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Lee CY, Jeng YT, Yang SF, Huang CT, Chao CC, Lian IB, Huang JY, Chang CK. Topographic and Surgical Risk Factors for Early Myopic Regression between Small Incision Lenticule Extraction and Laser In Situ Keratomileusis. Diagnostics (Basel) 2024; 14:1275. [PMID: 38928690 PMCID: PMC11202549 DOI: 10.3390/diagnostics14121275] [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: 05/08/2024] [Revised: 06/06/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Our objective was to evaluate the topographic and surgical factors of early myopic regression between laser in situ keratomileusis (LASIK) and small-incision lenticule extraction (SMILE). A retrospective case-control study was conducted, and 368 and 92 eyes were enrolled in the LASIK and SMILE groups via propensity score matching (PSM). Visual acuity, refractive status, axial length, and topographic/surgical parameters were collected. Multiple linear regression was applied to the yield coefficient and the 95% confidence interval (CI) of the parameters. The cumulative incidence of early myopic regression was higher in the LASIK group (p < 0.001). In the SMILE group, a lower central corneal thickness (CCT) thinnest value and a higher corneal cylinder associated with early myopic regression were observed; meanwhile, in the LASIK group, a lower CCT thinnest value, a higher steep corneal curvature, a larger optic zone, and a lower flap thickness related to early myopic regression were observed (all p < 0.05). In the SMILE group, a higher CCT difference correlated with early myopic regression was observed compared to the LASIK group (p = 0.030), and higher steep corneal curvature and lower cap/flap thickness (both p < 0.05) correlated with early myopic regression were observed in the LASIK group compared to the SMILE group. In conclusion, CCT differences significantly influence early myopic regression in the SMILE group; meanwhile, corneal curvature and flap thickness affect early myopic regression principally in the LASIK group.
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Affiliation(s)
- Chia-Yi Lee
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Nobel Eye Institute, Taipei 115, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung 412, Taiwan
| | - Yu-Ting Jeng
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Chin-Te Huang
- Department of Ophthalmology, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Department of Ophthalmology, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Chen-Cheng Chao
- Nobel Eye Institute, Taipei 115, Taiwan
- Department of Optometry, MacKay Junior College of Medicine, Nursing, and Management, Taipei 112, Taiwan
| | - Ie-Bin Lian
- Institute of Statistical and Information Science, National Changhua University of Education, Changhua 500, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Chao-Kai Chang
- Nobel Eye Institute, Taipei 115, Taiwan
- Department of Optometry, Da-Yeh University, Chunghua 515, Taiwan
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2
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Cui W, Chen S, Hu T, Zhou T, Qiu C, Jiang L, Cheng X, Ji J, Yao K, Han H. Nanoceria-Mediated Cyclosporin A Delivery for Dry Eye Disease Management through Modulating Immune-Epithelial Crosstalk. ACS NANO 2024; 18:11084-11102. [PMID: 38632691 DOI: 10.1021/acsnano.3c11514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Dry eye disease (DED) affects a substantial worldwide population with increasing frequency. Current single-targeting DED management is severely hindered by the existence of an oxidative stress-inflammation vicious cycle and complicated intercellular crosstalk within the ocular microenvironment. Here, a nanozyme-based eye drop, namely nanoceria loading cyclosporin A (Cs@P/CeO2), is developed, which possesses long-term antioxidative and anti-inflammatory capacities due to its regenerative antioxidative activity and sustained release of cyclosporin A (CsA). In vitro studies showed that the dual-functional Cs@P/CeO2 not only inhibits cellular reactive oxygen species production, sequentially maintaining mitochondrial integrity, but also downregulates inflammatory processes and repolarizes macrophages. Moreover, using flow cytometric and single-cell sequencing data, the in vivo therapeutic effect of Cs@P/CeO2 was systemically demonstrated, which rebalances the immune-epithelial communication in the corneal microenvironment with less inflammatory macrophage polarization, restrained oxidative stress, and enhanced epithelium regeneration. Collectively, our data proved that the antioxidative and anti-inflammatory Cs@P/CeO2 may provide therapeutic insights into DED management.
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Affiliation(s)
- Wenyu Cui
- Eye Center, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou 310009, P. R. China
| | - Sheng Chen
- Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, P. R. China
| | - Tianyi Hu
- Institute of Immunology, Zhejiang University School of Medicine, Hangzhou 310058, P. R. China
| | - Tinglian Zhou
- Eye Center, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou 310009, P. R. China
| | - Chen Qiu
- MOE Laboratory of Biosystems Homeostasis & Protection and iCell Biotechnology Regenerative Biomedicine Laboratory of College of Life Sciences, Zhejiang University, Hangzhou 310058, P. R. China
| | - Luyang Jiang
- Eye Center, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou 310009, P. R. China
| | - Xiaoyu Cheng
- Eye Center, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou 310009, P. R. China
| | - Jian Ji
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization of Ministry of Education, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310058, P. R. China
| | - Ke Yao
- Eye Center, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou 310009, P. R. China
| | - Haijie Han
- Eye Center, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou 310009, P. R. China
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Lee CY, Jeng YT, Chao CC, Lian IB, Huang JY, Yang SF, Chang CK. Refraction and topographic risk factors for early myopic regression after small-incision lenticule extraction surgery. Sci Rep 2024; 14:8732. [PMID: 38627567 PMCID: PMC11021515 DOI: 10.1038/s41598-024-59327-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
We sought to evaluate the topographic risk factors for early myopic regression after small-incision lenticule extraction (SMILE). A retrospective case‒control study was conducted, and individuals who underwent SMILE surgery were enrolled. Among them, 406 and 14 eyes were categorized into the nonregression and regression groups, respectively. The preoperative and postoperative parameters in the two groups were collected, including spherical refraction (SE), axial length (AXL) and topographic data. A generalized linear model was adopted to analyze the difference in each parameter between the two groups. After 6 months, UCVA decreased in the regression group, and SE increased in the regression group (both P < 0.05). The increase in the CCT at the thinnest point (P = 0.044), flat corneal curvature (P = 0.012) and TCRP (P = 0.001) were significantly greater in the regression group. Regarding the risk factors for myopic regression, preoperative SE, preoperative sphere power, preoperative AXL, preoperative flat corneal curvature, preoperative SA, early postoperative SE, early postoperative sphere power, early postoperative AXL and early postoperative CCT difference were significantly greater in the regression group (all P < 0.05). The SE, sphere power, AXL, preoperative flat corneal curvature, preoperative SA, and postoperative CCT difference correlate with early myopic regression after SMILE.
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Affiliation(s)
- Chia-Yi Lee
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist., Taipei, 100008, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan
| | - Yu-Ting Jeng
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist., Taipei, 100008, Taiwan
| | - Chen-Cheng Chao
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist., Taipei, 100008, Taiwan
- Department of Optometry, MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Ie-Bin Lian
- Institute of Statistical and Information Science, National Changhua University of Education, Changhua, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
| | - Chao-Kai Chang
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist., Taipei, 100008, Taiwan.
- Department of Optometry, Da-Yeh University, Chunghua, Taiwan.
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Tavakkoli F, Eleiwa TK, Elhusseiny AM, Damala M, Rai AK, Cheraqpour K, Ansari MH, Doroudian M, H Keshel S, Soleimani M, Djalilian AR, Sangwan VS, Singh V. Corneal stem cells niche and homeostasis impacts in regenerative medicine; concise review. Eur J Ophthalmol 2023:11206721221150065. [PMID: 36604831 DOI: 10.1177/11206721221150065] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The limbal stem cells niche (LSCN) is an optimal microenvironment that provides the limbal epithelial stem cells (LESCs) and strictly regulates their proliferation and differentiation. Disturbing the LSCN homeostasis can lead to limbal stem cell dysfunction (LSCD) and subsequent ocular surface aberrations, such as corneal stromal inflammation, persistent epithelial defects, corneal neovascularisation, lymphangiogenesis, corneal opacification, and conjunctivalization. As ocular surface disorders are considered the second main cause of blindness, it becomes crucial to explore different therapeutic strategies for restoring the functions of the LSCN. A major limitation of corneal transplantation is the current shortage of donor tissue to meet the requirements worldwide. In this context, it becomes mandatory to find an alternative regenerative medicine, such as using cultured limbal epithelial/stromal stem cells, inducing the production of corneal like cells by using other sources of stem cells, and using tissue engineering methods aiming to produce the three-dimensional (3D) printed cornea. Limbal epithelial stem cells have been considered the magic potion for eye treatment. Epithelial and stromal stem cells in the limbal niche hold the responsibility of replenishing the corneal epithelium. These stem cells are being used for transplantation to maintain corneal epithelial integrity and ultimately sustain optimal vision. In this review, we summarised the characteristics of the LSCN and their current and future roles in restoring corneal homeostasis in eyes with LSCD.
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Affiliation(s)
- Fatemeh Tavakkoli
- Department of Community Health, College of Health Technology, Cihan University, Erbil, Iraq.,SSR Stem Cell Biology Laboratory, Brien Holden Eye Research Centre, Centre for Ocular Regeneration, Hyderabad Eye Research Foundation, L.V. Prasad Eye Institute, Hyderabad, India.,Centre for Genetic Disorders, Banaras Hindu University, Varanasi, India
| | - Taher K Eleiwa
- Department of Ophthalmology, Benha University, Benha, Egypt
| | - Abdelrahman M Elhusseiny
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mukesh Damala
- SSR Stem Cell Biology Laboratory, Brien Holden Eye Research Centre, Centre for Ocular Regeneration, Hyderabad Eye Research Foundation, L.V. Prasad Eye Institute, Hyderabad, India.,School of Life Sciences, University of Hyderabad, Hyderabad, India
| | - Amit K Rai
- Centre for Genetic Disorders, Banaras Hindu University, Varanasi, India
| | - Kasra Cheraqpour
- Translational Eye Research Center, Farabi Eye Hospital, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad H Ansari
- Ophthalmic Research Center, Department of Ophthalmology, Labbafinejad Medical Center, 556492Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Doroudian
- Department of Cell and Molecular Biology, Faculty of Biological Sciences, 145440Kharazmi University, Tehran, Iran
| | - Saeed H Keshel
- Department of Tissue Engineering and Applied Cell Sciences, 556492Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Soleimani
- Department of Ophthalmology, 159636Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Ali R Djalilian
- Department of Ophthalmology, 159636Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Vivek Singh
- SSR Stem Cell Biology Laboratory, Brien Holden Eye Research Centre, Centre for Ocular Regeneration, Hyderabad Eye Research Foundation, L.V. Prasad Eye Institute, Hyderabad, India
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Reinstein DZ, Sekundo W, Archer TJ, Stodulka P, Ganesh S, Cochener B, Blum M, Wang Y, Zhou X. SMILE for Hyperopia With and Without Astigmatism: Results of a Prospective Multicenter 12-Month Study. J Refract Surg 2022; 38:760-769. [PMID: 36476297 DOI: 10.3928/1081597x-20221102-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the safety and effectiveness of small incision lenticule extraction (SMILE) in patients who have hyperopia with or without astigmatism. METHODS This was a prospective multicenter trial including 374 eyes of 199 patients treated by SMILE for hyperopia using the VisuMax femtosecond laser (Carl Zeiss Meditec AG). Inclusion criteria were sphere up to +6.00 diopters (D), cylinder up to 5.00 D, and maximum hyperopic meridian up to +7.00 D, with preoperative corrected distance visual acuity (CDVA) of 20/25 or better. The optical zone was 6.3 mm with a transition zone of 2 mm. The minimum lenticule thickness was set at 25 µm in the center and at 10 µm at the edge. Patients were examined at 1 day, 1 week, and 1, 3, 6, 9, and 12 months after surgery. Standard refractive surgery outcomes analysis was performed. RESULTS The preoperative spherical equivalent was +3.20 ± 1.48 D (range: +0.25 to +6.50 D). At the 12-month follow-up visit, 81% of eyes treated were within ±0.50 D and 93% of eyes were within ±1.00 D of intended correction. A total of 1.2% of eyes lost two or more lines of CDVA at the 12-month follow-up visit, and 83% were at least 20/20, corresponding to a safety index of 1.005 at 12 months. Of the 219 eyes with plano target, 68.8% had an uncorrected distance visual acuity of 20/20 or better and 88% were at least 20/25 uncorrected at 12 months. There were no statistically significant changes in contrast sensitivity. CONCLUSIONS SMILE was found to be an effective treatment method for the correction of compound hyperopic astigmatism, demonstrating a high level of efficacy, predictability, safety, and stability. [J Refract Surg. 2022;38(12):760-769.].
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Alcalde I, Sánchez-Fernández C, Del Olmo-Aguado S, Martín C, Olmiere C, Artime E, Quirós LM, Merayo-Lloves J. Synthetic Heparan Sulfate Mimetic Polymer Enhances Corneal Nerve Regeneration and Wound Healing after Experimental Laser Ablation Injury in Mice. Polymers (Basel) 2022; 14:polym14224921. [PMID: 36433048 PMCID: PMC9694493 DOI: 10.3390/polym14224921] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Abnormal corneal wound healing compromises visual acuity and can lead to neuropathic pain. Conventional treatments usually fail to restore the injured corneal tissue. In this study, we evaluated the effectiveness of a synthetic heparan sulfate mimetic polymer (HSmP) in a mouse model of corneal wound healing. (2) Methods: A surgical laser ablation affecting the central cornea and subbasal nerve plexus of mice was used as a model of the wound-healing assay. Topical treatment with HSmP was contrasted to its vehicle and a negative control (BSS). Corneal repair was studied using immunofluorescence to cell proliferation (Ki67), apoptosis (TUNEL assay), myofibroblast transformation (αSMA), assembly of epithelial cells (E-cadherin) and nerve regeneration (β-tubulin III). (3) Results: At the end of the treatment, normal epithelial cytoarchitecture and corneal thickness were achieved in HSmP-treated animals. HSmP treatment reduced myofibroblast occurrence compared to eyes irrigated with vehicle (p < 0.01) or BSS (p < 0.001). The HSmP group showed 50% more intraepithelial nerves than the BSS or vehicle groups. Only HSmP-treated corneas improved the visual quality to near transparent. (4) Conclusions: These results suggest that HSmP facilitates the regeneration of the corneal epithelium and innervation, as well as restoring transparency and reducing myofibroblast scarring after laser experimental injury.
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Affiliation(s)
- Ignacio Alcalde
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, University of Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Correspondence:
| | - Cristina Sánchez-Fernández
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, University of Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Susana Del Olmo-Aguado
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, University of Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Carla Martín
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, University of Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Department of Functional Biology, University of Oviedo, 33006 Oviedo, Spain
| | - Céline Olmiere
- Laboratoires Thea S.A.S., 63000 Clermont-Ferrand, France
| | - Enol Artime
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, University of Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Luis M. Quirós
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, University of Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Department of Functional Biology, University of Oviedo, 33006 Oviedo, Spain
| | - Jesús Merayo-Lloves
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, University of Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
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Effects of pituitary adenylate cyclase activating polypeptide (PACAP) in corneal epithelial regeneration and signal transduction in rats. Int J Pept Res Ther 2022. [DOI: 10.1007/s10989-022-10405-1] [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
AbstractCorneal epithelium responds to insults with a rapid wound healing, which is essential for maintaining vision. The proper balance of apoptotic and proliferation-stimulating pathways is critical for normal regeneration. Pituitary adenylate cyclase activating polypeptide (PACAP) is an important growth factor during the development of the nervous system and exerts cytoprotective effects in injuries. The aim of the present study was to investigate the effects of PACAP on corneal epithelial wound healing in rats and on two important protective signaling molecules, Akt and ERK1/2, both of which have been reported to play important roles during cell survival and regeneration, including corneal wound healing. Wistar rats received PACAP treatment in form of eyedrops, containing 1, 5 and 10 µg PACAP27, immediately and every two hours after corneal abrasion. Corneas were stained with fluorescein dye and further processed for histological staining or Western blot analysis for Akt and ERK1/2 expression. Our results showed that topical PACAP application enhanced corneal wound healing, as the area of injury was significantly less in PACAP-treated groups. Furthermore, both ERK1/2 and Akt signaling was induced upon PACAP administration in both injured and intact corneas. In summary, the present results show that PACAP enhances corneal wound healing in a rat model of corneal abrasion.
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Sheskin T, Geyer O, Lotan N, Sivan S. Controlled and time‐scheduled drug delivery: Polyanhydride‐based nanoparticles as ocular medication carriers. POLYM ADVAN TECHNOL 2021. [DOI: 10.1002/pat.5477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Tali Sheskin
- Department of Biomedical Engineering Technion – Israel Institute of Technology Haifa Israel
| | - Orna Geyer
- Azrieli Faculty of Medicine Bar‐Ilan University Safed Israel
- Department of Ophthalmology Galilee Medical Center Nahariya Israel
| | - Noah Lotan
- Department of Biomedical Engineering Technion – Israel Institute of Technology Haifa Israel
| | - Sarit Sivan
- Department of Biotechnology Engineering ORT Braude College of Engineering Karmiel Israel
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Charpentier S, Keilani C, Maréchal M, Friang C, De Faria A, Froussart-Maille F, Delbarre M. Corneal haze post photorefractive keratectomy. J Fr Ophtalmol 2021; 44:1425-1438. [PMID: 34538661 DOI: 10.1016/j.jfo.2021.05.006] [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: 01/17/2021] [Revised: 04/21/2021] [Accepted: 05/18/2021] [Indexed: 10/20/2022]
Abstract
Corneal haze represents subepithelial corneal fibrosis, a manifestation of a pathological healing process. It occurs as a result of an epithelial-stromal lesion involving a break in the epithelial barrier. It is an inflammatory response that involves the migration, multiplication and differentiation of keratocytes into mature myofibroblasts, causing loss of corneal transparency. Although it is a transient phenomenon, this complication is feared following refractive photokeratectomy (PRK), because it can cause alterations in the quality of vision, refractive regression and decreased visual acuity. The severity of these symptoms is correlated with the severity of the corneal haze, which can be assessed clinically or by objective means such as corneal densitometry measurement. The frequency and severity of corneal haze increase with the depth of photoablation in PRK and are therefore increased during the treatment of severe ametropia. Considering that no consensus exists, the application of mitomycin C (MMC) intraoperatively and topical corticosteroids postoperatively are conventionally used to inhibit collagen synthesis, sometimes in combination with various protocols depending on the center or surgeon. This review of the literature reports the current knowledge on corneal haze, in order to better understand it and optimise its prevention in the context of a decreased MMC supply, which has occurred in the past and could recur in the future.
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Affiliation(s)
- S Charpentier
- Service d'ophtalmologie, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94163 Saint-Mandé Cedex, France.
| | - C Keilani
- Service ophtalmologie, hôpital d'instruction des armées Percy, BP 406, 92141 Clamart Cedex, France
| | - M Maréchal
- Service ophtalmologie, hôpital d'instruction des armées Percy, BP 406, 92141 Clamart Cedex, France; Centre principal d'expertise du personnel naviguant, BP 406, 92141 Clamart Cedex, France
| | - C Friang
- Service ophtalmologie, hôpital d'instruction des armées Percy, BP 406, 92141 Clamart Cedex, France; Centre principal d'expertise du personnel naviguant, BP 406, 92141 Clamart Cedex, France
| | - A De Faria
- Service ophtalmologie, hôpital d'instruction des armées Percy, BP 406, 92141 Clamart Cedex, France; Centre principal d'expertise du personnel naviguant, BP 406, 92141 Clamart Cedex, France
| | - F Froussart-Maille
- Service ophtalmologie, hôpital d'instruction des armées Percy, BP 406, 92141 Clamart Cedex, France; Centre principal d'expertise du personnel naviguant, BP 406, 92141 Clamart Cedex, France; École du Val-de-Grâce, 1, place Alphonse Laveran, 75230 Paris Cedex 05, France
| | - M Delbarre
- Service ophtalmologie, hôpital d'instruction des armées Percy, BP 406, 92141 Clamart Cedex, France; Centre principal d'expertise du personnel naviguant, BP 406, 92141 Clamart Cedex, France
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10
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Chen JJ, Yang YF, Zeng Y. Comparison of the Levels of Transforming Growth Factor-β1 in Tear Fluid in Patients with High Myopia after Transepithelial Photorefractive Keratectomy and Laser Subepithelial Keratomileusis (LASEK). Bull Exp Biol Med 2020; 170:79-83. [PMID: 33231800 DOI: 10.1007/s10517-020-05008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Indexed: 11/26/2022]
Abstract
We compared the level of transforming growth factor-β1 (TGF-β1) in the tear fluid of 20 patients with high myopia who underwent transepithelial photorefractive keratectomy (T-PRK) in one eye and laser subepithelial keratomileusis (LASEK) in the contralateral eye. Tear fluid samples were collected with scaled microcapillary tubes before (day 0) and on days 1, 3, and 5 after surgery. The release of TGF-β1 was determined by multiplying the concentration of TGF-β1 by capillary tear fluid flow. Corneal haze was also evaluated in 1, 3, and 6 months after surgeries. The median TGF-β1 release after T-PRK and LASEK differed significantly on days 1 and 3 (p<0.005) and on day 5 (p<0.05). The mean corneal haze score after T-PRK and LASEK also significantly differed in 1 month (p<0.005), but no significant differences in this parameter were revealed at later terms. Thus, the level of TGF-β1 in the tear fluid after T-PRK was lower than after LASEK, which can be the cause of less pronounced corneal haze in 1 month after surgery.
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Affiliation(s)
- J J Chen
- Hezhou Hospital, Hezhou, Guangxi Zhuang Autonomous Region, PR China
| | - Y F Yang
- Huashan Eye Hospital of Kunming, Kunming, Yunnan Province, PR China
| | - Y Zeng
- Huashan Eye Hospital of Kunming, Kunming, Yunnan Province, PR China.
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11
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Establishing a Porcine Eye Model for Manual Sub-Bowman Layer Photorefractive Keratomileusis. J Ophthalmol 2020; 2020:9834760. [PMID: 32733701 PMCID: PMC7378610 DOI: 10.1155/2020/9834760] [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: 02/29/2020] [Revised: 04/26/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022] Open
Abstract
Objective To establish a porcine eye model for manual sub-Bowman layer photorefractive keratomileusis (SBPRK), which is a reformed surface ablation refractive surgery that results in preserving the corneal Bowman layer (BL). Methods The SBPRK group consisted of eleven eyes of 8 healthy pigs with BL flaps by mechanical technique followed by laser ablation. Regarding the remaining 5 eyes, 3 random eyes had transepithelium photorefractive keratectomy (TransPRK) (the TransPRK group), while the other 2 eyes were untreated (the blank control group). All the pigs were followed up for 8 weeks. Slit-lamp biomicroscopy and optical coherence tomography (OCT) were examined before the surgeries and at 1 week, 4 weeks, and 8 weeks after the surgeries. Results In a few days after the surgery, 3 eyes of the SBPRK group were excluded from the study because of poor healing of the corneal flaps. At the 1st postoperative week, one eye had an irregular defect of about 3 mm in the central corneal epithelium area; the cornea of the other 7 eyes had just light edema with intact epithelium just like the cornea of the TransPRK group. At the 4th week, in the SBPRK group, the cornea was slightly hazy (haze stage 1). While in the TransPRK group, the cornea was hazier (haze stage 2). At the 8th week, in the SBPRK group, both corneas were almost transparent, and the edges of the BL flaps could not be clearly seen. Meanwhile, in the TransPRK group, the corneal haze became lighter and thinner. OCT showed that, in the SBPRK group, there was high reflection in the BL layer, and it was obvious at 1 week postoperation, decreased at 4 weeks, and calmed down at 8 weeks. However, in the TransPRK group, the high reflection diffused in the anterior corneal stroma at 1 week postoperation, enhanced at 4 weeks, and weakened at 8 weeks. Conclusions Preserving the BL while conducting surface refractive surgery may result in less haze than TransPRK. However, further study is still needed, and this technique still requires refining until it becomes a standard clinical procedure.
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Qin L, Gao H, Xiong S, Jia Y, Ren L. Preparation of collagen/cellulose nanocrystals composite films and their potential applications in corneal repair. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2020; 31:55. [PMID: 32504216 DOI: 10.1007/s10856-020-06386-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Abstract
As the main component of the natural cornea, collagen (COL) has been widely applied to the construction of corneal repair materials. However, the applications of collagen are limited due to its poor mechanical properties. Cellulose nanocrystals (CNCs) possess excellent mechanical properties, optical transparency and good biocompatibility. Therefore, in this study, we attempted to introduce cellulose nanocrystals into collagen-based films to obtain corneal repair materials with a high strength. CNCs were incorporated at 1, 3, 5, 7 and 10 wt%. The physical properties of these composite films were characterized, and in vitro cell-based analyses were also performed. The COL/CNC films possessed better mechanic properties, and the introduction of CNCs did not affect the water content and light transmittance. The COL/CNC films demonstrated good biocompatibility toward rabbit corneal epithelial cells and keratocytes in vitro. Moreover, the collagen films with appropriate ration of CNCs effectively induced the migration of corneal epithelial cells and inhibited the myofibroblast differentiation of keratocytes. A collagen film with 7 wt% CNCs displayed the best combination of physical properties and biological performance in vitro among all the films. This study describes a nonchemical cross-linking method to enhance the mechanical properties of collagen for use in corneal repair materials and highlights potential application in corneal tissue engineering.
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Affiliation(s)
- Lanfeng Qin
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou, 510006, China
- National Engineering Research Centre for Tissue Restoration and Reconstruction, Guangzhou, 510006, China
- Guangdong Province Key Laboratory of Biomedical Engineering, South China University of Technology, Guangzhou, 510006, China
| | - Huichang Gao
- School of Medicine, South China University of Technology, Guangzhou, 510006, China.
| | - Sijia Xiong
- National Engineering Research Centre for Tissue Restoration and Reconstruction, Guangzhou, 510006, China
- Guangdong Province Key Laboratory of Biomedical Engineering, South China University of Technology, Guangzhou, 510006, China
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, 510641, China
| | - Yongguang Jia
- National Engineering Research Centre for Tissue Restoration and Reconstruction, Guangzhou, 510006, China
- Guangdong Province Key Laboratory of Biomedical Engineering, South China University of Technology, Guangzhou, 510006, China
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, 510641, China
| | - Li Ren
- National Engineering Research Centre for Tissue Restoration and Reconstruction, Guangzhou, 510006, China.
- Guangdong Province Key Laboratory of Biomedical Engineering, South China University of Technology, Guangzhou, 510006, China.
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, 510641, China.
- Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, 510005, China.
- Sino-Singapore International Joint Research Institute, Guangzhou, 510555, China.
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Liu L, Cheng W, Wu D, Chen L, Yu S, Zuo T, Zhang L, Yang K, Li H, Zhang H, Wei P, Ng ALK, Cheng GPM, Woo VCP, Yin J, Chiu K, Wang Y. The Differential Expression of Cytokines and Growth Factors After SMILE Compared With FS-LASIK in Rabbits. Invest Ophthalmol Vis Sci 2020; 61:55. [PMID: 32460319 PMCID: PMC7405797 DOI: 10.1167/iovs.61.5.55] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the differential expression of cytokines and growth factors in the cornea and aqueous humor after small incision lenticule extraction (SMILE) compared with femtosecond LASIK (FS-LASIK) using rabbit model. Methods Sixteen eyes of 16 rabbits in each group underwent SMILE or FS-LASIK with refractive correction of −6.00 DS/−1.00 DC. Eight additional rabbits served as controls. Pre- and 24 hours, 1 week, 1 month, and 3 months postoperatively, slit-lamp and anterior segment optical coherence tomography were performed, followed by cornea and aqueous humor collection. Apoptosis and proliferation were evaluated with TUNEL assay and Ki-67 immunostaining, respectively. The mRNA and protein expression of cytokines and growth factors was determined by RT-qPCR and Western blotting, respectively. Cytokine levels in the aqueous humor were detected with ELISA. Results Compared with FS-LASIK, SMILE induced less apoptosis and proliferation in the cornea within 1 week postoperatively. Levels of IL-1β, TNF-α, and EGFR in the cornea were significantly increased after FS-LASIK compared with SMILE within 24 hours. Levels of IL-8 in the aqueous humor remained elevated until 1 week after FS-LASIK but not SMILE. TGF-β1 level was elevated up to 1 month after both procedures, while BFGF level was kept high within 1 month after SMILE but not FS-LASIK. Conclusions SMILE could induce significantly less acute inflammation than FS-LASIK in the cornea and aqueous humor. The differential expression of TGF-β1 and BFGF between two procedures until 1 month might contribute to the post-SMILE delayed recovery and underline the importance of continued treatment postoperatively.
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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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Son YJ, Tse JW, Zhou Y, Mao W, Yim EKF, Yoo HS. Biomaterials and controlled release strategy for epithelial wound healing. Biomater Sci 2019; 7:4444-4471. [PMID: 31436261 DOI: 10.1039/c9bm00456d] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The skin and cornea are tissues that provide protective functions. Trauma and other environmental threats often cause injuries, infections and damage to these tissues, where the degree of injury is directly correlated to the recovery time. For example, a superficial skin or corneal wound may recover within days; however, more severe injuries can last up to several months and may leave scarring. Thus, therapeutic strategies have been introduced to enhance the wound healing efficiency and quality. Although the skin and cornea share similar anatomic structures and wound healing process, therapeutic agents and formulations for skin and cornea wound healing differ in accordance with the tissue and wound type. In this review, we describe the anatomy and epithelial wound healing processes of the skin and cornea, and summarize the therapeutic molecules that are beneficial to the respective regeneration process. In addition, biomaterial scaffolds that inherently possess bioactive properties or modified with therapeutic molecules for topical controlled release and enhanced wound healing efficiency are also discussed.
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Affiliation(s)
- Young Ju Son
- Department of Biomedical Materials Engineering, Kangwon National University, Chuncheon, 24341, Republic of Korea.
| | - John W Tse
- Department of Chemical Engineering, University of Waterloo, Waterloo, ON, Canada N2L 3G1.
| | - Yiran Zhou
- Department of Chemical Engineering, University of Waterloo, Waterloo, ON, Canada N2L 3G1.
| | - Wei Mao
- Department of Biomedical Materials Engineering, Kangwon National University, Chuncheon, 24341, Republic of Korea.
| | - Evelyn K F Yim
- Department of Chemical Engineering, University of Waterloo, Waterloo, ON, Canada N2L 3G1.
| | - Hyuk Sang Yoo
- Department of Biomedical Materials Engineering, Kangwon National University, Chuncheon, 24341, Republic of Korea. and Institute of Bioscience and Biotechnology, Kangwon National University, Republic of Korea
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Zhao X, Song W, Chen Y, Liu S, Ren L. Collagen-based materials combined with microRNA for repairing cornea wounds and inhibiting scar formation. Biomater Sci 2019; 7:51-62. [DOI: 10.1039/c8bm01054d] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AuNP/miR-133b can be released from cornea regeneration materials and entered into stromal cells to inhibit cornea scar formation.
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Affiliation(s)
- Xuan Zhao
- School of Materials Science and Engineering
- South China University of Technology
- Guangzhou 510006
- P. R. China
- National Engineering Research Center for Tissue Restoration and Reconstruction
| | - Wenjing Song
- School of Materials Science and Engineering
- South China University of Technology
- Guangzhou 510006
- P. R. China
- National Engineering Research Center for Tissue Restoration and Reconstruction
| | - Yawei Chen
- National Engineering Research Center for Tissue Restoration and Reconstruction
- Guangzhou 510006
- P. R. China
- Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education
- South China University of Technology
| | - Sa Liu
- School of Materials Science and Engineering
- South China University of Technology
- Guangzhou 510006
- P. R. China
- National Engineering Research Center for Tissue Restoration and Reconstruction
| | - Li Ren
- School of Materials Science and Engineering
- South China University of Technology
- Guangzhou 510006
- P. R. China
- National Engineering Research Center for Tissue Restoration and Reconstruction
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Wen D, Tu R, Flitcroft I, Wang Q, Huang Y, Song B, Yu A, Hu L, Zhao Y, Bao F, Yu Y, Lian H, Hoffart L, Kramm RL, Skiadaresi E, O'Brart D, Pallikaris I, Marshall J, McAlinden C, Huang J. Corneal Surface Ablation Laser Refractive Surgery for the Correction of Myopia: A Network Meta-analysis. J Refract Surg 2018; 34:726-735. [PMID: 30428092 DOI: 10.3928/1081597x-20180905-01] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 08/30/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE To systematically compare the efficacy, predictability, safety, postoperative haze, pain scores, and epithelial healing time of four corneal surface ablation procedures. METHODS PubMed, Embase, Cochrane Library, and the U.S. trial registry were searched up to June 2018. Randomized controlled trials were selected. Efficacy (uncorrected distance visual acuity of 20/20 or better), predictability (refractive spherical equivalent within ±0.50 diopters [D] of the target), and safety (loss of two or more lines of spectacle corrected distance visual acuity) were set as primary outcome measures. Haze, pain scores, and epithelial healing time were set as secondary outcome measures. RESULTS Eighteen studies involving 1,423 eyes were included. According to the Grading of Recommendations Assessment, Development, and Evaluation, the quality of outcomes were moderate to high (70.6%). There were no differences in efficacy, predictability, safety, haze, day 1 pain, and epithelial healing time between treatments. Epithelial laser in situ keratomileusis (epi-LASIK) had statistically significantly higher pain scores on day 3 compared to photorefractive keratectomy (PRK) (weighted mean differences [WMD] = 2.2, 95% credible intervals [CrI] = 0.19 to 4.01) and transepithelial PRK (T-PRK) (WMD = 2.7, 95% CrI = 0.51 to 4.84). The surface under the cumulative ranking curve ranking results (best to worst) showed laser epithelial keratomileusis (LASEK) ranked highest for efficacy, predictability, safety, and day 1 pain scores. Epi-LASIK ranked best for grade 1 haze scores. T-PRK ranked best for haze of 0.5 or higher, haze scores day 3 pain scores, and epithelial healing time. CONCLUSIONS Surface laser refractive surgeries are comparable in terms of efficacy, predictability, safety, and postoperative haze except for day 3 pain scores, with epi-LASIK being more painful compared to PRK and T-PRK. [J Refract Surg. 2018;34(11):726-735.].
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Goblet cell response after photorefractive keratectomy and laser in situ keratomileusis. J Cataract Refract Surg 2018; 42:1181-9. [PMID: 27531295 DOI: 10.1016/j.jcrs.2016.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/20/2016] [Accepted: 05/31/2016] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine whether patients without dry eye preoperatively have an altered conjunctival goblet cell density and mucin secretion postoperatively and to explore what factors affect changes in goblet cell density and mucin secretion. SETTING The former Walter Reed Army Medical Center, Washington, DC, USA. DESIGN Prospective nonrandomized clinical study. METHODS Impression cytology was used to determine conjunctival goblet cell density before and 1 week, 1 month, and 3 months after photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK). The McMonnies questionnaire, Schirmer test, tear breakup time, corneal sensitivity, rose bengal staining, and computerized videokeratoscopy were also performed to assess tear-film and ocular-surface health. RESULTS The ratio of goblet cell to total cells changed postoperatively from baseline in both groups (P < .001). The most significant change was a median 29% decrease 1 month postoperatively. However, there were no significant differences between groups over time (P = .772). The ratio of filled goblet cell to total goblet cell did not change significantly over the same time period (P = .128), and there were no significant differences between the PRK group and the LASIK group over time (P = .282). CONCLUSIONS Patients without apparent dry eye had an altered conjunctival goblet cell population after PRK or LASIK. The conjunctival goblet cell population tended to decrease in the early postoperative period after either surgery and was most affected by preoperative goblet cell density. The changes in the tear film and ocular surface did not seem to affect goblet cell mucin secretion after either procedure. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
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Eveleth DD, Eveleth JJ, Subramaniam A, Hahn R, Zhou P, Gordon MK, Bradshaw RA. An Engineered Human Fibroblast Growth Factor-1 Derivative, TTHX1114, Ameliorates Short-term Corneal Nitrogen Mustard Injury in Rabbit Organ Cultures. Invest Ophthalmol Vis Sci 2018; 59:4720-4730. [PMID: 30267094 PMCID: PMC6155473 DOI: 10.1167/iovs.18-24568] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/20/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose Organ cultures of rabbit corneas have been used to ascertain the effectiveness of a human fibroblast growth factor (FGF)-1 derivative (TTHX1114), lacking cysteine residues, to protect against and/or repair epithelial lesions following exposure to nitrogen mustard (NM). Methods Rabbit corneas were exposed to NM and cultured for up to 14 days, with or without drug (TTHX1114). At specified times, tissue was examined by histopathology and graded by a novel composite scale. Proliferation was measured by 5-ethynyl-2'-deoxyuridine (EdU) incorporation, and the expression of native FGF-1 and ADAM-17 after NM exposure was determined by immunofluorescence. Results Rabbit corneas, exposed to a single dose of NM, showed a nearly complete loss of epithelial cells by day 6 but were significantly regenerated by day 14. When treated continuously with TTHX1114 following vesicant exposure, the losses remained at day 2 levels. The loss of keratocytes in the stroma was not affected by TTHX1114. EdU incorporation over the same time course showed a steady increase in tissue that had not been treated with TTHX1114, while corneas that were treated with the drug showed a higher percent incorporation initially, which then decreased, indicating the strong proliferative response to TTHX1114. ADAM-17 was not significantly altered by TTHX1114 treatment. Corneal epithelial FGF-1 disappeared after only 1 day following exposure to NM. Conclusions TTHX1114 is protective against NM-induced damage of the corneal epithelium, possibly by supplying an NM-resistant source of trophic support and by stimulating regeneration of new epithelial cells. These responses underscore the potential value of TTHX1114 as an anti-vesicant therapeutic.
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Affiliation(s)
- David D. Eveleth
- Trefoil Therapeutics, Inc., San Diego, California, United States
| | | | | | - Rita Hahn
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, United States
| | - Peihong Zhou
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, United States
| | - Marion K. Gordon
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, United States
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Yan MK, Chang JS, Chan TC. Refractive regression after laser in situ keratomileusis. Clin Exp Ophthalmol 2018; 46:934-944. [PMID: 29700964 DOI: 10.1111/ceo.13315] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 04/13/2018] [Accepted: 04/19/2018] [Indexed: 12/23/2022]
Abstract
Uncorrected refractive errors are a leading cause of visual impairment across the world. In today's society, laser in situ keratomileusis (LASIK) has become the most commonly performed surgical procedure to correct refractive errors. However, regression of the initially achieved refractive correction has been a widely observed phenomenon following LASIK since its inception more than two decades ago. Despite technological advances in laser refractive surgery and various proposed management strategies, post-LASIK regression is still frequently observed and has significant implications for the long-term visual performance and quality of life of patients. This review explores the mechanism of refractive regression after both myopic and hyperopic LASIK, predisposing risk factors and its clinical course. In addition, current preventative strategies and therapies are also reviewed.
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Affiliation(s)
- Mabel K Yan
- The Alfred Hospital, Melbourne, Victoria, Australia
| | - John Sm Chang
- Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Tommy Cy Chan
- Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
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Abstract
Purpose Mitomycin C after photorefractive keratectomy (PRK) is used to reduce the development of haze and regression in higher intended corrections. The aim of this study was to investigate the safety, stability, and efficacy of EpiLASIK with mitomycin C. Methods Fifty eyes of 29 patients underwent EpiLASIK with the Gebauer EpiLift microkeratome. The mean preoperative spherical equivalent was −6.89 D (SD ±0.63, range −6.0 to −8.0 D). After the laser ablation, mitomycin C 0.02% was applied for 30 seconds on a sterile filter paper. Preoperatively and 1, 3, 6, and 12 months after surgery, a full ophthalmic examination was performed. Results In 42 of 50 eyes, the bandage contact lens was removed at day 3. Twelve months after surgery, 96% of all eyes were within ±1.0 D and 82% were within ±0.5 D of intended correction. Five percent of all patients lost 1 line of best-corrected Snellen visual acuity, 42% were stable, and 56% gained 1 or more lines. In most patients, the cornea was clear during the whole follow-up, and in 10% only trace haze was visible. The uncorrected visual acuity was at least 1.0 in 86% of all patients, and all patients reached 0.5. Conclusions EpiLASIK with mitomycin C with higher intended corrections seems to be an effective and safe procedure. With the application of mitomycin C, only minimal haze appears.
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Affiliation(s)
| | - Ramin Khoramnia
- Augenklinik, Klinikum rechts der Isar, Technische Universität München, München - Germany
| | - Mathias Maier
- Augenklinik, Klinikum rechts der Isar, Technische Universität München, München - Germany
| | - Chris P. Lohmann
- Augenklinik, Klinikum rechts der Isar, Technische Universität München, München - Germany
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Wei S, Wang Y, Wu D, Zu P, Zhang H, Su X. Ultrastructural Changes and Corneal Wound Healing After SMILE and PRK Procedures. Curr Eye Res 2016; 41:1316-1325. [PMID: 26863271 DOI: 10.3109/02713683.2015.1114653] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To compare keratocyte activation, cellular morphologic changes and wound healing after SMILE and PRK procedures using transmission electron microscope (TEM). METHODS In this study, 22 New Zealand white rabbits (10- to 15-week old) were used. The right eyes of all animals underwent SMILE procedure and the left eyes underwent PRK procedure. Cornea samples taken 1 day and 1 week postoperatively were examined using TEM. RESULTS Using TEM 1 day after SMILE procedure, the organization of collagen fibers seemed to have been preserved without thermal alterations. Keratocyte activation was observed in the anterior stroma. Disrupted collagen arrangement and debris of cells are visible in the area of damage, and some phagocytic cells and a large number of secondary lysosomes are visible in those cells. At the perimeter zone of the interface, many coenocytes and collagen fragments could be found within the phagocytic cell. One week after SMILE procedure, potential lacuna could be discerned. A large part of the interface of the lenticule extracted had an appearance of clearly being adhered to some mucus secretions. One day after PRK procedure, an irregular epithelial surface was visible using TEM. Keratocytes had been activated and the rough endoplasmic reticulum in those cells had expanded. One week after PRK procedure, the epithelial surface still was irregular and keratinization of the epithelium was still visible in some areas. Corneal endothelium cells were mildly damaged and some vacuoles within the cytoplasm could be discerned. In the anterior stroma, some unhealthy activated keratocytes could still be observed. New collagen fibrils were found present near the activated keratocytes. CONCLUSION Using TEM, keratocyte activation could still be observed after SMILE compared to after PRK procedure. Fewer cellular ultrastructural changes were seen after SMILE procedure. Unlike in PRK procedure, no damaged epithelium and endothelium were found after SMILE.
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Affiliation(s)
- Shengsheng Wei
- a Tianjin Eye Hospital & Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science , Tianjin Medical University , Tianjin , China
| | - Yan Wang
- a Tianjin Eye Hospital & Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science , Tianjin Medical University , Tianjin , China
| | - Di Wu
- a Tianjin Eye Hospital & Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science , Tianjin Medical University , Tianjin , China
| | - PeiPei Zu
- a Tianjin Eye Hospital & Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science , Tianjin Medical University , Tianjin , China
| | - Hui Zhang
- a Tianjin Eye Hospital & Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science , Tianjin Medical University , Tianjin , China
| | - Xiaolian Su
- a Tianjin Eye Hospital & Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science , Tianjin Medical University , Tianjin , China
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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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Abstract
Corneal wound healing is a complex process involving cell death, migration, proliferation, differentiation, and extracellular matrix remodeling. Many similarities are observed in the healing processes of corneal epithelial, stromal and endothelial cells, as well as cell-specific differences. Corneal epithelial healing largely depends on limbal stem cells and remodeling of the basement membrane. During stromal healing, keratocytes get transformed to motile and contractile myofibroblasts largely due to activation of transforming growth factor-β (TGF-β) system. Endothelial cells heal mostly by migration and spreading, with cell proliferation playing a secondary role. In the last decade, many aspects of wound healing process in different parts of the cornea have been elucidated, and some new therapeutic approaches have emerged. The concept of limbal stem cells received rigorous experimental corroboration, with new markers uncovered and new treatment options including gene and microRNA therapy tested in experimental systems. Transplantation of limbal stem cell-enriched cultures for efficient re-epithelialization in stem cell deficiency and corneal injuries has become reality in clinical setting. Mediators and course of events during stromal healing have been detailed, and new treatment regimens including gene (decorin) and stem cell therapy for excessive healing have been designed. This is a very important advance given the popularity of various refractive surgeries entailing stromal wound healing. Successful surgical ways of replacing the diseased endothelium have been clinically tested, and new approaches to accelerate endothelial healing and suppress endothelial-mesenchymal transformation have been proposed including Rho kinase (ROCK) inhibitor eye drops and gene therapy to activate TGF-β inhibitor SMAD7. Promising new technologies with potential for corneal wound healing manipulation including microRNA, induced pluripotent stem cells to generate corneal epithelium, and nanocarriers for corneal drug delivery are discussed. Attention is also paid to problems in wound healing understanding and treatment, such as lack of specific epithelial stem cell markers, reliable identification of stem cells, efficient prevention of haze and stromal scar formation, lack of data on wound regulating microRNAs in keratocytes and endothelial cells, as well as virtual lack of targeted systems for drug and gene delivery to select corneal cells.
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Affiliation(s)
- Alexander V Ljubimov
- Eye Program, Board of Governors Regenerative Medicine Institute, Departments of Biomedical Sciences and Neurosurgery, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Mehrnoosh Saghizadeh
- Eye Program, Board of Governors Regenerative Medicine Institute, Departments of Biomedical Sciences and Neurosurgery, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Alcalde I, Íñigo-Portugués A, Carreño N, Riestra AC, Merayo-Lloves JM. Effects of new biomimetic regenerating agents on corneal wound healing in an experimental model of post-surgical corneal ulcers. ACTA ACUST UNITED AC 2015; 90:467-74. [PMID: 26101128 DOI: 10.1016/j.oftal.2015.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 03/23/2015] [Accepted: 04/13/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The purpose of this study is to assess the effectiveness of the topical application of cacicol regenerating agent (RGTA) in an experimental model of corneal ulcer after photorefractive keratectomy (PRK) in mice. METHODS Mice were subjected to PRK surgery with a 2.0mm ablation zone on the central cornea and 45mm of depth on a VISX Star S2 excimer laser. Corneas were treated topically with cacicol drops 1hour and 48hours after injury. Control groups received balanced salt solution (BSS) in the same dosage. Clinical and histopathological events were evaluated at 1, 2, 3 and 7 days after surgery. Sections obtained through the central region of the corneas were used to analyze the histopathological events of injured and healed corneas. αSMA (myofibroblast transformation), E cadherin (assembly of epithelial cells) and neuronal class III β-tubulin (innervation) were performed. RESULTS Corneas treated topically with cacicol for 7 days showed a greater degree of transparency compared to controls. cacicol treated corneas showed improved epithelial cytoarchitecture. Analysis of αSMA profiles in the stroma showed that cacicol reduced or delayed the presence of myofibroblasts in the stroma compared to BSS (P<0.001). Finally, a putative neuroregenerative effect of cacicol was found in corneas subjected to an experimental PRK lesion. In some cases some interindividual variability could be observed due to the design of the experimental model. This is a limitation to consider, despite the statistical significance of the data. CONCLUSIONS In a model of laser induced surgical lesions in the cornea, topical application of an RGTA (i.e. cacicol) could be involved in avoiding myofibroblast scarring formation and promoting nerve regeneration.
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Affiliation(s)
- I Alcalde
- Fundación de Investigación Oftalmológica, Oviedo, España; Universidad de Oviedo, Oviedo, España.
| | - A Íñigo-Portugués
- Fundación de Investigación Oftalmológica, Oviedo, España; Universidad de Oviedo, Oviedo, España
| | - N Carreño
- Instituto Oftalmológico Fernández-Vega, Oviedo, España
| | - A C Riestra
- Instituto Oftalmológico Fernández-Vega, Oviedo, España
| | - J M Merayo-Lloves
- Fundación de Investigación Oftalmológica, Oviedo, España; Instituto Oftalmológico Fernández-Vega, Oviedo, España; Universidad de Oviedo, Oviedo, España
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26
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Abstract
Corneal photorefractive surgery is currently performed by ablation of corneal stroma under the stromal flap. A stromal flap is created using a femtosecond (FS) laser or mechanical microkeratome, although the FS laser procedure is considered safer and more accurate. This review assesses and compares the use of FS laser versus mechanical microkeratome ablation for corneal stromal characteristics mainly examined by histology and cellular biological responses. Supporting data from our studies, using corneas of enucleated porcine eye globes, are included in this review. Histological analysis and experimental studies of cellular/tissue responses to FS laser irradiation should be further investigated, and the equipment used to perform these techniques should be improved.
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Aslanides IM, Selimis VD, Bessis NV, Georgoudis PN. A pharmacological modification of pain and epithelial healing in contemporary transepithelial all-surface laser ablation (ASLA). Clin Ophthalmol 2015; 9:685-90. [PMID: 25931809 PMCID: PMC4404873 DOI: 10.2147/opth.s81061] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose We report our experience with the use of the matrix regenerating agent (RGTA) Cacicol® after reverse transepithelial all-surface laser ablation (ASLA)-SCHWIND to assess the safety, efficacy, pain, and epithelial healing. Methods Forty eyes of 20 myopic patients were prospectively recruited to a randomized fellow eye study. Patients underwent transepithelial ASLA in both eyes, with one of the eyes randomly assigned to the use of the RGTA Cacicol. Postoperative pain and vision were subjectively assessed with the use of a questionnaire on the operative day, at 24 hours, 48 hours and 72 hours. Epithelial defect area size was measured at 24 hours, 48 hours, and 72 hours. Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were assessed at 1 month. Results Mean UDVA at 1 month was LogMAR 0.028. The epithelial defect area was 10.91 mm2 and 13.28 mm2 at 24 hours and 1.39 mm2 and 1.24 mm2 at 48 hours for treated and nontreated eyes, respectively. Overall, 50% and 65% of treated and nontreated eyes healed by 48 hours. There was no statistically significant difference in the subjective vision between the groups, although vision of patients in the RGTA group was reported to be better. Pain scores were better at 24 hours and 48 hours in the RGTA group but with no statistically significant difference. Conclusion The use of RGTA Cacicol shows faster epithelial recovery after transepithelial ASLA for myopia. Subjectively reported scores of pain and subjective vision were better in the RGTA group, although the difference was not statistically significant. There seems to be a consensual acceleration of epithelial healing even in eyes that did not receive treatment. There were no adverse events and no incidents of inflammation, delayed healing, or haze.
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Wirostko B, Rafii M, Sullivan DA, Morelli J, Ding J. Novel Therapy to Treat Corneal Epithelial Defects: A Hypothesis with Growth Hormone. Ocul Surf 2015; 13:204-212.e1. [PMID: 26045234 DOI: 10.1016/j.jtos.2014.12.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 10/23/2022]
Abstract
Impaired corneal wound healing that occurs with ocular surface disease, trauma, systemic disease, or surgical intervention can lead to persistent corneal epithelial defects (PCED), which result in corneal scarring, ulceration, opacification, corneal neovascularization, and, ultimately, visual compromise and vision loss. The current standard of care can include lubricants, ointments, bandage lenses, amniotic membranes, autologous serum eye drops, and corneal transplants. Various inherent problems exist with application and administration of these treatments, which often may not result in a completely healed surface. A topically applicable compound capable of promoting corneal epithelial cell proliferation and/or migration would be ideal to accelerate healing. We hypothesize that human growth hormone (HGH) is such a compound. In a recent study, HGH was shown to activate signal transducer and activators of transcription-5 (STAT5) signaling and promote corneal wound healing by enhancing corneal epithelial migration in a co-culture system of corneal epithelial cells and fibroblasts. These effects require an intact communication between corneal epithelia and fibroblasts. Further, HGH promotes corneal wound healing in a rabbit debridement model, thus demonstrating the effectiveness of HGH in vivo as well. In conclusion, HGH may represent an exciting and effective topical therapeutic to promote corneal wound healing.
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Affiliation(s)
- Barbara Wirostko
- Jade Therapeutics, Inc., University of Utah Research Park, Salt Lake City, UT; Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - MaryJane Rafii
- Jade Therapeutics, Inc., University of Utah Research Park, Salt Lake City, UT
| | - David A Sullivan
- Schepens Eye Research Institute, Massachusetts Eye & Ear Infirmary, and Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Julia Morelli
- Jade Therapeutics, Inc., University of Utah Research Park, Salt Lake City, UT
| | - Juan Ding
- Schepens Eye Research Institute, Massachusetts Eye & Ear Infirmary, and Department of Ophthalmology, Harvard Medical School, Boston, MA.
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Platelet recruitment promotes keratocyte repopulation following corneal epithelial abrasion in the mouse. PLoS One 2015; 10:e0118950. [PMID: 25775402 PMCID: PMC4361664 DOI: 10.1371/journal.pone.0118950] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/12/2015] [Indexed: 12/25/2022] Open
Abstract
Corneal abrasion not only damages the epithelium but also induces stromal keratocyte death at the site of injury. While a coordinated cascade of inflammatory cell recruitment facilitates epithelial restoration, it is unclear if this cascade is necessary for keratocyte recovery. Since platelet and neutrophil (PMN) recruitment after corneal abrasion is beneficial to epithelial wound healing, we wanted to determine if these cells play a role in regulating keratocyte repopulation after epithelial abrasion. A 2 mm diameter central epithelial region was removed from the corneas of C57BL/6 wildtype (WT), P-selectin deficient (P-sel-/-), and CD18 hypomorphic (CD18hypo) mice using the Algerbrush II. Corneas were studied at 6h intervals out to 48h post-injury to evaluate platelet and PMN cell numbers; additional corneas were studied at 1, 4, 14, and 28 days post injury to evaluate keratocyte numbers. In WT mice, epithelial abrasion induced a loss of anterior central keratocytes and keratocyte recovery was rapid and incomplete, reaching ~70% of uninjured baseline values by 4 days post-injury but no further improvement at 28 days post-injury. Consistent with a beneficial role for platelets and PMNs in wound healing, keratocyte recovery was significantly depressed at 4 days post-injury (~30% of uninjured baseline) in P-sel-/- mice, which are known to have impaired platelet and PMN recruitment after corneal abrasion. Passive transfer of platelets from WT, but not P-sel-/-, into P-sel-/- mice prior to injury restored anterior central keratocyte numbers at 4 days post-injury to P-sel-/- uninjured baseline levels. While PMN infiltration in injured CD18hypo mice was similar to injured WT mice, platelet recruitment was markedly decreased and anterior central keratocyte recovery was significantly reduced (~50% of baseline) at 4–28 days post-injury. Collectively, the data suggest platelets and platelet P-selectin are critical for efficient keratocyte recovery after corneal epithelial abrasion.
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Lin T, Gong L. Sodium hyaluronate eye drops treatment for superficial corneal abrasion caused by mechanical damage: a randomized clinical trial in the People's Republic of China. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:687-94. [PMID: 25678773 PMCID: PMC4322606 DOI: 10.2147/dddt.s77270] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate the effectiveness and safety of 0.3% sodium hyaluronate (HA) compared to recombinant bovine basic fibroblast growth factor (rb-bFGF) for the treatment of corneal epithelial abrasion caused by mechanical damage in Chinese patients. METHODS Thirty patients were randomly assigned to the HA or rb-bFGF treatment group. The HA group was treated with 0.3% HA and 0.5% levofloxacin, and the rb-bFGF group was treated with topical rb-bFGF and 0.5% levofloxacin. The primary endpoint was the clinical effectiveness rates at day 3. Secondary endpoints were the dimensions of the wound area and the percentage of wound closure. RESULTS After 3 days of treatment, the clinical effectiveness rates of the HA group and the rb-bFGF group were 86.67% (13/15) and 93.33% (14/15), respectively. The dimensions of the wound area were reduced from 9.83±8.50 to 0.02±0.06 mm(2) for the HA group at day 7, and from 10.58±9.94 to 0.02±0.07 mm(2) for the rb-bFGF group. At day 3, the wound closure was almost complete in both groups; 94.73% in the HA group compared to 95.77% in the rb-bFGF group (P>0.05). CONCLUSION Topical 0.3% HA provided a promising treatment for superficial corneal abrasion caused by mechanical damage in a manner similar to rb-bFGF.
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Affiliation(s)
- Tong Lin
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, People's Republic of China
| | - Lan Gong
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, People's Republic of China
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AlKharashi M, Bower KS, Stark WJ, Daoud YJ. Refractive surgery in systemic and autoimmune disease. Middle East Afr J Ophthalmol 2014; 21:18-24. [PMID: 24669141 PMCID: PMC3959036 DOI: 10.4103/0974-9233.124082] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Patients with underlying systemic disease represent challenging treatment dilemma to the refractive surgeon. The refractive error in this patient population is accompanied by a systemic disease that may have an ocular or even a corneal component. The literature is rather sparse about the use of laser refractive surgery (LRS) and such procedure is not approved by the United States Food and Drug Administration (FDA) in this patient population. Patients with collagen vascular disease, diabetes mellitus (DM), allergic and atopic disease, or human immunodeficiency virus (HIV) are never ideal for LRS. Patients with uncontrolled systemic disease or ocular involvement of the disease should not undergo LRS. However, a patient with well-controlled and mild disease, no ocular involvement, and not on multidrug regimen may be a suitable candidate if they meet stringent criteria. There is a need for a large, multicenter, controlled trial to address the safety and efficacy of LRS in patients with systemic disease before such technology can be widely adopted by the refractive surgery community.
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Affiliation(s)
- Majed AlKharashi
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kraig S Bower
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | - Walter J Stark
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yassine J Daoud
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
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Abstract
Corneal wound healing is a complex process: its mechanisms and the underlying genetic control are not fully understood. It involves the integrated actions of multiple growth factors, cytokines and proteases produced by epithelial cells, stromal keratocytes, inflammatory cells and lacrimal gland cells. Following an epithelial insult, multiple cytokines are released triggering a cascade of events that leads to repair the epithelial defect and remodelling of the stroma to minimize the loss of transparency and function. In this review, we examine the literature surrounding the genomics of corneal wound healing with respect to the following topics: epithelial and stromal wound healing (including inhibition); corneal neovascularisation; the role of corneal nerves in wound healing; the endothelium; the role of aquaporins and aptamers. We also examine the effect of ectasia on corneal wound healing with regard to keratoconus and following corneal surgery. A better understanding of the cellular and molecular changes that occur during repair of corneal wounds will provide the opportunity to design treatments that selectively modulate key phases of the healing process resulting in scars that more closely resemble normal corneal architecture.
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Affiliation(s)
- Nick J R Maycock
- Eye Department, Queen Alexandra Hospital, Portsmouth, UKNational Institute for Health Research (NIHR), Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Pothula S, Bazan HEP, Chandrasekher G. Regulation of Cdc42 expression and signaling is critical for promoting corneal epithelial wound healing. Invest Ophthalmol Vis Sci 2013; 54:5343-52. [PMID: 23833064 DOI: 10.1167/iovs.13-11955] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Cdc42, a member of Rho GTPases (guanosine triphosphatases), participates in cytokine- and growth factor-controlled biological functions in mammalian tissues. Here, we examined Cdc42 role in corneal epithelial wound healing and the influence of hepatocyte, keratinocyte, and epidermal growth factor (HGF, KGF, and EGF)-mediated signaling on Cdc42. METHODS Epithelial wounds were created on the corneas of live rabbits by complete debridement and in rabbit corneal epithelial primary cultures through scratch injury. Cdc42 expression in cultures was suppressed using Cdc42 siRNA. Cdc42 activation was determined by pull-down assays with PAK-agarose beads. Cdc42 expression was analyzed by immunoblotting and immunofluorescence. Association of Cdc42 with cell-cycle proteins was identified by immunoprecipitation. RESULTS In rabbit corneas, significant increase in Cdc42 expression that occurred 2 to 4 days after the injury coincided with wound closure, and by 8 days the expression reached near basal levels. Silencing of Cdc42 expression in cultures caused inhibition of wound closure as a result of 60% to 75% decrease in epithelial migration and growth. HGF, KGF, and EGF increased Cdc2 expression, activation, and its phosphorylation on ser71. Inhibition of growth factor-mediated PI-3K signaling resulted in the downregulation of Cdc42 expression and its phosphorylation. Increased association of cell-cycle proteins p27(kip) and cyclin-dependent kinase 4 (CDK4) with Cdc42; and phosphorylated Cdc42 with plasma membrane leading edges was also observed in the presence of growth factors. CONCLUSIONS Cdc42 is an important regulator of corneal epithelial wound repair. To promote healing, Cdc42 may interact with receptor tyrosine kinase-activated signaling cascades that participate in cell migration and cell-cycle progression.
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Affiliation(s)
- Swetha Pothula
- Department of Pharmaceutical Sciences, College of Pharmacy, South Dakota State University, Brookings, South Dakota 57007, USA
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Chen J, Chen Y, Han SN. Comparison of TGF-β1 in tears and corneal haze following Epi-LASIK with and without mitomycin C. Int J Ophthalmol 2013; 6:312-5. [PMID: 23826524 DOI: 10.3980/j.issn.2222-3959.2013.03.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 03/28/2013] [Indexed: 12/22/2022] Open
Abstract
AIM To compare transforming growth factor-β1 (TGF-β1) levels in tears and the degree of corneal haze formation following epithelial laser in situ keratomileusis (Epi-LASIK) with and without the use of mitomycin C (MMC) and to investigate the effect of MMC on corneal wound healing. METHODS Thirty-two patients (64 eyes) with high myopia underwent Epi-LASIK surgery, and MMC was randomly used in one eye in each patient. The epithelialization process was observed, and the TGF-β1 level in tears was measured at 1 day, 3, and 7 days postoperatively for comparison with baseline. Corneal haze was graded at 1 month, 3, and 6 months after surgery. RESULTS Mean preoperative spherical equivalent refraction was -8.24±2.18D (range -6.00 to -10.50D) in the MMC group and -7.82±1.55D (range -6.00 to -9.75D) in the non-MMC group. There was no significant difference between the two groups (P=0.38). Mean epithelialization time was (5.02±0.68) days in the MMC group and (4.86±0.57) days in the non-MMC group (P=0.31). Tear fluid TGF-β1 levels were similar before surgery (P=0.34), but were significantly higher in the non-MMC group at 1 day, 3, and 7 days postoperatively (P=0.004, 0.008, and 0.012, respectively). Corneal haze scores 1 month after surgery were significantly higher in the non-MMC group (P=0.03), and similar at 3 and 6 months after surgery (P=0.28 and 0.62, respectively). CONCLUSION MMC did not delay epithelialization. In early postoperative period, lower TGF-β1 levels in tears and a lower grade of corneal haze were observed in the MMC group. Our findings suggest that the ability of MMC to inhibit Epi-LASIK-induced haze might be mediated through TGF-β1 suppression.
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Affiliation(s)
- Jing Chen
- Department of Ophthalmology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, Guangdong Province, China
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Roszkowska AM, De Grazia L, Visalli M, Mondello M, Teti D, Venza M, Venza I. Contact lens wearing and chronic cigarette smoking positively correlate with TGF-β1 and VEGF tear levels and impaired corneal wound healing after photorefractive keratectomy. Curr Eye Res 2012; 38:335-41. [PMID: 23216133 DOI: 10.3109/02713683.2012.745880] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To study the correlation of gender, contact lens (CL) wearing, chronic drinking and chronic smoking with wound healing cytokine levels and corneal recovery after photorefractive keratectomy (PRK). MATERIALS AND METHODS One hundred and twenty-eight age-matched patients (180 eyes) undergoing PRK were enrolled. PDGF, EGF, VEGF, HGF and TGF-β(1) protein levels were measured in tears by enzyme-linked immunosorbent assay either preoperatively or 2, 7 and 15 days after PRK. Patients were seen between one day and five days postoperatively for the evaluation of epithelial healing. Delayed re-epithelialization was defined as healing after day 5. All patients were followed for haze formation for a minimum of three months. RESULTS All cytokines increased significantly during the first two postoperative days (p < 0.001). PDGF, EGF, HGF decreased to the preoperative levels by day 7, whereas TGF-β1 and VEGF remained elevated over the entire period of observation of 15 days, although to a lesser extent than the second day after surgery, in CL-wearers and smokers, respectively (p < 0.01). The Pearson correlation analysis showed that: (i) CL-wearing positively correlated with TGF-β1 amounts, while chronic smoking positively correlated with VEGF production; (ii) CL-wearing and TGF-β1 amount were found to be associated with early haze formation, whereas chronic smoking and VEGF level with delayed re-epithelialization. No association was found between gender or alcohol consumption and cytokine levels or wound healing. CONCLUSIONS Our findings highlight for the first time the important role that cigarette smoking and CL wearing may have in altering the tear cytokine network and impairing corneal epithelial wound repair after surgical injury.
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Affiliation(s)
- Anna M Roszkowska
- Department of Experimental Specialized Medical and Surgical and Odontostomatology Sciences, University of Messina, Messina, Italy
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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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Zhang Y, Chen YG, Xia YJ, Qi H. Comparison of Tear cytokines and clinical outcomes between off-flap and on-flap epi-LASIK with mitomycin C. J Refract Surg 2012; 28:632-8. [PMID: 22947291 DOI: 10.3928/1081597x-20120815-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 07/24/2012] [Indexed: 01/07/2023]
Abstract
PURPOSE To compare tear cytokines and clinical outcomes between off-flap and on-flap epi-LASIK eyes and explore the possible mechanism for the clinical differences. METHODS This double-masked, randomized study enrolled 18 myopic patients who underwent off-flap epi-LASIK with mitomycin C (MMC) in 1 eye and on-flap epi-LASIK with MMC in the contralateral eye. Tears were collected from each eye preoperatively and 2 hours, 1 day, and 5 days postoperatively. Concentrations of multiple tear cytokines were measured by a multiplex immunobead assay. Uncorrected distance visual acuity (UDVA), refraction, haze scores, pain scores, and percentage of corneal epithelial healing were evaluated. RESULTS Compared with the on-flap group, the off-flap group had outcomes of better UDVA and higher percentages of epithelial healing at 5 days after surgery (P<.001) and lower levels of haze at 1 month after surgery (P=.049). Preoperatively, no significant differences were noted in the release rate of all tear cytokines between groups. At 2 hours postoperatively, the release rate of tear basic fibroblast growth factor (bFGF), platelet-derived growth factor-BB (PDGF-BB), interleukin-8 (IL-8), and tumor necrosis factor alpha (TNF-α) in the off-flap group were significantly lower than those in the on-flap group (P=.011, .017, .048, and .041, respectively). CONCLUSIONS Off-flap epi-LASIK with MMC offers faster corneal epithelial healing and visual recovery, and temporary less haze than on-flap epi-LASIK with MMC. The lower tear levels of bFGF, PDGF-BB, IL-8, and TNF-α in the offflap group 2 hours after surgery may suggest a possible mechanism for the clinical differences.
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Affiliation(s)
- Yu Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
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Wilson SL, El Haj AJ, Yang Y. Control of scar tissue formation in the cornea: strategies in clinical and corneal tissue engineering. J Funct Biomater 2012; 3:642-87. [PMID: 24955637 PMCID: PMC4031002 DOI: 10.3390/jfb3030642] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 08/27/2012] [Accepted: 08/30/2012] [Indexed: 12/13/2022] Open
Abstract
Corneal structure is highly organized and unified in architecture with structural and functional integration which mediates transparency and vision. Disease and injury are the second most common cause of blindness affecting over 10 million people worldwide. Ninety percent of blindness is permanent due to scarring and vascularization. Scarring caused via fibrotic cellular responses, heals the tissue, but fails to restore transparency. Controlling keratocyte activation and differentiation are key for the inhibition and prevention of fibrosis. Ophthalmic surgery techniques are continually developing to preserve and restore vision but corneal regression and scarring are often detrimental side effects and long term continuous follow up studies are lacking or discouraging. Appropriate corneal models may lead to a reduced need for corneal transplantation as presently there are insufficient numbers or suitable tissue to meet demand. Synthetic optical materials are under development for keratoprothesis although clinical use is limited due to implantation complications and high rejection rates. Tissue engineered corneas offer an alternative which more closely mimic the morphological, physiological and biomechanical properties of native corneas. However, replication of the native collagen fiber organization and retaining the phenotype of stromal cells which prevent scar-like tissue formation remains a challenge. Careful manipulation of culture environments are under investigation to determine a suitable environment that simulates native ECM organization and stimulates keratocyte migration and generation.
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Affiliation(s)
- Samantha L Wilson
- Institute for Science and Technology in Medicine, School of Medicine, Keele University, Staffordshire, ST4 7QB, UK.
| | - Alicia J El Haj
- Institute for Science and Technology in Medicine, School of Medicine, Keele University, Staffordshire, ST4 7QB, UK.
| | - Ying Yang
- Institute for Science and Technology in Medicine, School of Medicine, Keele University, Staffordshire, ST4 7QB, UK.
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O'Brart DPS, Williams K. Pterygium after hyperopic laser-assisted sub-epithelial keratomileusis (LASEK). Clin Exp Optom 2012; 96:336-8. [PMID: 22775539 DOI: 10.1111/j.1444-0938.2012.00769.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 04/01/2012] [Accepted: 04/17/2012] [Indexed: 11/28/2022] Open
Abstract
A 61-year-old Caucasian woman with hyperopia presented for laser refractive surgery. She had healthy eyes with the exception of a less than 0.5 mm Salzmann's nodule at 5 o'clock near the limbus of the right eye. She underwent bilateral hyperopic laser-assisted sub-epithelial keratomileusis (LASEK) combined with removal of the Salzmann's nodule. At six months, she was emmetropic with unaided vision of 6/6; however, at 10 months, she noticed a reduction of acuity in her right eye and was found to have a pterygium at 5 o'clock, encroaching 3.5 mm onto the corneal surface. She underwent excision biopsy, local application of mitomycin-C (0.2 mg/ml for two minutes) and conjunctival auto-grafting. Following surgery for the pterygium, vision returned to 6/6 unaided but six months later, there was limited recurrence (1.5 mm) of the pterygium reducing unaided vision to 6/9, due to the induction of astigmatism of -1.25 dioptres. This has remained stable for 14 months. Pterygium growth may be associated with surface excimer laser surgery and the presence of peripheral Salzmann's nodules might be a risk factor.
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Affiliation(s)
- David P S O'Brart
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
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Knox Cartwright NE, Tyrer JR, Jaycock PD, Marshall J. Effects of Variation in Depth and Side Cut Angulations in LASIK and Thin-flap LASIK Using a Femtosecond Laser: A Biomechanical Study. J Refract Surg 2012; 28:419-25. [DOI: 10.3928/1081597x-20120518-07] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 04/24/2012] [Indexed: 11/20/2022]
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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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Sia RK, Coe CD, Edwards JD, Ryan DS, Bower KS. Visual Outcomes After Epi-LASIK and PRK for Low and Moderate Myopia. J Refract Surg 2012; 28:65-71. [DOI: 10.3928/1081597x-20111004-01] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 08/08/2011] [Indexed: 11/20/2022]
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Chen J, Wong-Chong J, SundarRaj N. FGF-2- and TGF-β1-induced downregulation of lumican and keratocan in activated corneal keratocytes by JNK signaling pathway. Invest Ophthalmol Vis Sci 2011; 52:8957-64. [PMID: 22025571 DOI: 10.1167/iovs.11-8078] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Downregulation of lumican and keratocan expression is an undesirable phenotypic change that occurs during corneal wound healing. The present study was intended to determine whether the activation of Jun N-terminal kinase (JNK)-signaling pathway is involved in their downregulation in TGF-β1- and FGF-2-activated keratocytes. METHODS Keratocytes, isolated from rabbit corneal stroma, and cultured in a serum-free medium, pretreated or not treated with JNK inhibitor (SP600125), were activated with FGF-2/heparin sulfate (HS) or TGF-β1 in the presence or absence of SP600125. In another set of experiments, keratocytes were transfected with JNK1/2 Dicer-substrate RNA (DsiRNA) and then activated with TGF-β1 or FGF-2/HS. Specific phenotypic changes were analyzed immunocytochemically and correlated with Western blot analyses. The relative levels of specific mRNAs were estimated by quantitative RT-PCR using specific reagents. RESULTS The FGF-2/HS- or TGF-β-induced activation of corneal stromal keratocytes to fibroblast- or myofibroblast-phenotype, respectively, resulted in marked decreases in cell surface-associated and secreted keratan sulfate proteoglycans (KSPGs). Both keratocan and lumican proteins and their mRNAs were downregulated in the activated keratocytes. However, JNK inhibition during the activation of keratocytes, pretreated with the JNK inhibitor, suppressed the reduction in the cell-surface associated and secreted KSPGs (lumican and keratocan), and their mRNA transcripts. Downregulation of total KSPGs and their mRNAs was also inhibited by decreasing JNK1 and JNK2 levels via JNK1/2 DsiRNA transfection of keratocytes before their activation. CONCLUSIONS Extrapolating from the present study, FGF-2- and TGF-β1-activation of JNK signaling pathway may be partly responsible for the downregulation of keratocan and lumican expression in activated corneal keratocytes observed during corneal stromal wound healing.
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Affiliation(s)
- Jian Chen
- Department of Ophthalmology, Ophthalmology and Visual Science Research Center, Eye and Ear Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA
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Zainal Abidin F, Hui CK, Luan NS, Mohd Ramli ES, Hun LT, Abd Ghafar N. Effects of edible bird's nest (EBN) on cultured rabbit corneal keratocytes. Altern Ther Health Med 2011; 11:94. [PMID: 21992551 PMCID: PMC3213154 DOI: 10.1186/1472-6882-11-94] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 10/12/2011] [Indexed: 01/01/2023]
Abstract
Background There has been no effective treatment or agent that is available for corneal injury in promoting corneal wound healing. Previous studies on edible bird's nest extract (EBN) had reported the presence of hormone-like substance; avian epidermal growth factor that could stimulate cell division and enhance regeneration. This study aimed to investigate the effects of EBN on corneal keratocytes proliferative capacity and phenotypical changes. Methods Corneal keratocytes from six New Zealand White Rabbits were isolated and cultured until Passage 1. The proliferative effects of EBN on corneal keratocytes were determined by MTT assay in serum-containing medium (FDS) and serum-free medium (FD). Keratocytes phenotypical changes were morphologically assessed and gene expression of aldehyde dehydrogenase (ALDH), collagen type 1 and lumican were determined through RT-PCR. Results The highest cell proliferation was observed when both media were supplemented with 0.05% and 0.1% EBN. Cell proliferation was also consistently higher in FDS compared to FD. Both phase contrast micrographs and gene expression analysis confirmed the corneal keratocytes retained their phenotypes with the addition of EBN. Conclusions These results suggested that low concentration of EBN could synergistically induce cell proliferation, especially in serum-containing medium. This could be a novel breakthrough as both cell proliferation and functional maintenance are important during corneal wound healing. The in vitro test is considered as a crucial first step for nutri-pharmaceutical formation of EBN-based eye drops before in vivo application.
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Jiang X, McClellan SA, Barrett RP, Berger EA, Zhang Y, Hazlett LD. VIP and growth factors in the infected cornea. Invest Ophthalmol Vis Sci 2011; 52:6154-61. [PMID: 21666233 DOI: 10.1167/iovs.10-6943] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Vasoactive intestinal peptide (VIP) is an anti-inflammatory neuropeptide that downregulates proinflammatory cytokines and promotes healing in a susceptible model of P. aeruginosa keratitis. Growth factors also play a role in corneal healing and restoration of tissue homeostasis after wounding. However, whether VIP treatment modulates growth factors to promote healing in the infected cornea remains untested and is the purpose of this study. METHODS C57BL/6 (B6) mice were injected with VIP and mRNA and protein levels, and immunostaining for EGF, FGF, HGF, and VEGF-A were done. Exogenous treatment with a mixture of the growth factors also was tested and levels of cytokines, defensins, and bacterial counts were determined. RESULTS Real-time RT-PCR, immunostaining, and ELISA data demonstrated that treatment with VIP enhanced levels of EGF, FGF, and HGF during disease, and that VEGF-A, and associated angiogenic molecules also were increased by VIP. Moreover, immunohistochemical studies confirmed that both epithelial and stromal cells participated in growth factor production. Most notably, treatment with a mixture of EGF, FGF, and HGF after disease onset, prevented corneal perforation when compared with controls. This outcome was associated with downregulation of proinflammatory cytokines such as macrophage inflammatory protein-2 (MIP-2), upregulation of anti-inflammatory cytokines such as TGF-β, and antimicrobials β-defensins 2 and 3, as well as decreased plate counts at 1 day postinfection (p.i.) (P = 0.0001). CONCLUSIONS Collectively, the data provide evidence that VIP treatment modulates growth factors, angiogenic molecules, and defensins in the infected cornea and that this in turn promotes healing and restoration of tissue homeostasis.
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Affiliation(s)
- Xiaoyu Jiang
- Department of Anatomy and Cell Biology, Wayne State University School of Medicine, Detroit, Michigan 48201, USA
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Lee JY, Youm DJ, Choi CY. Conventional Epi-LASIK and lamellar epithelial debridement in myopic patients with dermatologic keloids. KOREAN JOURNAL OF OPHTHALMOLOGY 2011; 25:206-9. [PMID: 21655048 PMCID: PMC3102826 DOI: 10.3341/kjo.2011.25.3.206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 09/01/2010] [Indexed: 12/02/2022] Open
Abstract
We report the outcome of conventional epipolis laser in situ keratomileusis (Epi-LASIK, flap-on) and lamellar epithelial debridement (LED; Epi-LASIK, flap-off) in myopic patients with dermatologic keloids. Three patients, who were all noted to be susceptible to keloid scarring, received conventional Epi-LASIK in their right eyes and LED in their left eyes. The patients were followed-up for 6 to 21 months after their surgeries, and the outcomes were then evaluated. In case 1, the preoperative spherical equivalent (SE) was -6.5 diopters (D) in the right eye (OD) and -6.25 D in the left eye (OS). At 21 months postoperatively, the uncorrected visual acuity (UCVA) was 20 / 12.5 in both eyes. In case 2, the preoperative SE was -5.25 (OD) / -6.00 (OS). After six months, the postoperative UCVA was 20 / 12.5 in both eyes. In case 3, the preoperative SE was -4.5 (OD) / -2.0 (OS). The UCVA at the six-month follow-up was 20 / 12.5 in both eyes. No adverse events, including corneal haze, occurred in any of the patients. All three of our patients reported excellent visual outcomes following both conventional Epi-LASIK and LED, despite their histories of keloid formation. The present cases suggest that both Epi-LASIK and LED may be safe and effective techniques for myopic patients with dermatologic keloids.
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Affiliation(s)
- Jun Yong Lee
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Meta-analysis: clinical outcomes of laser-assisted subepithelial keratectomy and photorefractive keratectomy in myopia. Ophthalmology 2010; 117:1912-22. [PMID: 20709406 DOI: 10.1016/j.ophtha.2010.02.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 01/08/2010] [Accepted: 02/02/2010] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To examine possible differences in clinical outcomes between laser-assisted subepithelial keratectomy (LASEK) and photorefractive keratectomy (PRK) for myopia. DESIGN Systematic review and meta-analysis. PARTICIPANTS Patients from previously reported randomized controlled trials (RCTs) and comparative studies of LASEK and PRK with clinical outcomes. METHODS A comprehensive literature search was performed using the Cochrane Collaboration methodology to identify RCTs and comparative studies comparing LASEK and PRK for myopia. MAIN OUTCOME MEASURES Primary outcome parameters included uncorrected visual acuity (UCVA) of 20/20 or better, manifest refractive spherical equivalent (SE) within ± 0.50 diopters (D), final refractive SE, and final UCVA of 20/40 or worse. Secondary outcome parameters included healing time of corneal epithelium, postoperative pain, and corneal haze. RESULTS Twelve studies were identified and used for comparing PRK (499 eyes) with LASEK (512 eyes) for myopia. There were no significant differences in odds ratio (OR), weighted mean difference (WMD), and standardized mean difference (SMD) in the primary and secondary outcome measures. The final mean refractive SE (WMD, 0.00; 95% confidence interval [CI], -0.08 to 0.07; P = 0.95), manifest refractive SE within ± 0.50 D of the target (OR, 0.90; 95% CI, 0.63-1.29; P = 0.56), patients achieving UCVA of 20/20 or better (OR, 0.86; 95% CI, 0.61-1.20; P = 0.37), final UCVA of 20/40 or worse (OR, 1.26; 95% CI, 0.63-2.51; P = 0.52), re-epithelialization time (WMD, 0.08; 95% CI, -0.44 to 0.59; P = 0.77), and postoperative pain (SMD, 0.26; 95% CI, -0.20 to 0.72; P = 0.27) were analyzed. However, LASEK-treated eyes showed less corneal haze at 1 month after surgery (WMD, 0.25; 95% CI, 0.10-0.39; P = 0.0007) and 3 months after surgery (WMD, 0.14; 95% CI, 0.01-0.26; P = 0.03) compared with PRK. No statistically significant difference was observed between the 2 groups at 6 months after surgery (WMD, 0.14; 95% CI, -0.02 to 0.30; P = 0.08). CONCLUSIONS In this meta-analysis, LASEK-treated eyes had no significant benefits over PRK-treated ones with regard to clinical outcomes. Less corneal haze was observed in LASEK-treated eyes at 1 to 3 months after surgery.
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Rhim JH, Kim JH, Yeo EJ, Kim JC, Park SC. Caveolin-1 as a novel indicator of wound-healing capacity in aged human corneal epithelium. Mol Med 2010; 16:527-34. [PMID: 20644900 DOI: 10.2119/molmed.2010.00046] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 07/14/2010] [Indexed: 12/13/2022] Open
Abstract
Excess caveolin-1 has been reported to play a role in age-dependent hyporesponsiveness to growth factors in vitro. Therefore, we hypothesized that caveolin-1-dependent hyporesponsiveness to growth factors in aged corneal epithelial cells might be responsible for delayed wound healing in vivo. To test this hypothesis, we evaluated corneal wound-healing time by vital staining using fluorescein after laser epithelial keratomileusis (LASEK). We compared wound-healing times in young, middle-aged and elderly patients. We also examined caveolin-1 levels and other aging markers, such as p53 and p21, in the corneal epithelium. Elderly patients generally had higher caveolin-1 levels in the corneal epithelia than young patients. There were, however, variations among individuals with increased caveolin-1 in some young patients and decreased levels in some elderly patients. Wound-healing time after LASEK correlated well with the corneal caveolin-1 status. Therefore, we suggest that caveolin-1 status might be responsible for delayed wound healing in elderly patients after LASEK. Caveolin-1 status might be a regulator for wound-healing capacity and a novel target for in vivo adjustment.
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Affiliation(s)
- Ji Heon Rhim
- Department of Biochemistry and Molecular Biology, Aging and Apoptosis Research Center, Institute on Aging, Seoul National University College of Medicine, Seoul, Korea
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Huh MIL, Kim YH, Park JH, Bae SW, Kim MH, Chang Y, Kim SJ, Lee SR, Lee YS, Jin EJ, Sonn JK, Kang SS, Jung JC. Distribution of TGF-β isoforms and signaling intermediates in corneal fibrotic wound repair. J Cell Biochem 2009; 108:476-88. [DOI: 10.1002/jcb.22277] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Mitomycin C has played a deciding role in the current revival of excimer laser surface ablation techniques. We review the literature regarding mechanism of action of mitomycin C, histological effects on the cornea, and indications, dose, exposure time, and toxicity of mitomycin C in corneal refractive surgery. Mitomycin C is an alkylating agent with cytotoxic and antiproliferative effects that reduces the myofibroblast repopulation after laser surface ablation and, therefore, reduces the risk of postoperative corneal haze. It is used prophylactically to avoid haze after primary surface ablation and therapeutically to treat pre-existing haze. There is no definite evidence that establishes an exact diopter limit or ablation depth at which to apply prophylactic mitomycin C. It is usually applied at a concentration of 0.2mg/ml (0.02%) for 12 to 120 seconds over the ablated stroma, although some studies suggest that lower concentrations (0.01%, 0.002%) could also be effective in preventing haze when treating low to moderate myopia. This dose of mitomycin C has not been associated with any clinically relevant epithelial corneal toxicity. Its effect on the endothelium is more controversial: two studies report a decrease in endothelial cell density, but the majority of reports suggest that the endothelium is not altered. Regarding mitomycin C's effect on keratocyte population, although animal studies report keratocyte depletion after its use, longer follow-up suggested that the initial keratocyte depletion does not persist over time.
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