of Science (WoS), Scopus, PubMed, Wiley, and EBSCOhost databases. The literature search identified 444 potential relevant published articles, with 29 relevant articles selected based on inclusion and exclusion criteria following screening and appraising processes. Physicochemical and biocompatibility (in vitro and in vivo) characterization methods are highlighted, which are inconsistent throughout various studies. Despite the variability in the methodology approach, it is postulated that the modification of the collagen biomatrix improves its mechanical and biocompatibility properties toward CECs and LESCs. All findings are discussed in this review, which provides a general view of recent trends in this field.
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Affiliation(s)
- Nur Amalia Ra’oh
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Rohaina Che Man
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine (CTERM), Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Norzana Abd Ghafar
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Muhamad Ramdzan Buyong
- Institute of Microengineering and Nanoelectronics (IMEN), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Ng Min Hwei
- Centre for Tissue Engineering and Regenerative Medicine (CTERM), Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Wan Haslina Wan Abdul Halim
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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Thompson V, Moshirfar M, Clinch T, Scoper S, Linn SH, McIntosh A, Li Y, Eaton M, Ferriere M, Stasi K. Topical Ocular TRPV1 Antagonist SAF312 (Libvatrep) for Postoperative Pain After Photorefractive Keratectomy. Transl Vis Sci Technol 2023; 12:7. [PMID: 36917119 PMCID: PMC10020951 DOI: 10.1167/tvst.12.3.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Purpose Evaluation of safety and efficacy of topical ocular SAF312 (Libvatrep) in post-photorefractive keratectomy (PRK) pain. Methods In this placebo (vehicle)-controlled, participant- and investigator-masked study, 40 participants were randomized (1:1) to two treatment sequences in a bilateral PRK crossover design (SAF312 2.5% followed by vehicle [or vice versa], one eye drop, four times daily for 72 hours after PRK). Primary endpoints were visual analog scale (VAS) pain scores at 6 hours after first drop of study drug and average VAS scores over 0 to 12 hours postoperatively. Secondary endpoints included postoperative oral rescue medication (ORM) use and adverse events (AEs). Results All 40 participants completed the study. Both primary endpoints were met; mean difference in VAS pain scores between SAF312- and vehicle-treated eyes was -11.13 (P = 0.005, -25%) at 6 hours postoperatively and -8.56 (P = 0.017, -22%) over 0 to 12 hours. Mean VAS pain scores with SAF312 were consistently lower than with vehicle from 1 hour postoperatively up to 30 hours (P ≤ 0.10 observed in 8/11 time points). Less ORM was taken with SAF312 up to 0 to 72 hours postoperatively, with a trend of fewer participants taking ORM at 0 to 24 hours postoperatively with SAF312 versus vehicle. No serious AEs were reported. All ocular AEs were mild and transient, and none were drug related. SAF312-treated eyes showed no delay in wound healing and had a lower grade 4 conjunctival hyperemia 24 hours postoperatively versus vehicle-treated eyes. Conclusions SAF312 was well tolerated and effective in reducing ocular pain post-PRK. Translational Relevance Topical SAF312 presents a new therapeutic option for patients undergoing PRK.
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Affiliation(s)
- Vance Thompson
- Vance Thompson Vision, Sioux Falls, SD, USA.,University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, USA
| | - Majid Moshirfar
- Hoopes, Durrie, Rivera Research, Hoopes Vision, Draper, UT, USA
| | | | | | - Steven H Linn
- Hoopes, Durrie, Rivera Research, Hoopes Vision, Draper, UT, USA
| | | | - Yifang Li
- Novartis Pharmaceuticals Corp., East Hanover, NJ, USA
| | - Matt Eaton
- Novartis Institute of Biomedical Research, Cambridge, MA, USA
| | | | - Kalliopi Stasi
- Novartis Institute of Biomedical Research, Cambridge, MA, USA
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Jost M, Pfaeffli O, Kaufmann C, Reichmuth V, Thiel M, Baenninger P. Efficacy of Diclofenac in Pain Reduction after Topography-Guided Transepithelial Surface Ablation. Klin Monbl Augenheilkd 2022; 239:386-389. [PMID: 35320868 DOI: 10.1055/a-1739-0410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To report the efficacy of postoperative diclofenac eye drops for pain reduction in patients undergoing topography-guided transepithelial surface ablation. METHODS Retrospective consecutive case series of patients undergoing topography-guided transepithelial surface ablation for refractive myopia treatment using a 1 KHz excimer laser. Patients were divided into three groups. Group 1 did not receive any diclofenac drops, group 2 received one diclofenac drop postoperatively (day 1), and group 3 received one drop of diclofenac postoperatively (day 1) and on the day after treatment (day 2). Postoperative pain was self-assessed by patients per eye daily for the first 4 consecutive days (days 1 to 4) after the treatment using the visual analogue scale (VAS). We compared VAS with respect to the use of additional oral or topical treatment as well as VAS with regards to the total amount of ablated tissue (< 50 µm, 50 - 100 µm, ≥ 100 µm) among the groups. RESULTS We enrolled 163 eyes of 163 patients (55.0% female), with a mean age of 31.3 years (SD ± 6.6; range 21 - 68). We excluded 16 patients who applied other additional analgesics. Group 1 comprised 35 eyes (21%), group 2 had 21 eyes (13%), and group 3 consisted of 107 eyes (66%). Median pain score (VAS) was 5 (range 0, 10) in group 1, which was higher than in groups 2 (median 1, range 0 to 7) and 3 (median 1.5, range 0 to 7) on the day of surgery (p < 0.0001). Percentage of patients using an additional oral NSAID on days 1 and 2 was significantly higher in group 1 (69/83%) when compared to groups 2 (24/43%) or 3 (31/49%) (p < 0.001 day 1, p = 0.001 day 2). No correlation was found between pain sensation and maximum ablation depth (Spearman correlation p > 0.05). CONCLUSION The instillation of one drop of diclofenac after topography-guided transepithelial surface ablation reduced subjective pain sensation according to VAS and decreased the need for additional topical anesthetic drops or oral NSAID.
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Affiliation(s)
- Moritz Jost
- Augenklinik, Luzerner Kantonsspital, Luzern, Switzerland.,Ophthalmology, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | | | - Claude Kaufmann
- Augenklinik, Luzerner Kantonsspital, Luzern, Switzerland.,Ophthalmology, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | | | - Michael Thiel
- Augenklinik, Luzerner Kantonsspital, Luzern, Switzerland.,Ophthalmology, Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Wang Y, Shen F, Sun W, Wang Q, Zhao X. Bandage contact lens soaked in 0.1% diclofenac to relieve early postoperative pain and foreign body sensation after transepithelial photorefractive keratectomy. Eur J Ophthalmol 2022; 32:3321-3327. [PMID: 35196147 DOI: 10.1177/11206721221082301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To study the effects of a bandage contact lens immersed in 0.1% diclofenac on pain management for patients undergoing transepithelial photorefractive keratectomy (TPRK). METHODS In a prospective, comparative, contralateral, randomized, double-masked study, we assessed a total of 51 patients. The eyes of each patient were randomly divided into two groups. After TPRK, a normal soft bandage contact lens was placed on one eye as the control group, and a bandage contact lens soaked in diclofenac was placed on the other eye as the experimental group. When the bandage contact lens was not removed, postoperative pain and other ocular discomforts were compared at 2, 18, and 24 h and 2, 3, 4, and 5 postoperative days. Patients were then examined after 1 month. Visual acuity and subepithelial haze were also evaluated. RESULTS The mean pain score was 2.69 ± 1.96 in the control group, which was significantly higher than that in the experimental group, which received the diclofenac-soaked bandage contact lens at 2 postoperative hours. The statistical difference between the two groups' mean foreign body sensation at 2 postoperative hours was detected (p = 0.035). No differences were detected between the two groups' subepithelial haze scores or visual acuity. CONCLUSION A bandage contact lens soaked in 0.1% diclofenac solution can be used as a potential drug-delivery system to relieve early postoperative pain and foreign body sensation after TPRK.
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Affiliation(s)
- Yuan Wang
- 150163Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou 325027, Zhejiang, China.,Hangzhou Xihu Zhijiang Eye hospital, 366 Xiangshan, Hangzhou 310008, Zhejiang, China
| | - Fei Shen
- Hangzhou Xihu Zhijiang Eye hospital, 366 Xiangshan, Hangzhou 310008, Zhejiang, China
| | - Weiyang Sun
- Hangzhou Xihu Zhijiang Eye hospital, 366 Xiangshan, Hangzhou 310008, Zhejiang, China
| | - Qinmei Wang
- 150163Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou 325027, Zhejiang, China.,Hangzhou Xihu Zhijiang Eye hospital, 366 Xiangshan, Hangzhou 310008, Zhejiang, China
| | - Xiangyang Zhao
- Hangzhou Xihu Zhijiang Eye hospital, 366 Xiangshan, Hangzhou 310008, Zhejiang, China
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In vivo biocompatibility evaluation of in situ-forming polyethylene glycol-collagen hydrogels in corneal defects. Sci Rep 2021; 11:23913. [PMID: 34903788 PMCID: PMC8668970 DOI: 10.1038/s41598-021-03270-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 12/01/2021] [Indexed: 12/26/2022] Open
Abstract
The available treatment options include corneal transplantation for significant corneal defects and opacity. However, shortage of donor corneas and safety issues in performing corneal transplantation are the main limitations. Accordingly, we adopted the injectable in situ-forming hydrogels of collagen type I crosslinked via multifunctional polyethylene glycol (PEG)-N-hydroxysuccinimide (NHS) for treatment and evaluated in vivo biocompatibility. The New Zealand White rabbits (N = 20) were randomly grouped into the keratectomy-only and keratectomy with PEG-collagen hydrogel-treated groups. Samples were processed for immunohistochemical evaluation. In both clinical and histologic observations, epithelial cells were able to migrate and form multilayers over the PEG-collagen hydrogels at the site of the corneal stromal defect. There was no evidence of inflammatory or immunological reactions or increased IOP for PEG-collagen hydrogel-treated corneas during the four weeks of observation. Immunohistochemistry revealed the presence of α-smooth muscle actin (α-SMA) in the superior corneal stroma of the keratectomy-only group (indicative of fibrotic healing), whereas low stromal α-SMA expression was detected in the keratectomy with PEG-collagen hydrogel-treated group. Taken together, we suggest that PEG-collagen may be used as a safe and effective alternative in treating corneal defect in clinical setting.
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Corneal Epithelial Removal with a Newly Designed Epithelial Brush. J Ophthalmol 2021; 2021:4668056. [PMID: 35154818 PMCID: PMC8828349 DOI: 10.1155/2021/4668056] [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: 09/02/2021] [Accepted: 11/02/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to evaluate and compare the effectiveness of a newly developed epithelial removal brush with conventional methods in a rabbit model of corneal epithelial defects. The corneal epithelia of thirty-seven rabbits were removed by three different methods including blades (blade group), newly developed epithelial brushes (Ocu group), and conventional rotating brushes (Amo group). The defect area was measured with light microscopy immediately and at 4, 18, 24, and 50 hours after removal. Corneas were obtained immediately and at 24 and 50 hours and subjected to hematoxylin and eosin (H&E) and immunofluorescence staining using proliferating cell nuclear antigen (PCNA) and phosphorylated heat shock protein 27 (pHSP27) antibodies. The residual stromal surface was observed by scanning electron microscopy (SEM). In the Ocu group, epithelia were significantly recovered at 18, 24, and 50 hours compared with immediately after removal, and in the blade and Amo groups, epithelia were significantly recovered only at 50 hours after epithelial removal. The expression levels of PCNA and pHSP27 did not differ among three groups. There was significantly more inflammatory cell infiltration in the blade group than in the other groups. SEM showed a more regular and uniform residual stromal surface in the Ocu group than in the other groups. The newly developed epithelial brush showed better polishing ability and led to earlier significant epithelial recovery and a more regular and uniform stromal surface than conventional methods in this rabbit model of epithelial defects. Accumulation of clinical data is expected to expand the scope of application of new brushes for laser surface ablation.
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Comparison of the effect of removing bandage contact lens on the days 3 and 5 following photorefractive keratectomy. Int Ophthalmol 2021; 42:575-580. [PMID: 34635956 DOI: 10.1007/s10792-021-02029-z] [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: 01/14/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
AIM To compare the outcomes of removing bandage contact lens (BCL) on days 3 and 5 after photorefractive keratectomy (PRK). METHODS One hundred patients who underwent PRK (a total of 200 eyes) were enrolled in the present study. The subjects were assigned to two groups. Group 1 consisted of the right eyes of subjects and bandage contact lenses removal were on the 3rd day; Group 2 consisted of the fellow eyes of same subjects and removed bandage contact lenses on the 5th day after PRK. Then, data obtained from both groups were compared. To evaluate complications, the subjects underwent a slit-lamp examination in all visits. RESULTS Filamentary keratitis was observed in one eye in both groups. The frequency of haze was higher in group 1; however, it was not significant between the two groups. Using mixed model analysis, significant differences were observed in the rate of complications as well as pain and eye discomfort scores between the groups (P < 0.05). No major complication was reported. CONCLUSION Majority of post-PRK corneal epithelial defect is healed on day 3. However, keeping BCL for 5 days postoperatively instead of the three days produces a slightly lower rate of total complication.
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Mohammadpour M, Khorrami-Nejad M, Shakoor D. Role of artificial tears with and without hyaluronic acid in controlling ocular discomfort following PRK: a randomized clinical trial. Int J Ophthalmol 2021; 14:1225-1230. [PMID: 34414088 DOI: 10.18240/ijo.2021.08.14] [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: 08/15/2020] [Accepted: 03/03/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To compare outcomes of applying preservative free artificial tears (PFAT) with and without hyaluronic acid (HA) in early postoperative course following photorefractive keratectomy (PRK). METHODS In this triple-blinded randomized clinical trial, PRK procedure was performed on both eyes of 230 patients. Following PRK, patients were divided into three groups: the HA+ group, 44 patients PFAT containing HA; the HA- group, 71 patients PFAT without HA were administered 5 times per day (every 4h); the third group, 115 patients received no PFAT before lens removal. On the 1st and 4th postoperative day, Visual Analogue Score (VAS) was utilized to evaluate patient's level of pain. Participants were asked to complete a questionnaire about the severity of eye discomfort ranked from 0 to 10 (0=no complaint; 10=most severe complaint experienced). RESULTS In eyes receiving PFAT with or without HA (Drop group), mean scores for epiphora, foreign body sensation, and blurred vision on the 1st postoperative day were statistically lower (P<0.05). Filamentous keratitis (FK) was detected in 11 (4.7%) eyes, and recurrent corneal erosion (RCE) was observed in 5 (2.1%) eyes. In the control group, FK was noted in 16 (6.9%) eyes while 13 (5.6%) eyes had RCE and 5 (2.1%) eyes had corneal haze. The rate of complications was statistically lower in Drop group (P=0.009). However, the aforementioned scores were not statically different between HA+ and HA- group one and two (P=0.29). CONCLUSION Following PRK, applying PFAT with and without HA yields faster visual recovery, decreases postoperative ocular discomfort and haze formation; however there is no additive effect for HA.
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Affiliation(s)
- Mehrdad Mohammadpour
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Masoud Khorrami-Nejad
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran.,School of Rehabilitation, Tehran University of Medical Sciences, Tehran 1148965111, Iran
| | - Delaram Shakoor
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
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Pourjabbar B, Biazar E, Heidari Keshel S, Ahani-Nahayati M, Baradaran-Rafii A, Roozafzoon R, Alemzadeh-Ansari MH. Bio-polymeric hydrogels for regeneration of corneal epithelial tissue*. INT J POLYM MATER PO 2021. [DOI: 10.1080/00914037.2021.1909586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Bahareh Pourjabbar
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esmaeil Biazar
- Tissue Engineering group, Department of Biomedical Engineering, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
| | - Saeed Heidari Keshel
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Milad Ahani-Nahayati
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Reza Roozafzoon
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Advanced Medical Sciences and Technologies, School of Paramedicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Hasan Alemzadeh-Ansari
- Ophthalmic Research Center, Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Paik DW, Lim DH, Chung TY. Effects of taking pregabalin (Lyrica) on the severity of dry eye, corneal sensitivity and pain after laser epithelial keratomileusis surgery. Br J Ophthalmol 2020; 106:474-479. [PMID: 33303426 DOI: 10.1136/bjophthalmol-2020-317570] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/27/2020] [Accepted: 11/14/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Corneal nerve damage after laser epithelial keratomileusis (LASEK) is thought to be the cause of dry eye and pain. Therefore, we investigated whether taking pregabalin (Lyrica), which reduces peripheral neuropathic pain, alleviates corneal nerve sensitivity after surgery and reduces dry eye and pain. METHODS Patients were treated with pregabalin (150 mg two times a day for 15 days) from the day before surgery onward and compared with those who did not receive the medications. Before surgery, the severity of dry eye was assessed. Then, corneal sensitivity was assessed by esthesiometry and pain was assessed according to the Visual Analogue Scale. Images of the sub-basal nerve plexus were analysed using confocal microscopy to evaluate nerve regeneration at 6 months. RESULTS Forty eyes in the pregabalin group and 40 eyes in the control group were included in this study. No significant differences regarding the severity of dry eye, corneal sensitivity test results and nerve fibre density existed between the two groups until 6 months. The pregabalin group showed significantly reduced pain at 1 week. CONCLUSIONS Taking pregabalin during LASEK surgery may affect corneal nerve sensitivity and reduce pain. However, for up to 6 months thereafter, corneal sensitivity and nerve fibre density are not significantly different from findings in the control group, so pregabalin does not seem to affect nerve regeneration or structural changes.
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Affiliation(s)
- Dong Won Paik
- Department of Ophthalmology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea (the Republic of)
| | - Dong Hui Lim
- Department of Ophthalmology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea (the Republic of).,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Seoul, Korea (the Republic of)
| | - Tae-Young Chung
- Department of Ophthalmology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea (the Republic of)
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Oral l-Cysteine Supplementation Enhances the Long Term-Effect of Topical Basic Fibroblast Growth Factor (bFGF) in Reducing the Corneal Haze after Photorefractive Keratectomy in Myopic Patients. Pharmaceuticals (Basel) 2020; 13:ph13040067. [PMID: 32326563 PMCID: PMC7243117 DOI: 10.3390/ph13040067] [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: 03/25/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022] Open
Abstract
We aimed at evaluating the long-term effects of l-cysteine oral supplementation to basic fibroblast growth factor (bFGF) eye-drops on corneal re-epithelization and transparency in myopic patients subjected to photorefractive keratectomy (PRK). Forty patients subjected to bilateral PRK for myopia were enrolled and randomly divided into two groups receiving an additional therapy together with the standard postoperative treatment consisting in local tobramycin 0.3%, dexamethasone 0.1%, diclofenac 0.1%, and 0.2% hyaluronate. Group 1 included 20 patients (11 males and 9 females; 34.09 ± 8 years of age) receiving only bFGF eye-drops (10 μg/10 μL) four times a day for 7 days starting from the day of surgery; Group 2 included 20 patients (12 males and 8 females; 37.35 ± 11.5 years of age) who were postoperatively administered with topical basic fibroblast growth factor (bFGF; 10 μg/10 μL) four times a day for 7 days plus oral l-cysteine supplementation (500 mg/capsule) once a day for 15 days, starting 7 days before PRK. Patients were followed-up for 12 months. Clinical ophthalmologic parameters were recorded for all the 80 examined eyes. The corneal transparency was evaluated in vivo by slit lamp and confocal microscopy. The data showed that: (a) the corneal haze occurred in a smaller percentage of the patients who were postoperatively administered with topical bFGF plus oral l-cysteine supplementation (Group 2) compared to patients who received only bFGF (Group 1); (b) at 6 months of follow-up, the stromal mean image brightness of the patients belonging to Group 2 was significantly lower than that of the Group 1 (p < 0.03), and, interestingly, the difference was even more evident at 12 month from the treatment (p < 0.001). Moreover, the final mean of the spherical equivalent refraction was −0.06 ± 0.2 D in Group 1 and −0.08 ± 0.3 D in Group 2, whereas the final uncorrected distance visual acuity (UDVA) was equal or superior to 20/25 in 100% of eyes in both Group 1 and 2. Post refractive patients can benefit from the administration of l-cysteine before the surgery and in association with bFGF in the early postoperative period, showing a faster corneal re-epithelization able to prevent corneal haze in the long-term recovery.
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Shetty R, Dalal R, Nair AP, Khamar P, D’Souza S, Vaishnav R. Pain management after photorefractive keratectomy. J Cataract Refract Surg 2019; 45:972-976. [DOI: 10.1016/j.jcrs.2019.01.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/31/2018] [Accepted: 01/29/2019] [Indexed: 11/15/2022]
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Comparison of the Lotrafilcon B and Comfilcon A Silicone Hydrogel Bandage Contact Lens on Postoperative Ocular Discomfort After Photorefractive Keratectomy. Eye Contact Lens 2018; 44 Suppl 2:S273-S276. [DOI: 10.1097/icl.0000000000000471] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zarei-Ghanavati S, Jafarpour S, Radyn-Majd A, Hosseinikhah-Manshadi H. Evaluation of early postoperative ocular pain after photorefractive keratectomy and corneal crosslinking. J Cataract Refract Surg 2018; 44:566-570. [DOI: 10.1016/j.jcrs.2018.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/27/2018] [Accepted: 02/17/2018] [Indexed: 11/26/2022]
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Dahmana N, Mugnier T, Gabriel D, Kaltsatos V, Bertaim T, Behar-Cohen F, Gurny R, Kalia YN. Topical Administration of Spironolactone-Loaded Nanomicelles Prevents Glucocorticoid-Induced Delayed Corneal Wound Healing in Rabbits. Mol Pharm 2018; 15:1192-1202. [DOI: 10.1021/acs.molpharmaceut.7b01028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Naoual Dahmana
- School of Pharmaceutical Sciences, University of Geneva & University of Lausanne, CMU - 1 rue Michel Servet, 1211 Geneva 4, Switzerland
| | | | - Doris Gabriel
- Apidel SA, 29 Quai du Mont Blanc, 1201 Geneva, Switzerland
| | | | - Thierry Bertaim
- CEVA Santé Animal, 10 Avenue de la Ballastière, 33500 Libourne, France
| | - Francine Behar-Cohen
- Fondation Asile des Aveugles, Hôpital Ophtalmique Jules-Gonin, 15 Avenue de France, 1004 Lausanne, Switzerland
- INSERM, UMRS 872 Team 17, Centre de Recherche des Cordeliers, 15 rue de l’Ecole de Médecine, 75006 Paris, France
| | - Robert Gurny
- School of Pharmaceutical Sciences, University of Geneva & University of Lausanne, CMU - 1 rue Michel Servet, 1211 Geneva 4, Switzerland
- Apidel SA, 29 Quai du Mont Blanc, 1201 Geneva, Switzerland
| | - Yogeshvar N. Kalia
- School of Pharmaceutical Sciences, University of Geneva & University of Lausanne, CMU - 1 rue Michel Servet, 1211 Geneva 4, Switzerland
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Chang JS. June consultation #4. J Cataract Refract Surg 2017; 43:855-857. [DOI: 10.1016/j.jcrs.2017.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Comparison of bandage contact lens removal on the fourth versus seventh postoperative day after photorefractive keratectomy: A randomized clinical trial. J Curr Ophthalmol 2016. [PMID: 28626819 PMCID: PMC5463006 DOI: 10.1016/j.joco.2016.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare the outcomes of bandage contact lens (BCL) removal on the fourth versus seventh post-operative day following photorefractive keratectomy (PRK). METHODS This study recruited eyes of patients who underwent PRK surgery. The patients were randomly assigned to 2 groups. In Group 1 BCL was removed on the 4th postoperative day, while in Group 2, BCL was removed on the 7th postoperative day. After BCL removal, patients were asked to express their pain score and eye discomfort. At one and three months follow-up examinations, visual acuity scale was assessed. Slit-lamp examination was performed in all visits to evaluate complications. RESULTS 260 eyes of 130 patients underwent PRK. The age and sex ratio were not significantly different between the two groups. One month after the surgery, the logMAR uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were significantly lower in Group 2 (P value = 0.016, 0.001 respectively), however, the UDVA and CDVA were not significantly different after 3 months (P > 0.05). In Group 1, filamentary keratitis (FK) was observed in 10 (7.6%) eyes, 6 (4.61%) eyes were diagnosed with recurrent corneal erosion (RCE) and corneal haze was detected in 3 (2.3%) eyes. However, in Group 2, RCE was observed in 4 (2.3%) and FK was noted in 4 (3.07%) eyes. No haze was seen in Group 2. The difference in rate of complications was statistically significant (14.6% and 6.1% in Groups 1 and 2, respectively, P = 0.02). Pain and eye discomfort scores were not significantly different (P > 0.05). There was no major complications including infectious keratitis in either groups. CONCLUSION Following PRK surgery, BCL removal on the seventh postoperative day yields faster visual rehabilitation and lower rate of postoperative complications with no increase in eye pain, discomfort or infection.
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Abstract
PURPOSE To compare the profiles of postoperative photorefractive keratectomy (PRK) pain between both eyes under the same conditions and to verify the preoperative predictors of pain such as gender, anxiety, knowledge of the procedure, and spherical equivalent refractive error (SERE). METHODS This prospective study included 86 eyes of 43 patients with myopia who underwent PRK in both eyes at an interval of 14 days between the procedures. Before surgery, subjects answered the State Anxiety Inventory. After surgery, usual PRK pain treatment was given. Subjects answered the Visual Analog Scale, the Brief Pain Inventory (BPI), and the McGill Pain Questionnaire at 1, 24, 48, 72, and 96 hours after surgery. Pain scores and anxiety were compared between each eye using the Wald test and paired Student t test, respectively. The Wald test was performed for gender and SERE for each eye separately. RESULTS There were no statistically significant differences between both eyes for all time points regarding the Visual Analog Scale, BPI, and McGill Pain Questionnaire-Pain Rating Index pain scores. Subjects were less anxious on average before the second surgery compared with before the first surgery (P < 0.001); however, it was not related to pain ratings after surgery. Gender did not significantly affect any scale of pain, and the SERE between -3 diopters (D) and -5 D (P = 0.035) revealed effects on the BPI. CONCLUSIONS The profiles of postoperative pain after PRK were similar between both eyes under the same conditions. In this study, a high SERE was the only predictor for increased pain after PRK.
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Kim SK, Hong JP, Nam SM, Stulting RD, Seo KY. Analgesic effect of preoperative topical nonsteroidal antiinflammatory drugs on postoperative pain after laser-assisted subepithelial keratectomy. J Cataract Refract Surg 2015; 41:749-55. [PMID: 25840299 DOI: 10.1016/j.jcrs.2014.06.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 05/31/2014] [Accepted: 06/12/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the effect of preoperative topical nonsteroidal antiinflammatory drugs (NSAIDs) on postoperative pain after laser-assisted subepithelial keratectomy (LASEK) and to investigate their mechanism. SETTING Severance Eye Hospital and Saeyan Eye Clinic, Seoul, South Korea. DESIGN Prospective randomized clinical trial. METHODS Participants in 2 related studies were assessed. Study 1 comprised patients scheduled for bilateral LASEK (Group 1) who were randomized to receive an NSAID in 1 eye and a placebo in the fellow eye 30, 20, and 10 minutes before LASEK. Postoperative pain, glare, tearing, and irritation were assessed using a visual analog scale. Study 2 comprised healthy subjects (Group 2) who were randomly divided into subgroups. The participants in these subgroups were randomized to receive ketorolac tromethamine 0.5% in 1 eye and placebo (ofloxacin 0.3%) in the fellow eye (Group 2A), proparacaine hydrochloride 0.5% in 1 eye and placebo in the fellow eye (Group 2B), or ketorolac tromethamine 0.5% in 1 eye and placebo in the fellow eye, followed 10 minutes later by 1 drop of proparacaine hydrochloride 0.5% in both eyes (Group 2C). In all 3 groups, corneal sensitivity was measured after 1, 2, and 6 hours. RESULTS The mean postoperative pain score in the NSAID-pretreated eye was statistically significantly lower than in the placebo-pretreated eye 6, 12, and 24 hours postoperatively (P < .05). The mean corneal sensitivity was statistically significantly lower in the NSAID-treated eye than in the placebo-treated eye at 1 and 2 hours in Groups 2A and 2C (P < .05). CONCLUSION Preoperative administration of topical NSAIDs before LASEK effectively reduces postoperative pain. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Se Kyung Kim
- From the Nune Eye Hospital (Kim), the Saeyan Eye Clinic (Hong), and the Department of Ophthalmology (Seo), Eye and Ear Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, and the Department of Ophthalmology (Nam), CHA Bundang Medical Center, CHA University, Seongnam, South Korea; the Stulting Research Center (Stulting), Woolfson Eye Institute, Atlanta, Georgia, USA
| | - Jin Pyo Hong
- From the Nune Eye Hospital (Kim), the Saeyan Eye Clinic (Hong), and the Department of Ophthalmology (Seo), Eye and Ear Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, and the Department of Ophthalmology (Nam), CHA Bundang Medical Center, CHA University, Seongnam, South Korea; the Stulting Research Center (Stulting), Woolfson Eye Institute, Atlanta, Georgia, USA
| | - Sang Min Nam
- From the Nune Eye Hospital (Kim), the Saeyan Eye Clinic (Hong), and the Department of Ophthalmology (Seo), Eye and Ear Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, and the Department of Ophthalmology (Nam), CHA Bundang Medical Center, CHA University, Seongnam, South Korea; the Stulting Research Center (Stulting), Woolfson Eye Institute, Atlanta, Georgia, USA
| | - Robert Doyle Stulting
- From the Nune Eye Hospital (Kim), the Saeyan Eye Clinic (Hong), and the Department of Ophthalmology (Seo), Eye and Ear Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, and the Department of Ophthalmology (Nam), CHA Bundang Medical Center, CHA University, Seongnam, South Korea; the Stulting Research Center (Stulting), Woolfson Eye Institute, Atlanta, Georgia, USA
| | - Kyoung Yul Seo
- From the Nune Eye Hospital (Kim), the Saeyan Eye Clinic (Hong), and the Department of Ophthalmology (Seo), Eye and Ear Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, and the Department of Ophthalmology (Nam), CHA Bundang Medical Center, CHA University, Seongnam, South Korea; the Stulting Research Center (Stulting), Woolfson Eye Institute, Atlanta, Georgia, USA.
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Meduri A, Scorolli L, Scalinci SZ, Grenga PL, Lupo S, Rechichi M, Meduri E. Effect of the combination of basic fibroblast growth factor and cysteine on corneal epithelial healing after photorefractive keratectomy in patients affected by myopia. Indian J Ophthalmol 2015; 62:424-8. [PMID: 24145571 PMCID: PMC4064216 DOI: 10.4103/0301-4738.119420] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: This study sought to evaluate the effect of basic fibroblast growth factor eye drops and cysteine oral supplements on corneal healing in patients treated with photorefractive keratectomy (PRK). Materials and Methods: One hundred and twenty patients treated bilaterally with PRK for myopia were enrolled at one of two eye centers (Clinica Santa Lucia, Bologna, Italy and Department of Ophthalmology, University of Magna Graecia, Catanzaro, Italy) and were treated at the former center. Sixty patients included in the study group (Group 1) were treated postoperatively with topical basic fibroblast growth factor plus oral L-cysteine supplements, whereas 60 subjects included in the control group (Group 2) received basic fibroblast growth factor eye drops. We recorded the rate of corneal re-epithelialization and patients were followed-up every 30 days for 6 months. Statistical analyses were performed on the collected data. Results: The eyes in Group 1 demonstrated complete re-epithelialization at Day 5, whereas the eyes in Group 2 achieved this status on Day 6. No side-effects were reported. Conclusions: Patients treated with basic fibroblast growth factor eye drops and L-cysteine oral supplements benefit from more rapid corneal re-epithelialization. In human eyes, this combination treatment appeared to be safe and effective in accelerating corneal surfacing after surgery. Financial Disclosure: No author has any financial or proprietary interest in any material or method used in this study. Trial Registration: Current Controlled Trials ISRCTN73824458.
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Affiliation(s)
- Alessandro Meduri
- Department of Ophthalmology, Surgical Specialities, University of Messina, Messina, Italy
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Current trends in pain management after photorefractive and phototherapeutic keratectomy. Curr Opin Ophthalmol 2015; 26:255-9. [DOI: 10.1097/icu.0000000000000170] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chae JJ, McIntosh Ambrose W, Espinoza FA, Mulreany DG, Ng S, Takezawa T, Trexler MM, Schein OD, Chuck RS, Elisseeff JH. Regeneration of corneal epithelium utilizing a collagen vitrigel membrane in rabbit models for corneal stromal wound and limbal stem cell deficiency. Acta Ophthalmol 2015; 93:e57-66. [PMID: 25495158 DOI: 10.1111/aos.12503] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 06/15/2014] [Indexed: 12/27/2022]
Abstract
PURPOSE This study was performed to evaluate the potential of a collagen-based membrane, collagen vitrigel (CV), for reconstructing corneal epithelium in the stromal wound and limbal stem cell deficiency (LSCD) models. METHODS Three groups of rabbits were used in the stromal wound model: CV affixed using fibrin glue (CV + FG group, n = 9), fibrin glue only (FG group, n = 3) and an untreated control group (n = 3). In the LSCD model, one group received CV containing human limbal epithelial cells (CV + hLEC group, n = 2) and the other was an untreated control (n = 1). Gross observation, including fluorescent staining, pathological examination, immunohistochemistry and electron microscopy, was used to evaluate the effect of CV on the corneal epithelium. RESULTS In the stromal wound model, fluorescent staining showed that epithelial reconstruction occurred as rapidly in the CV + FG group as it did in the control group. The pathological examination proved that the CV supported a healthy corneal epithelium in the CV + FG group, whereas FG led to hypertrophy and inappropriate differentiation of corneal epithelium in the FG group. In the LSCD model, the corneas in the CV + hLEC group showed sustained tissue transparency with good epithelialization, low inflammatory response and reduced neovascularization. However, the control cornea was translucent and showed high amounts of inflammation and neovascularization. CONCLUSION We have demonstrated that CV supports corneal epithelial differentiation and prevents epithelial hypertrophy, in addition to serving as a scaffold for hLEC transplantation, without complications.
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Affiliation(s)
- J. Jeremy Chae
- Translational Tissue Engineering Center; Wilmer Eye Institute and Department of Biomedical Engineering; Johns Hopkins University; Baltimore Maryland USA
| | - Winnette McIntosh Ambrose
- Translational Tissue Engineering Center; Wilmer Eye Institute and Department of Biomedical Engineering; Johns Hopkins University; Baltimore Maryland USA
| | - Freddy A. Espinoza
- Translational Tissue Engineering Center; Wilmer Eye Institute and Department of Biomedical Engineering; Johns Hopkins University; Baltimore Maryland USA
| | - Daniel G. Mulreany
- Translational Tissue Engineering Center; Wilmer Eye Institute and Department of Biomedical Engineering; Johns Hopkins University; Baltimore Maryland USA
| | - Shengyong Ng
- Translational Tissue Engineering Center; Wilmer Eye Institute and Department of Biomedical Engineering; Johns Hopkins University; Baltimore Maryland USA
| | - Toshiaki Takezawa
- Division of Animal Sciences; National Institute of Agrobiological Sciences; Tsukuba Japan
| | - Morgana M. Trexler
- Research and Exploratory Development Department; The Johns Hopkins University Applied Physics Laboratory; Laurel Maryland USA
| | - Oliver D. Schein
- Department of Ophthalmology; Johns Hopkins University; Baltimore Maryland USA
| | - Roy S. Chuck
- Department of Ophthalmology; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx New York USA
| | - Jennifer H. Elisseeff
- Translational Tissue Engineering Center; Wilmer Eye Institute and Department of Biomedical Engineering; Johns Hopkins University; Baltimore Maryland USA
- Department of Ophthalmology; Johns Hopkins University; Baltimore Maryland USA
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Eslampoor A, Ehsaei A, Abrishami M. Effect of topical diclofenac on postoperative photorefractive keratectomy pain: a randomized, controlled trial. Clin Exp Ophthalmol 2014; 42:810-4. [DOI: 10.1111/ceo.12343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 03/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Alireza Eslampoor
- Cornea Research Center, Faculty of Medicine; Mashhad University of Medical Sciences; Tehran Iran
| | - Asieh Ehsaei
- Refractive Errors Research Center, School of Paramedical Sciences; Mashhad University of Medical Sciences; Tehran Iran
- Department of Optometry, School of Paramedical Sciences; Mashhad University of Medical Sciences; Tehran Iran
| | - Mojtaba Abrishami
- Eye Research Center, Faculty of Medicine; Mashhad University of Medical Sciences; Tehran Iran
- Eye Research Center, Farabi Eye Hospital; Tehran University of Medical Sciences; Tehran Iran
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Woreta FA, Gupta A, Hochstetler B, Bower KS. Management of post-photorefractive keratectomy pain. Surv Ophthalmol 2013; 58:529-35. [DOI: 10.1016/j.survophthal.2012.11.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 10/31/2012] [Accepted: 11/01/2012] [Indexed: 11/15/2022]
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Corneal Inflammation Following Corneal Photoablative Refractive Surgery With Excimer Laser. Surv Ophthalmol 2013; 58:11-25. [DOI: 10.1016/j.survophthal.2012.04.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 04/16/2012] [Accepted: 04/24/2012] [Indexed: 11/24/2022]
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Mohammadi SF, Z Mehrjardi H, Vakili STT, Majdi M, Mirhadi S, Rahimi F. Pain and Its Determinants in Photorefractive Keratectomy. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2012; 1:336-9. [PMID: 26107725 DOI: 10.1097/apo.0b013e31826c4c5d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the determinants of early postoperative pain in photorefractive keratectomy. DESIGN A prospective cross-sectional study. METHODS One hundred and four myopic-astigmatic patients undergoing bilateral standard photorefractive keratectomy were evaluated for early postoperative pain severity. On day 1 postoperatively, the level of pain experienced was reported by the patient on a visual analog scale of 0 to 10. At the preoperative interview, data were collected on clinical, demographic, and social characteristics to find potential pain determinants. RESULTS The median reported pain level was 3. About 20% of subjects reported a pain score of 6 or higher, and 2.9% (6 eyes of 4 patients) reported the highest pain score. The presence of external eye inflammatory signs was associated with higher levels of pain (P < 0.001). Patients with a higher body mass index reported more severe pain (P = 0.006). An inverse association was found between pain and harmful lifestyle choices (P = 0.008). Demographic characteristics, history of contact lens wear, history of major operation, past experience of severe pain, knowledge about the operation's adverse effects, preoperative insomnia, preoperative anxiety, operative factors, and refractive indices were not related to the severity of pain experienced (all P > 0.05). CONCLUSIONS The association of pain with ocular surface inflammation suggests that inflammatory processes have a role in early postoperative pain, supporting the use of anti-inflammatory agents for pain management. Prescription of weight-adjusted dosages of analgesics is recommended on the basis of the association between severity of postoperative pain and body mass index.
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Affiliation(s)
- S-Farzad Mohammadi
- From the *Eye Research Center, Farabi Eye Hospital and †Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Tappeiner C, Flueckiger F, Boehnke M, Goldblum D, Garweg JG. Effect of topical anesthetic agents and ethanol on corneoepithelial wound healing in an ex vivo whole-globe porcine model. J Cataract Refract Surg 2012; 38:519-24. [DOI: 10.1016/j.jcrs.2011.09.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 09/11/2011] [Accepted: 09/16/2011] [Indexed: 10/14/2022]
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Meduri A, Aragona P, Grenga PL, Roszkowska AM. Effect of Basic Fibroblast Growth Factor on Corneal Epithelial Healing After Photorefractive Keratectomy. J Refract Surg 2012; 28:220-3. [DOI: 10.3928/1081597x-20120103-02] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 11/23/2011] [Indexed: 12/29/2022]
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Recurrent Corneal Hypertrophic Scar After Laser-Assisted Subepithelial Keratectomy With Mitomycin C Treatment. Cornea 2011; 30:1030-4. [DOI: 10.1097/ico.0b013e3181e846bb] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bilateral Comparison of Conventional Epithelial Laser In Situ Keratomileusis and Lamellar Epithelial Debridement for Moderate to High Myopia. Cornea 2010; 29:853-7. [DOI: 10.1097/ico.0b013e3181ca33e6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Reynolds A, Moore JE, Naroo SA, Moore CBT, Shah S. Excimer laser surface ablation - a review. Clin Exp Ophthalmol 2010; 38:168-82. [DOI: 10.1111/j.1442-9071.2010.02230.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Ghanem VC, Kara-José N, Ghanem RC, Coral SA. Photorefractive keratectomy and butterfly laser epithelial keratomileusis: a prospective, contralateral study. J Refract Surg 2008; 24:671-84. [PMID: 18811109 DOI: 10.3928/1081597x-20080901-06] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate results of two surface excimer laser refractive surgery techniques--photorefractive keratectomy (PRK) and butterfly laser epithelial keratomileusis (butterfly LASEK). METHODS A prospective, randomized, double-masked study of 51 patients (102 eyes) who underwent laser refractive surgery. One eye of each patient was randomized to be operated with PRK and the fellow eye with butterfly LASEK. Patients were followed for 1 year. RESULTS No significant difference between groups for distance uncorrected visual acuity (UCVA) (P = .559) was noted. At 1 year, 98% (50 eyes) in the PRK group and 96.1% (49 eyes) in the butterfly LASEK group reached UCVA of 20/20. Predictability, efficacy, safety, and stability were not statistically significant between groups. Safety index was 1.0 for PRK and 0.996 for butterfly LASEK. One eye in the butterfly LASEK group lost one line of best-spectacle corrected visual acuity. At 12 months, 94.1% (48 eyes) and 86.3% (44 eyes) in the PRK and butterfly LASEK groups (P = .188), respectively, had a spherical equivalent refraction of +/- 0.50 diopters. Slight haze was observed in both groups. A statistical difference in haze between the groups was observed only in the first postoperative month, with higher intensity in the butterfly LASEK group (0.18 +/- 0.39) compared to the PRK group (0.08+/- 0.21) (P = .04). CONCLUSIONS Butterfly LASEK had similar predictability, efficacy, safety, stability, and haze incidence to PRK for the treatment of low to moderate myopia. However, on the second postoperative day, PRK showed better UCVA than butterfly LASEK.
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Lee JJ, Kim MK, Shin KS, Shin MS, Wee WR, Lee JH. Transforming growth factor-β expression in rat eyes with mechanical debridement of corneal epithelium or epithelial flap. J Cataract Refract Surg 2008; 34:662-9. [DOI: 10.1016/j.jcrs.2007.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2007] [Accepted: 12/07/2007] [Indexed: 10/22/2022]
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Effectiveness of Cultured Human Keratinocyte Onlays on Epithelial Healing and Clinical Outcome After Photorefractive Keratectomy. J Refract Surg 2008; 24:826-32. [DOI: 10.3928/1081597x-20081001-10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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PRK and Butterfly LASEK: Prospective, Randomized, Contralateral Eye Comparison of Epithelial Healing and Ocular Discomfort. J Refract Surg 2008; 24:591-9. [DOI: 10.3928/1081597x-20080601-07] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tsiklis NS, Kymionis GD, Kounis GA, Pallikaris AI, Diakonis VF, Charisis S, Markomanolakis MM, Pallikaris IG. One-year results of photorefractive keratectomy and laser in situ keratomileusis for myopia using a 213 nm wavelength solid-state laser. J Cataract Refract Surg 2007; 33:971-7. [PMID: 17531689 DOI: 10.1016/j.jcrs.2007.02.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Accepted: 02/27/2007] [Indexed: 11/16/2022]
Abstract
PURPOSE To study the long-term results of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) in low to moderate myopic corrections using the Pulzar Z1 system (CustomVis), a 213 nm wavelength solid-state laser. SETTING University refractive surgery center. METHODS This prospective noncomparative case series comprised 20 patients (40 eyes) who had refractive surgery using the Pulzar Z1 laser system. Manifest refraction, uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), safety, predictability, stability, and confocal microscopy images were evaluated. RESULTS Ten patients (20 eyes) had PRK and 10 patients (20 eyes) had LASIK. The mean follow-up was 13.9 months +/- 1.1 (SD) (range 12 to 17 months) and 14.6 +/- 1.2 months (range 12 to 18 months) in the PRK group and LASIK group, respectively. No eye lost a line of Snellen BSCVA during the follow-up period; 2 eyes (10%) gained 2 Snellen lines. There was a statistically significant decrease in spherical equivalent manifest refraction postoperatively in both groups (P<.05). Refractive stability was obtained during the first postoperative month and remained stable during the follow-up period, with no significant changes between any interval in both groups (P>.05). At the last follow-up, 95% of all eyes were within +/-1.00 diopter of emmetropia. No late postoperative complications were observed. CONCLUSION Refractive surgery using the Pulzar Z1 213 nm wavelength solid-state laser was a safe, effective procedure in the treatment of low to moderate myopia.
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Affiliation(s)
- Nikolaos S Tsiklis
- Medical School Department of Ophthalmology, Institute of Vision and Optics, University of Crete, 71003 Heraklion, Crete, Greece.
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Trattler W, McDonald M. Double-Masked Comparison of Ketorolac Tromethamine 0.4% Versus Nepafenac Sodium 0.1% for Postoperative Healing Rates and Pain Control in Eyes Undergoing Surface Ablation. Cornea 2007; 26:665-9. [PMID: 17592313 DOI: 10.1097/ico.0b013e31805290ce] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Determine the degree of postoperative pain and rate of healing in eyes treated with either ketorolac tromethamine 0.4% (Acular LS) or nepafenac sodium 0.1% (Nevanac) after flapless surface ablation [epi-laser in situ keratomileusis (LASIK)]. METHODS Prospective, randomized, double-masked, paired-eye comparison. Patients undergoing flapless surface ablation were randomized to receive ketorolac in 1 eye and nepafenac in the other. Drops were instilled immediately after the surgical procedure, and patients continued to instill the masked drops 3 times daily for 5 days. Study follow-up visits were at days 1 and 5 postoperatively. Patients were queried by phone regarding their level of pain at 5 hours postoperatively and on days 2, 3, and 4. Outcome measures included postoperative pain levels including need for additional rescue medications, rate of healing, and adverse events. RESULTS Although the original target population was 60 eyes of 30 patients, this study was halted after only 14 eyes of 7 patients because of concern for patient safety, because most patients in 1 arm developed haze. Eyes treated with nepafenac healed at a slower rate than eyes treated with ketorolac in 57% of patients. Mean time to healing was 5.7 +/- 1.1 days with ketorolac and 7.9 +/- 2.1 days with nepafenac (P = 0.066). Moreover, eyes treated with nepafenac exhibited statistically significant greater mean hazing scores at week 2 (P = 0.024) and month 1 (P = 0.039). Throughout the study, a greater percentage of nepafenac-treated eyes exhibited haze than did ketorolac-treated eyes. This difference was statistically significant at week 2 (P = 0.005) and month 1 (P = 0.039). Patients reported significantly more pain in nepafenac-treated eyes at day 3 when pain was at its peak (P = 0.046). CONCLUSIONS In patients undergoing epi-LASIK, a statistically significant trend postoperative toward increased corneal haze was seen with nepafenac compared with ketorolac. Nepafenac therapy resulted in a non-statistically significant trend toward delayed healing. The study was halted because of safety concerns.
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Mastropasqua L, Nubile M, Lanzini M, Carpineto P, Ciancaglini M, Pannellini T, Di Nicola M, Dua HS. Epithelial dendritic cell distribution in normal and inflamed human cornea: in vivo confocal microscopy study. Am J Ophthalmol 2006; 142:736-44. [PMID: 17056357 DOI: 10.1016/j.ajo.2006.06.057] [Citation(s) in RCA: 155] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 06/19/2006] [Accepted: 06/19/2006] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate dendritic cell (DCs) density, distribution, and morphology in central corneal and limbal epithelium in normal subjects and patients with immune-mediated corneal inflammation using in vivo confocal microscopy (IVCM). DESIGN Comparative case-controlled, observational confocal microscopy study. METHODS A total of 135 eyes of 135 patients were investigated. Group 1 (normal eyes) included 45 eyes of 45 healthy volunteers, group 2 photorefractive keratectomy (PRK-treated eyes) included 45 myopic eyes of 45 patients treated with PRK, and group 3 (inflamed eyes) comprised 45 eyes of 45 patients affected by immune-mediated corneal inflammation. The central cornea and limbus were examined for epithelial dendritic-shaped cells using laser scanning IVCM. DCs density was calculated using image analysis software. RESULTS Cells with a branching dendritic morphology were visualized in the basal epithelial layer, basal lamina, and subbasal nerve plexus, in the central cornea, and in the basal layer and basal membrane of the limbal epithelium. The limbal epithelium demonstrated DCs in 93.3%, 89%, and 97.7% of eyes in group 1, 2, and 3, respectively (P = ns). Central epithelial DCs were observed in 20.0% and 13.3% of eyes in group 1 and 2 (P = ns), while in 93.3% of eyes in group 3 (P < .001). DCs were found to be significantly higher at the limbus compared with central cornea in each group (P < .001). Cell densities observed in group 3 were significantly greater than groups 1 and 2, at both locations (P < .05). CONCLUSIONS Laser scanning IVCM is a useful method for evaluating epithelial DCs distribution at the limbus and central cornea in both healthy and diseased eyes.
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Affiliation(s)
- Leonardo Mastropasqua
- Department of Medicine and Aging Science, Ophthalmic Clinic, University of Chieti-Pescara, Chieti, Italy
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Martínez-García MC, Merayo-Llovés J, Blanco-Mezquita T, Mar-Sardaña S. Wound healing following refractive surgery in hens. Exp Eye Res 2006; 83:728-35. [PMID: 16701650 DOI: 10.1016/j.exer.2006.02.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 02/15/2006] [Accepted: 02/16/2006] [Indexed: 10/24/2022]
Abstract
The wound-healing response is critical to the outcome of refractive surgery and studying wound healing contributes to an understanding of the pathophysiology of other corneal injuries. Animal models allow research to be conducted with sufficient samples and under controlled parameters. We studied the hen to determine the healing process from clinical, biophysical, and biological standpoints after photorefractive keratectomy (PRK). PRK (-6.0 diopters) was performed in hen eyes. At 3, 6, 12, 24, 48, and 72 h and 5, 7, 15, 30, and 60 days postoperatively, we studied the clinical follow-up, objective measurements of light transmission (direct transmittance), apoptosis by TUNEL assay, proliferation by immunocytochemical analysis of 5-bromo-2'-deoxyuridine, and expression of alpha smooth muscle actin (SMA) in myofibroblasts in the corneas. Hen corneas reepithelialize quickly. Haze developed from 5 to 60 days after surgery and was correlated with the appearance and finalization of the expression of SMA. The direct transmittance of light was low during the first 15 days and improved at 30 and 60 days. TUNEL-positive cells were observed 3 h after surgery and the numbers decreased thereafter. Epithelial proliferation began at 12 h and was greater at 48 h, while stromal cell proliferation began at 24 h and was greater at 72 h. The hen cornea is anatomically similar to the human cornea, and the manner in which it heals is a good model for studying different surgical techniques and pharmacologic assays.
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Affiliation(s)
- M C Martínez-García
- Department of Cellular Biology and Pharmacology, Faculty of Medicine, Ramón y Cajal, n degrees 7, 47005 Valladolid, Spain.
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Cairns G, Ormonde SE, Gray T, Hadden OB, Morris T, Ring P, McGhee CNJ. Assessing the accuracy of Orbscan II post-LASIK: apparent keratectasia is paradoxically associated with anterior chamber depth reduction in successful procedures. Clin Exp Ophthalmol 2005; 33:147-52. [PMID: 15807822 DOI: 10.1111/j.1442-9071.2005.00975.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To establish a relationship between the forward protrusion of the cornea (keratectasia), following successful LASIK, and anterior chamber depth. METHODS One hundred and fifteen eyes of 59 patients who had undergone Zyoptix LASIK and 39 eyes of 21 patients who had undergone PlanoScan LASIK at the Eye Institute, Centre for Refractive Surgery, Remuera, Auckland, New Zealand, were included in the study. The results of Orbscan II acquisitions, taken before and 8.3 weeks +/- 4.0 (mean +/- standard deviation) following the procedure, were analysed to determine the amount of forward protrusion of the central 2 mm diameter of the posterior surface. The apparent keratectasia was then related to the Orbscan II anterior chamber depth (ACD) measurement in a linear mixed model analysis that included 'right or left eye', 'sex', 'type of LASIK procedure', 'change in pachymetry', 'postoperative pachymetry', 'change in anterior corneal curvature', 'postoperative anterior corneal curvature', 'planned ablation depth' and 'time until follow-up' as factors and covariates. RESULTS The mean +/- SD amount of keratectasia determined by Orbscan II was 22.8 +/- 26.8 microm for the Zyoptix group and 16.9 +/- 24.6 microm for the PlanoScan group. The reduction in depth of the anterior chamber was 14.7 +/- 79.3 microm for the Zyoptix group and 18.2 +/- 68.8 microm for the PlanoScan group. The mixed model analysis demonstrated strong relationships with postoperative pachymetry and change in anterior corneal curvature (P < 0.001 and P < 0.001, respectively). Furthermore, the statistical model showed a marked significant difference in the Orbscan II assessment of keratectasia and change in ACD (P < 0.001). CONCLUSION Using the Orbscan II device, the forward protrusion of the posterior corneal surface appears to coincide with a paradoxical reduction in depth of the anterior chamber. Although the keratectasia found in this study is accompanied by thin postoperative corneas and larger central pachymetry change, the contradictory decrease in anterior chamber depth creates uncertainty of measurement, and of ectasia as a mechanism of regression.
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Affiliation(s)
- Gerard Cairns
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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Leung DYL, Yeung EFY, Law RWK, Young AL, Lam DSC. In Vivo Confocal Microscopy of Epithelial Inclusions From Aberrant Wound Healing After Astigmatic Keratotomy. Cornea 2004; 23:299-301. [PMID: 15084865 DOI: 10.1097/00003226-200404000-00014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To report confocal microscopic findings in vivo of delayed prominent epithelial inclusions at a gaped incision groove after astigmatic keratotomy (AK). METHODS Astigmatic keratotomy using paired arcuate incisions was performed on the right eye of a 59-year-old man who had a preoperative refraction of +2.50 DS, -7.00 DC x 80. The procedure and initial postoperative course were uneventful, and his refraction was OD +1.00 DS, -2.50 DC x 60 at 16 months. However, at 17 months postsurgery, tiny pearl-like lesions appeared along one of the incision grooves. In vivo confocal microscopy was performed to investigate these lesions. RESULTS Under confocal microscopy, clusters of epithelial inclusions inside the gaped incision groove corresponded to the pearl-like lesions observed clinically. A confluent layer of flat, regular and polygonal epithelial cells covered the wall of the groove. Activated keratocytes were observed adjacently. The number of keratocytes around the groove, however, did not appear to increase in comparison to normal corneal wound healing and scar formation. No foreign body, infective, or inflammatory signs were observed. CONCLUSIONS Aberrant wound healing was identified in post-AK incisions, similar to post-radial keratotomy cases. Confocal microscopy is a useful tool to study the wound healing of AK incisions and to rule out foreign bodies or infective elements as illustrated by this case. To the best of our knowledge, this is the first reported in vivo confocal study of AK wound healing in humans.
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Affiliation(s)
- Dexter Y L Leung
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong, People's Republic of China
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Shoji N, Hayashi E, Shimizu K, Uga S, Sugita J. Central Corneal Haze Increased by Radial Keratotomy Following Photorefractive Keratectomy. J Refract Surg 2003; 19:560-5. [PMID: 14518745 DOI: 10.3928/1081-597x-20030901-11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To report a case of central corneal haze induced by minimally invasive radial keratotomy (mini-RK) after photorefractive keratectomy (PRK) and subsequent deep lamellar keratoplasty. METHODS We report a case (one eye of one patient) of central corneal haze that worsened after mini-RK was performed 2 years following PRK. Four years later, a second PRK was done, myopic regression was subsequently observed, and corneal haze persisted. Deep lamellar keratoplasty was performed and a corneal graft was taken, which was examined by light and electron microscopy. RESULTS In the ablated area, irregularity of the basal membrane and hypertrophy of the corneal epithelium were observed. In the stromal layer, collagen fibers showed disorder in their disposition. Aggregated activated keratocytes were observed. An epithelial plug filling the gap of the RK incision persisted for 6 years after the mini-RK. The RK incision was easily divided when deep lamellar keratoplasty was performed and the patient obtained a stable visual outcome. CONCLUSIONS It is possible that mini-RK enhancement after PRK induces central corneal haze and reduces corneal integrity. Deep lamellar keratoplasty for refractory corneal haze after refractive surgery was useful in this eye.
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Affiliation(s)
- Nobuyuki Shoji
- Department of Orthoptics and Visual Science, Kitasato University School of Allied Health Science, Kanagawa, Japan.
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Suominen S, Pietilä J, Mäkinen P, Uusitalo H. A new index to measure the accuracy of refractive operations. ACTA OPHTHALMOLOGICA SCANDINAVICA 2003; 81:336-42. [PMID: 12859259 DOI: 10.1034/j.1600-0420.2003.00094.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To create a new index to help evaluate the accuracy of the outcome of refractive surgery. METHODS By combining information given by the cross-cylinder form of surgically induced refractive change (SIRC) and basic methods of vector analysis, we constructed a new index which serves as a tool to evaluate postoperatively the changes achieved by refractive surgery. This new index gives easily understandable numerical values and takes into account changes in both spherical refraction and astigmatism. We demonstrated the use of this index in two study populations consisting of 20 consecutive eyes operated on using two different lasers, Meditec MEL60 and MEL70, respectively. RESULTS Although postoperative uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were better in the MEL70 group, the difference of photoefractive keratectomy (PRK) for combined astigmatism and myopia was not statistically significant. Comparison of the changes in refraction achieved by the two lasers indicated that the MEL60 was more accurate; this was also seen when comparing the total index of error between the two groups. CONCLUSIONS We suggest the use of this total index of error (TIE) in clinical praxis because it provides an easy and accurate method of evaluating the accuracy of refractive operations. These inaccuracies might otherwise go unnoticed if the basic values only (e.g. UCVA, BCVA and haze) were used in postoperative evaluation.
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Affiliation(s)
- S Suominen
- Department of Ophthalmology, University of Tampere, Medical School, 33100 Tampere, Finland.
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Philipp WE, Speicher L, Göttinger W. Histological and immunohistochemical findings after laser in situ keratomileusis in human corneas. J Cataract Refract Surg 2003; 29:808-20. [PMID: 12686254 DOI: 10.1016/s0886-3350(02)01611-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To describe histopathological and immunohistochemical findings in human corneas after myopic laser in situ keratomileusis (LASIK) followed by iatrogenic keratectasia and after hyperopic LASIK. SETTING Department of Ophthalmology, University of Innsbruck, Innsbruck, Austria. METHODS Clinical, histological, and immunohistochemical investigations were performed of 1 human cornea with iatrogenic keratectasia following myopic LASIK and 1 human cornea with irregular astigmatism and central scar formation after hyperopic LASIK. Corneal buttons were obtained during penetrating keratoplasty in both patients. RESULTS Histopathological examination showed thinning of the central stroma with a posterior residual thickness of 190 microm in the patient with iatrogenic keratectasia after myopic LASIK and significant midperipheral thinning in the patient who had hyperopic LASIK. However, this characteristic ablation profile of the stroma after hyperopic LASIK was partially mitigated and compensated by the epithelium, which was significantly thinned in the center and markedly thickened in the midperiphery. Traces of wound healing with minimal scar tissue were present at the flap margin after myopic and hyperopic LASIK. In a few sections of the cornea with keratectasia after myopia LASIK, only a few collagen lamellae were visible crossing between the posterior residual stroma and the superficial flap. Immunohistochemical examination revealed minimally increased staining of dermatan sulfate proteoglycan within the stroma adjacent to the interface of the microkeratome incision. Increased staining of hepatocyte growth factor was found on keratocytes/fibroblasts at the flap margin in both corneas. CONCLUSIONS The wound-healing response is generally poor after LASIK, which may result in significant weakening of the tensile strength of the cornea after myopic LASIK, probably due to biomechanically ineffective superficial lamella. After LASIK in patients with high hyperopia, compensatory epithelial thickening in the annular midperipheral ablation zone might be partly responsible for regression.
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Affiliation(s)
- Arash J Ahmadi
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, 02114, USA
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Oliveira-Soto L, Charman WN. Some possible longer-term ocular changes following excimer laser refractive surgery. Ophthalmic Physiol Opt 2002; 22:274-88. [PMID: 12162478 DOI: 10.1046/j.1475-1313.2002.00022.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
While the short- and medium-term refractive and acuity results of excimer laser refractive surgery may now be generally satisfactory, the relatively brief history of the procedures involved (around 10 years or less) means that those concerned with eye care must remain vigilant to the possibility of longer-term problems. This paper reviews some relevant studies of potential post-surgical effects, including imperfect corneal healing and recovery of innervation, reduced corneal sensitivity and dry eye problems, changes in corneal rigidity leading to slow refractive change, possibly misleading reductions in measured intraocular pressure, and retinal and vitreous pathology.
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Berry M, Jeffreys D. Ocular injuries from household chemicals: early signs as predictors of recovery. IN VITRO & MOLECULAR TOXICOLOGY 2002; 14:5-13. [PMID: 11689152 DOI: 10.1089/109793301316882504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
We undertook a study of patients with nonsevere ocular injuries from chemicals used in the home to (1) establish the frequency of presentation to the Accident and Emergency (A&E) Department; (2) assess and grade any common symptoms and signs of injury; and (3) evaluate cytokine concentrations in the preocular fluid as markers of toxicity. Of the 216 reviewed chemical injuries, 85% were sustained by adults (twice as many men than women). Chemicals implicated were: alkalis, cleaners, organic solvents, personal hygiene products, contact lens solutions, and disinfectants. Conjunctival redness occurred in 80% of cases, irrespective of chemical. Low correlations were obtained for the extent, type, and degree of epithelial damage in different areas of the lower lid and bulbar conjunctiva. With one exception, interleukin (IL)1beta and IL10 levels were not different in control and injured eyes, whereas IL6 was significantly elevated above uninjured levels. We have shown that interleukins, as representatives of signal chemicals, can be noninvasively sampled and reliably measured in tears after chemical injury. An indication of injury is obtained clearly from IL6 levels in tears, and there is a hint that the pattern of IL1beta/IL10 might help discriminate between levels of severity. A larger study is needed to verify these results.
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Affiliation(s)
- M Berry
- University of Bristol, Division of Ophthalmology, Bristol Eye Hospital, Bristol, United Kingdom.
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