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Carletti P, Sepulveda Beltran PA, Levine H, Dubovy SR, Perez VL, Amescua G. Long-Term Comprehensive Management of Bilateral Limbal Stem Cell Deficiency Secondary to Severe Chemical Burn: 10 Years of Follow-Up. Ocul Immunol Inflamm 2023; 31:1629-1634. [PMID: 35816015 DOI: 10.1080/09273948.2022.2090965] [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: 04/20/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To describe the long-term management of bilateral limbal stem cell deficiency secondary to a severe chemical burn. METHODS Descriptive case report. IMPORTANCE This case highlights the importance of early intervention in ocular chemical burns for the preservation of tissue integrity and avoidance of perforation. We also review the use of proper ocular surface reconstructive techniques to restore the function of the limbal area, as well as the immunomodulatory strategies and follow-up needed for these interventions.
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Affiliation(s)
- Piero Carletti
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Harry Levine
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sander R Dubovy
- Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Victor L Perez
- Duke Eye Center, Duke University, Durham, North Carolina, USA
- Foster Center for Ocular Immunology, Duke University, Durham, North Carolina, USA
| | - Guillermo Amescua
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Pion T, Alnouri G, Sataloff RT. A New Risk of Using Alkaline Drops in Patients With Laryngopharyngeal Reflux. J Voice 2023; 37:801.e1-801.e2. [PMID: 34162496 DOI: 10.1016/j.jvoice.2021.04.007] [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: 03/10/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
Laryngopharyngeal reflux (LPR) is common in the otolaryngologist's office, and a multimodal treatment regimen is employed often. Counseling patients on lifestyle modifications is important. Alkaline water consumption has been recommended as a nonmedical "antacid" for its value in deactivating pepsin, a proteolytic enzyme responsible for laryngeal tissue inflammatory changes in LPR. Alkaline water can be found as premade bottled water, or it can be made at home by titrating regular-pH water with concentrated alkaline drops. We present a patient who mistakenly instilled the alkaline drops into her eye, causing alkali-related chemical burns to the sclera and cornea, which subsequently resulted in scar.
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Affiliation(s)
- Tyler Pion
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Ghiath Alnouri
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.
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Bu J, Wu Y, Li K, Zhang M, Zhang R, Sun L, Guo Y, He H, Li S, Liu Z, Li W. Transitory alkali exposure on meibomian gland orifices induces meibomian gland dysfunction. Ocul Surf 2023; 29:406-415. [PMID: 37327868 DOI: 10.1016/j.jtos.2023.06.007] [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: 01/28/2023] [Revised: 05/25/2023] [Accepted: 06/13/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE To determine pathological changes of meibomian glands (MGs) after transient exposure of the rat eyelid margin to alkali solution. METHODS Filter paper infiltrated with 1 N sodium hydroxide solution was applied to the eyelid margin of Sprague-Dawley rats for 30 s under general anesthesia, without touching the conjunctiva, after which the ocular surface and eyelid margin were examined by slit-lamp microscopy. In vivo confocal microscopy and stereomicroscopy were subsequently applied to observe MG morphology on day 5, day 10 and day 30 post alkali injury. Eyelid cross-sections were processed for H&E staining, Oil red O staining and immunofluorescent staining. RESULTS After alkali injury, there was marked plugging of MG orifices, telangiectasia and hypertrophy of the eyelid margin, while corneal epithelium was intact at post-injury days 5 and 10. However, 30 days after alkali injury, mild corneal epithelial damage was observed. Degeneration of MG acini was observed at days 5 and became aggravated at days 10 and 30, along with MG duct dilation and acini loss. Oil red O staining showed lipid accumulation in the dilated duct. Inflammatory cell infiltration and the presence of apoptotic cells was seen in the MG loci 5 days post injury, but diminished at days 10 and 30. Cytokeratin 10 expression was increased in dilated duct, while cytokeratin 14, PPAR-γ, Ki67 and LRIG1 expression were decreased in the acini of injured loci. CONCLUSIONS Transitory alkali exposure of the rat eyelid margin obstructs the MG orifice and induces pathological changes of MG dysfunction.
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Affiliation(s)
- Jinghua Bu
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Fujian Engineering and Research Center of Eye Regenerative Medicine, School of Medicine, Xiamen University, Xiamen, Fujian, China.
| | - Yang Wu
- Xiamen Branch, Zhongshan Hospital of Fudan University, Xiamen, Fujian, China
| | - Kechun Li
- University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Minjie Zhang
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Fujian Engineering and Research Center of Eye Regenerative Medicine, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Rongrong Zhang
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Fujian Engineering and Research Center of Eye Regenerative Medicine, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Le Sun
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Fujian Engineering and Research Center of Eye Regenerative Medicine, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yuli Guo
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Fujian Engineering and Research Center of Eye Regenerative Medicine, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Hui He
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Fujian Engineering and Research Center of Eye Regenerative Medicine, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Shiying Li
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Fujian Engineering and Research Center of Eye Regenerative Medicine, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Zuguo Liu
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Fujian Engineering and Research Center of Eye Regenerative Medicine, School of Medicine, Xiamen University, Xiamen, Fujian, China; Xiamen University Affiliated Xiamen Eye Center, Xiamen, Fujian, China
| | - Wei Li
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Fujian Engineering and Research Center of Eye Regenerative Medicine, School of Medicine, Xiamen University, Xiamen, Fujian, China; Xiamen University Affiliated Xiamen Eye Center, Xiamen, Fujian, China.
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Liu J, Xu Y, Huang Y, Sun X, Peng Y, Song W, Yuan J, Ren L. Collagen membrane loaded with doxycycline through hydroxypropyl chitosan microspheres for the early reconstruction of alkali-burned cornea. Int J Biol Macromol 2023:125188. [PMID: 37270120 DOI: 10.1016/j.ijbiomac.2023.125188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/03/2023] [Accepted: 05/30/2023] [Indexed: 06/05/2023]
Abstract
Corneal alkali burn is one of the most devastating ophthalmic emergencies correlated with remarkable morbidity resulting in severe visual impairment. Appropriate intervention in the acute phase determines the eventual outcome for later corneal restoration treatment. Since the epithelium plays an essential role in inhibiting inflammation and promoting tissue repair, sustained anti-matrix metalloproteinases (MMPs) and pro-epithelialization are the prior remedies during the first week. In this study, a drug-loaded collagen membrane (Dox-HCM/Col) that could be sutured to overlay the burned cornea was developed to accelerate the early reconstruction. Doxycycline (Dox), a specific inhibitor of MMPs, was encapsulated in collagen membrane (Col) through hydroxypropyl chitosan microspheres (HCM) to develop Dox-HCM/Col, affording a preferable pro-epithelialization microenvironment and an in-situ controlled release. Results showed that loading HCM into Col prolonged the release time to 7 days, and Dox-HCM/Col could significantly suppress the expression of MMP-9 and -13 in vitro and in vivo. Furthermore, the membrane accelerated the corneal complete re-epithelialization and promoted early reconstruction within the first week. Overall, Dox-HCM/Col was a promising biomaterial membrane for treating alkali-burned cornea in the early stage, and our attempt may provide a clinically feasible method for the ocular surface reconstruction.
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Affiliation(s)
- Jia Liu
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510006, China; National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, China; Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, China; Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, China; Innovation Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China
| | - Yingni Xu
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510006, China; National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, China; Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, China; Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, China; Innovation Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China
| | - Yongrui Huang
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510006, China; National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, China; Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, China; Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, China; Innovation Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China
| | - Xiaomin Sun
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510006, China; National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, China; Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, China; Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, China; Innovation Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China
| | - Yuehai Peng
- National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, China; Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, China; Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, China; Innovation Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China; School of Biology and Biological Engineering, South China University of Technology, Guangzhou 510006, China; Guangzhou Proud Seeing Biotechnology Co., Ltd, Guangzhou 510623, China
| | - Wenjing Song
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510006, China; National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, China; Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, China; Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, China; Innovation Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China.
| | - Jin Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510623, China.
| | - Li Ren
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510006, China; National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, China; Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, China; Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, China; Innovation Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, China; Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou 510005, China.
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Bansal P, Singh M, Gupta Y, Gotmare N, Thakar M, Arora R. An atypical presentation of sympathetic ophthalmia following chemical ocular burns. J Ophthalmic Inflamm Infect 2023; 13:25. [PMID: 37193928 DOI: 10.1186/s12348-023-00348-z] [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: 05/01/2022] [Accepted: 04/30/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Sympathetic ophthalmia is a rare disease that can present as bilateral granulomatous uveitis after a penetrating trauma or surgery in one eye. FINDINGS We report a case of a 47-year-old male with history of decreased vision in the right eye, six months after sustaining severe chemical injury in the left eye. He was diagnosed with sympathetic ophthalmia and was treated with corticosteroids and long-term immunosuppressive therapy, leading to complete resolution of intraocular inflammation. Final visual acuity was 20/30 at one year of follow up. CONCLUSIONS Sympathetic Ophthalmia following chemical ocular burns is extremely uncommon. It can present as a diagnostic and therapeutic challenge. It warrants early diagnosis and management.
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Affiliation(s)
- Pooja Bansal
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, 110002, India.
| | - Maninder Singh
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, 110002, India
| | - Yashi Gupta
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, 110002, India
| | - Nikhil Gotmare
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, 110002, India
| | - Meenakshi Thakar
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, 110002, India
| | - Ritu Arora
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, 110002, India
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Rauchman SH, Locke B, Albert J, De Leon J, Peltier MR, Reiss AB. Toxic External Exposure Leading to Ocular Surface Injury. Vision (Basel) 2023; 7:vision7020032. [PMID: 37092465 PMCID: PMC10123707 DOI: 10.3390/vision7020032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 04/07/2023] Open
Abstract
The surface of the eye is directly exposed to the external environment, protected only by a thin tear film, and may therefore be damaged by contact with ambient particulate matter, liquids, aerosols, or vapors. In the workplace or home, the eye is subject to accidental or incidental exposure to cleaning products and pesticides. Organic matter may enter the eye and cause infection. Ocular surface damage can trigger a range of symptoms such as itch, discharge, hyperemia, photophobia, blurred vision, and foreign body sensation. Toxin exposure can be assessed clinically in multiple ways, including via measurement of tear production, slit-lamp examination, corneal staining, and conjunctival staining. At the cellular level, environmental toxins can cause oxidative damage, apoptosis of corneal and conjunctival cells, cell senescence, and impaired motility. Outcomes range from transient and reversible with complete healing to severe and sight-compromising structural changes. Classically, evaluation of tolerance and safety was carried out using live animal testing; however, new in vitro and computer-based, in silico modes are superseding the gold standard Draize test. This review examines how environmental features such as pollutants, temperature, and seasonality affect the ocular surface. Chemical burns to the eye are considered, and approaches to protect the ocular surface are detailed.
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Affiliation(s)
| | - Brandon Locke
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA
| | - Jacqueline Albert
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA
| | - Joshua De Leon
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA
| | - Morgan R. Peltier
- Department of Psychiatry and Behavioral Health, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
| | - Allison B. Reiss
- Department of Medicine and Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA
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Kaplan AT, Yalcin SO, Günaydın NT, Kaymak NZ, Gün RD. Ocular-periocular burns in a tertiary hospital: Epidemiologic characteristics. J Plast Reconstr Aesthet Surg 2023; 76:208-215. [PMID: 36527902 DOI: 10.1016/j.bjps.2022.10.049] [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: 05/14/2022] [Revised: 10/10/2022] [Accepted: 10/25/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE Ocular burns are ophthalmic emergencies that can cause devastating injuries. This study aimed to analyze the epidemiology, complications, and management of ocular-periocular burns. METHODS A total of 193 patients with ocular-periocular burns were admitted to our tertiary hospital from January 2018 to December 2020. The demographic characteristics of the patients, injury variables, complications, and treatments were evaluated. RESULTS There were 142 male (73.6%) and 51 female (26.4%) patients with a mean age of 32.53±17.75 years. The average total body surface area was 12% (range, 1-80%). Injuries were most common at work (52.3%) and home (36.3%). Thermal burns were the most common injuries (74.6%), followed by chemical (14.5%) and electrical burns (10.9%). Alkaline agents (75.0%), mainly sodium hydroxide and lime, were common in chemical burns. Superficial lid burns were significantly higher in the thermal group (p < 0.001), and grade III-IV corneal burns were significantly higher in the chemical group (p < 0.001). Various complications were developed in 50 (13%) eyes. Medical treatment only was performed in 318 (82.4%) eyes, and additional surgical treatment was performed in 64 (17.6%) eyes; however, 54 (14.0%) underwent more than one surgery. The most common complications were corneal scars (7.3%), limbal deficiency (4.1%), and ectropion (3.9%). The most frequent procedures performed were amniotic membrane transplantation (AMT) (11.9%) and tarsorrhaphy (6.7%). CONCLUSION Chemical burns, limbal and conjunctival ischemia, and full-thickness eyelid defects had a poor prognosis. The degree of limbal deficiency and ınjury of intraocular structures were found to have a great influence on the outcome of their visual acuity.
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Affiliation(s)
- Aysin Tuba Kaplan
- Ophthalmology Department, SBU Kartal Dr. Lutfi Kırdar City Hospital, Kartal, Istanbul 34865, Turkey.
| | - Sibel Oskan Yalcin
- Ophthalmology Department, SBU Kartal Dr. Lutfi Kırdar City Hospital, Kartal, Istanbul 34865, Turkey
| | - Nesrin Tutas Günaydın
- Ophthalmology Department, SBU Kartal Dr. Lutfi Kırdar City Hospital, Kartal, Istanbul 34865, Turkey
| | - Nilüfer Zorlutuna Kaymak
- Ophthalmology Department, SBU Kartal Dr. Lutfi Kırdar City Hospital, Kartal, Istanbul 34865, Turkey
| | - Raziye Dönmez Gün
- Ophthalmology Department, SBU Kartal Dr. Lutfi Kırdar City Hospital, Kartal, Istanbul 34865, Turkey
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Ten Years of Pediatric Ocular Chemical Burn Experience in a Tertiary Eye Care Center in Turkey. Eye Contact Lens 2021; 48:175-179. [DOI: 10.1097/icl.0000000000000858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 12/09/2022]
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9
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Kesim E, Pirhan D, Yardimoglu Yilmaz M, Yuksel N, Yazir Y, Bicaklioglu G, Furat Rencber S. Comparative Analysis of Matrix-Regenerating Agent and Corneal Cross-Linking in an Experimental Alkali Burn Rabbit Model. Curr Eye Res 2021; 47:187-195. [PMID: 34435926 DOI: 10.1080/02713683.2021.1971722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to investigate the clinical and histopathological effects of corneal cross-linking (CXL) and matrix-regenerating agent (RGTA) treatments after corneal alkali burn. MATERIALS AND METHODS Twenty-four alkali-burned corneas from 24 rabbits were divided into three groups: control, CXL, and RGTA. All animals were investigated for epithelial healing, opacification, ulceration, and neovascularization at days 1, 7, 14, and 21 after the alkali burn. Corneas were excised and sent for histological examination on day 21. RESULTS One animal each from the CXL and control groups exhibited moderate ulceration, while no ulceration was observed in the RGTA group. No significant difference was observed among the groups in corneal thickness or corneal opacity measurements at the final visit (p = .058 and p = .544, respectively). Both RGTA and CXL treatments were effective in terms of epithelial healing and neovascularization (p = .023 and p = .03, respectively). On histological examination, the CXL and RGTA groups were more effective in treating epithelial loss, stromal edema, corneal vascularization, and leukocytic infiltration than the control group (p < .05). The immunohistochemical staining scores of the CXL and RGTA groups for caspase-3, vascular endothelial growth factor, and matrix metalloproteinase-9 in the epithelium and stroma were significantly lower than those in the control group (p < .05). In the immunohistochemical examination for inducible nitric oxide synthase, epithelial staining scores were similar among the groups (p > .05). In contrast, the stromal staining scores of the CXL and RGTA groups were lower than those of the control group (p < .05). CONCLUSION Both CXL and RGTA therapies were effective in reducing anatomical and histopathological complications after corneal alkali burn. Further investigation is needed to determine the optimal timing, duration, and dosage of these treatments.
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Affiliation(s)
- Enes Kesim
- Department of Ophthalmology, Tuzla State Hospital, Istanbul, Turkey
| | - Dilara Pirhan
- Department of Ophthalmology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Melda Yardimoglu Yilmaz
- Department of Histology and Embryology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Nursen Yuksel
- Department of Ophthalmology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Yusufhan Yazir
- Department of Histology and Embryology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | | | - Selenay Furat Rencber
- Department of Histology and Embryology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
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M Al-Mohaimeed M. Comprehensive Profiling through a Cross-sectional Assessment on the Awareness about Eye Protection Safety among Dental Professionals in Saudi Arabia. Ophthalmic Epidemiol 2021; 29:515-522. [PMID: 34402736 DOI: 10.1080/09286586.2021.1966808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Eye injuries account for 3-4% of all occupational injuries; however, dental practitioners are at relatively high risk of occupational ocular incidents during their practices. The study aims to assess the attitude, knowledge, and awareness towards the safety of the eye; measures undertaken for its protection and its probable variations regarding age, gender, qualification, and years of practice among dental practitioners in Saudi Arabia (SA). METHODS In this cross-sectional study, 348 dental practitioners and dental staff from SA participated. Besides demography, information regarding their knowledge, attitude, perception towards eye safety protection, and measures followed was collected through a 28-questions structured questionnaire posted online. RESULTS Among the participants, 47.4% were male, 52.6% female, and 55% dentists. The data revealed that about 47% of the dentists were following clinical safety programs in their practice, 68% were employing a very high-level eye protection measure, whereas about 40% followed these measures just before starting the procedure, yet nearly 38% of the dentists faced ocular injury. Female practitioners had the highest level of knowledge on eye safety and protection. Multivariate binary logistic regression analysis showed that the awareness of the need for eye protection and inclusion of safety-glasses for UV protection were significant independent determinants of eye-injury incidence among dental professionals. CONCLUSION This survey comprehensively profiles dental professionals' awareness and attitude about safety measures for their eye protection in their practice. Thus, the outcome of the study may pave the way for practicing an evidence-based safety approach towards the prevention of occupational ocular incidents in SA.
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Affiliation(s)
- Mansour M Al-Mohaimeed
- Department of Ophthalmology, College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia
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11
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Chehade JA, Bhattacharya S, Iezzi R. Inkjet-Printed Graphene Sensors for the Bedside Detection of Tear Film pH. Transl Vis Sci Technol 2021; 10:10. [PMID: 34003944 PMCID: PMC7961110 DOI: 10.1167/tvst.10.3.10] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine whether an inexpensive, graphene thin-film electronic pH sensor could be used to measure tear film pH. Methods The pH-sensitive electrolyte-gated graphene field-effect transistors (EG-GFETs) were fabricated by patterning graphene ink and ultraviolet-cured dielectric onto 125 µm–thick polyimide substrate using a nanomaterials inkjet printer. A flow-cell was used to exchange test solutions and record current flow through the EG-GFET. Laboratory reference pH test solutions were used to calibrate the sensor. Contrived tears with lipids were pH buffered using HCL (1 M) or NAOH (1 M) to produce tear solutions ranging in pH from 2.0 to 9.5. A laboratory-reference pH meter was used to verify the pH of each solution. Dirac curves that demonstrate pH-dependent changes in current flow through the EG-GFET were measured for each test solution, using dual sourcemeters. Results Graphene EG-GFET devices were highly sensitive to changes in artificial tear-film pH. The Dirac voltage was defined as the gate voltage at which minimum source drain current was measured. The relationship between Dirac voltage and tear film pH was highly linear with a slope of 17.2 mV per pH unit over the range of solutions tested, from pH 2.0 to pH 9.5 (r2 = 0.977). Conclusions Graphene field-effect transistors accurately measure tear film pH and may be useful in the emergency management of ocular adnexal exposure to acids or bases. Translational Relevance Thin-film graphene sensors are low cost and can rapidly map tear-film pH at multiple sites on the ocular surface and within the conjunctival fornices, avoiding subjective, colorimetric test-paper methods.
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Affiliation(s)
| | - Santanu Bhattacharya
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Jacksonville, FL, USA
| | - Raymond Iezzi
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
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[Acute chemical burns of the eye : S1 guidelines of the German Ophthalmological Society (DOG) and the Professional Association of German Ophthalmologists (BVA)]. Ophthalmologe 2021; 118:103-116. [PMID: 33666702 DOI: 10.1007/s00347-021-01326-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/29/2022]
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Nuwormegbe SA, Kim SW. AMPK Activation by 5-Amino-4-Imidazole Carboxamide Riboside-1-β-D-Ribofuranoside Attenuates Alkali Injury-Induced Corneal Fibrosis. Invest Ophthalmol Vis Sci 2021; 61:43. [PMID: 32561924 PMCID: PMC7415321 DOI: 10.1167/iovs.61.6.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Increased TGF-β1 synthesis after corneal alkali injury is implicated in corneal fibrosis, as it promotes transdifferentiation of keratocytes into myofibroblasts. The activation of 5'-adenosine monophosphate-activated protein kinase (AMPK) by 5-amino-4-imidazole carboxamide riboside-1-β-d-ribofuranoside (AICAR) inhibits TGF-β1-induced fibrosis in other cell types. We investigated the antifibrotic effect of AICAR in corneal fibroblasts after alkali injury. Methods Mouse models of corneal alkali burn, produced by placing 2-mm-diameter filter paper soaked in 0.1-N NaOH on the right cornea for 30 seconds, were treated with the test drugs 4× daily for 21 days. The central cornea was scanned by optical coherence tomography (OCT). Corneal tissues were obtained and processed for western blotting and immunohistochemistry. For in vitro analysis, primary human corneal fibroblasts were treated directly with TGF-β1 to induce fibrosis, with or without AICAR pretreatment. Myofibroblast activation and extracellular matrix (ECM) protein synthesis were detected by western blotting, real-time PCR, and collagen gel contraction assay. Signaling proteins were analyzed by western blotting. Results Alkali injury induced the upregulation of TGF-β1 expression, which led to increased α-smooth muscle actin (α-SMA) and fibronectin synthesis and myofibroblast differentiation. AMPK activation by AICAR significantly suppressed TGF-β1 and ECM protein expression. The antifibrotic effect of AICAR was AMPK dependent, as treatment with the AMPK inhibitor Compound C attenuated the antifibrotic response. Conclusions AMPK activation by AICAR suppresses the myofibroblast differentiation and ECM synthesis that occur after alkali injury in corneal fibroblasts.
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Gouveia RM, Connon CJ. Biomechanical Modulation Therapy-A Stem Cell Therapy Without Stem Cells for the Treatment of Severe Ocular Burns. Transl Vis Sci Technol 2020; 9:5. [PMID: 33240564 PMCID: PMC7671857 DOI: 10.1167/tvst.9.12.5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/07/2020] [Indexed: 12/16/2022] Open
Abstract
Ocular injuries caused by chemical and thermal burns are often unmanageable and frequently result in disfigurement, corneal haze/opacification, and vision loss. Currently, a considerable number of surgical and pharmacological approaches are available to treat such injuries at either an acute or a chronic stage. However, these existing interventions are mainly directed at (and limited to) suppressing corneal inflammation and neovascularization while promoting re-epithelialization. Reconstruction of the ocular surface represents a suitable but last-option recourse in cases where epithelial healing is severely impaired, such as due to limbal stem cell deficiency. In this concise review, we discuss how biomechanical modulation therapy (BMT) may represent a more effective approach to promoting the regeneration of ocular tissues affected by burn injuries via restoration of the limbal stem cell niche. Specifically, the scientific basis supporting this new therapeutic modality is described, along with our growing understanding of the role that tissue biomechanics plays in stem cell fate and function. The potential impact of BMT as a future treatment option for the management of injuries affecting tissue compliance is also further discussed.
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Affiliation(s)
- Ricardo M Gouveia
- Biosciences Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Che J Connon
- Biosciences Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Newcastle upon Tyne, UK
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Silva LD, Santos A, Hirai F, Allemann N, Berezovsky A, Salomão SR, Oliveira PRCD, Andrade G, Maia A, Sousa LBD, Oliveira LAD. B-scan ultrasound, visual electrophysiology and perioperative videoendoscopy for predicting functional results in keratoprosthesis candidates. Br J Ophthalmol 2020; 106:32-36. [PMID: 33093153 DOI: 10.1136/bjophthalmol-2020-316962] [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: 05/20/2020] [Revised: 09/08/2020] [Accepted: 10/03/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS We analysed the ability of B-scan ultrasound, ocular electrophysiology testing and videoendoscopic examination for predicting visual prognosis in Boston Type 1 keratoprosthesis (KPro-1) candidates. Indirect anatomical and electrophysiological findings and results from direct endoscopic evaluations were correlated with postoperative functional data. METHODS In this prospective and interventional study, we included 13 individuals who had previously been indicated for Kpro-1 surgery. All subjects underwent preoperative screening, including ophthalmic evaluation, B-scan ultrasound, electrophysiological testing, and perioperative intraocular videoendoscopic evaluation (VE). B-scan ultrasound, electrophysiological testing, and VE evaluation results were categorised as favourable or unfavourable predictors of postoperative functional results according to predefined criteria. The predictability values of B-scan ultrasound, electrophysiological testing, and VE prognostication were calculated based on the visual acuity level achieved. RESULTS All surgeries and perioperative VEs were uneventful. Preoperative best-corrected visual acuity (BCVA) ranged from light perception to counting fingers. The 1-year postoperative BCVA was better than 20/200 (satisfactory visual acuity result) in 10 eyes (76.9%) and 20/40 or better in 5 eyes (38.5%). B-scan ultrasound presented a positive predictive value (PPV) of 85.7% for satisfactory postoperative visual acuity, electroretinography showed a PPV of 66.7%, and visual evoked potential presented a PPV of 66.7%. The perioperative VE PPV of a negative finding for satisfactory visual acuity was 100%. CONCLUSIONS Fundoscopic visualisation by intraocular VE is a minimally invasive procedure that can be used to predict functional outcomes in keratoprosthesis candidates. This technique demonstrated better prognostication in keratoprosthesis candidates than B-scan ultrasound and electrophysiological testing.
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Affiliation(s)
- Luzia Diegues Silva
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil.,Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, United States of America
| | - Albert Santos
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Flavio Hirai
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Norma Allemann
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil.,Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, United States of America
| | - Adriana Berezovsky
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Solange Rios Salomão
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | | | - Gabriel Andrade
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - André Maia
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Luciene Barbosa de Sousa
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
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Hoffman JJ, Casswell EJ, Shortt AJ. Assault-related severe ocular chemical injury at a London ophthalmic referral hospital: a 3-year retrospective observational study. BMJ Open 2020; 10:e038109. [PMID: 33077563 PMCID: PMC7574930 DOI: 10.1136/bmjopen-2020-038109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To understand the incidence, causes, management and outcomes of intentional (assault) and unintentional severe ocular chemical injuries (SOCI) at an urban tertiary referral centre in the UK. DESIGN Retrospective observational study. SETTING A London tertiary referral ophthalmic centre, Moorfields Eye Hospital. PARTICIPANTS All cases of SOCI presenting between 1 September 2011 and 31 August 2014 were identified. The definition of SOCI was grade 3 or 4 on the Hughes-Roper-Hall classification system. We identified 25 cases (6 in 2011-2012, 8 in 2012-2013, 11 in 2013-2014). Median age was 31.1 years. 23 cases (92%) were male. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the proportion of cases of SOCI caused by assault, per year. Secondary outcome measures included the number of cases of SOCI, injury characteristics and mechanism, initial and long-term management, visual outcome and the need for surgical intervention. RESULTS Between 2011 and 2012, 3/6 cases were due to assault (50%); between 2012 and 2013, 7/8 were due to assault (87.5%); and between 2013 and 2014, 6/11 were due to assault (54.4%). Assault was responsible for 16/25 (64%) cases overall, while 8/25 (32%) cases were work related. The causative agent was known to be alkali in 16/25 (64%), while 10/25 (40%) did not complete the follow-up. The mean number of clock hours of limbal ischaemia was 5.24 (SD 2.97). 17/25 (68%) were Hughes-Roper-Hall grade 3. Surgical intervention occurred in 1/25. The final best-corrected visual acuity was 6/12 or worse in 11/25 (44%) and was counting fingers or worse in 4/25 (16%). CONCLUSIONS Previous studies found that SOCI had a low incidence and that work-related injuries were the most common cause. Our study demonstrates an increasing incidence of SOCI, which may be accounted for by a rise in assault using corrosive substances. A high number of patients did not attend regularly for follow-up and visual outcomes from these injuries are poor.
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Affiliation(s)
- Jeremy John Hoffman
- Accident and Emergency Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- National Institute of Health Research (NIHR) Biomedical Research Centre, University College London Institute of Ophthalmology, London, UK
| | - Edward Joshua Casswell
- Accident and Emergency Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- National Institute of Health Research (NIHR) Biomedical Research Centre, University College London Institute of Ophthalmology, London, UK
| | - Alex John Shortt
- National Institute of Health Research (NIHR) Biomedical Research Centre, University College London Institute of Ophthalmology, London, UK
- Department of External Eye Diseases, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Pathophysiology and management of glaucoma and ocular hypertension related to trauma. Surv Ophthalmol 2020; 65:530-547. [PMID: 32057763 DOI: 10.1016/j.survophthal.2020.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 12/21/2022]
Abstract
Ocular trauma is a significant cause of blindness worldwide, particularly if associated with glaucoma. Direct damage from blunt or penetrating trauma, bleeding, inflammation, lens-related problems, orbital and brain vascular pathologies related to trauma, and chemical injuries may increase intraocular pressure and lead to traumatic glaucoma. Treatment may be as simple as eliminating the underlying cause in some conditions or management can be challenging, depending on the mechanism of damage. If proper management is not undertaken, visual outcomes can be poor. We discuss a broad spectrum of trauma-related mechanisms of intraocular pressure elevation, as well as their management.
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Choi H, Phillips C, Oh JY, Potts L, Reger RL, Prockop DJ, Fulcher S. Absence of Therapeutic Benefit of the Anti-Inflammatory Protein TSG-6 for Corneal Alkali Injury in a Rat Model. Curr Eye Res 2019; 44:873-881. [PMID: 30935217 DOI: 10.1080/02713683.2019.1597893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Purpose: To investigate the therapeutic efficacy of tumor necrosis factor (TNF)-α stimulated gene/protein 6 (TSG-6) in a rat model of corneal alkali injury. Methods: Corneal alkali injury was produced by placing an NaOH-soaked filter paper disk on the central cornea of the right eye of an anesthetized male Lewis (LEW/Crl) rat. Recombinant human TSG-6, or an equal volume of phosphate-buffered saline (PBS), was administered intravenously (IV), by anterior chamber (AC) injection, or as a topical drop. The affected eyes were photographed daily using a dissecting microscope and documented for clinical time course analysis of corneal opacification. Corneal tissue was excised at pre-determined therapeutic endpoints, with subsequent qRT-PCR or histological analyses. Results: The continuous monitoring of corneal alkali injury progression revealed TSG-6 treatments do not show sufficient effectiveness in vivo regardless of IV injection, AC injection, or topical application. Corneal opacification and neovascularization were not diminished, and gene expression was not impacted by these treatments. However, both IV and AC administration of TSG-6 significantly suppressed pro-inflammatory cytokines compared to PBS-treated eyes. Conclusion: We conclude that the therapeutic potential of TSG-6 is insufficient in a rat corneal alkali injury model.
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Affiliation(s)
- Hosoon Choi
- a Department of Basic Research, Central Texas Veterans Research Foundation , Temple , Texas , USA
| | - Casie Phillips
- a Department of Basic Research, Central Texas Veterans Research Foundation , Temple , Texas , USA
| | - Joo Youn Oh
- b Department of Ophthalmology, Seoul National University Hospital , Seoul , Republic of Korea
| | - Luke Potts
- c Department of Ophthalmology and Surgery, Scott and White Eye Institute , Temple , Texas , USA
| | - Roxanne L Reger
- d Institute for Regenerative Medicine, College of Medicine, Texas A&M University , College Station , Texas , USA
| | - Darwin J Prockop
- d Institute for Regenerative Medicine, College of Medicine, Texas A&M University , College Station , Texas , USA
| | - Samuel Fulcher
- e Department of Surgery, Central Texas Veterans Health Care System , Temple , Texas , United States of America
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Genova RM, Meyer KJ, Anderson MG, Harper MM, Pieper AA. Neprilysin inhibition promotes corneal wound healing. Sci Rep 2018; 8:14385. [PMID: 30258206 PMCID: PMC6158251 DOI: 10.1038/s41598-018-32773-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 09/10/2018] [Indexed: 12/11/2022] Open
Abstract
Neprilysin (NEP), an ectoenzyme that modulates inflammation by degrading neuropeptides, was recently identified in the human corneal epithelium. The cornea expresses many NEP substrates, but the function of NEP in homeostatic maintenance and wound healing of the cornea is unknown. We therefore investigated the role of this enzyme under naive and injured conditions using NEP-deficient (NEP-/-) and wild type (WT) control mice. In vivo ocular surface imaging and histological analysis of corneal tissue showed no differences in limbal vasculature or corneal anatomy between naive NEP-/- and WT mice. Histological examination revealed increased corneal innervation in NEP-/- mice. In an alkali burn model of corneal injury, corneal wound healing was significantly accelerated in NEP-/- mice compared to WT controls 3 days after injury. Daily intraperitoneal administration of the NEP inhibitor thiorphan also accelerated corneal wound healing after alkali injury in WT mice. Collectively, our data identify a previously unknown role of NEP in the cornea, in which pharmacologic inhibition of its activity may provide a novel therapeutic option for patients with corneal injury.
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Affiliation(s)
- Rachel M Genova
- Department of Molecular Physiology and Biophysics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Kacie J Meyer
- Department of Molecular Physiology and Biophysics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Iowa City Department of Veterans Affairs Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, USA
- Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Stephen A. Wynn Institute for Vision Research, Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Michael G Anderson
- Department of Molecular Physiology and Biophysics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Iowa City Department of Veterans Affairs Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, USA
- Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Stephen A. Wynn Institute for Vision Research, Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Matthew M Harper
- Iowa City Department of Veterans Affairs Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, USA.
- Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
| | - Andrew A Pieper
- Department of Molecular Physiology and Biophysics, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
- Iowa City Department of Veterans Affairs Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, USA.
- Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
- Stephen A. Wynn Institute for Vision Research, Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
- Harrington Discovery Institute, University Hospital Case Medical Center, Department of Psychiatry, Case Western Reserve University, Geriatric Research Education and Clinical Centers, Louis Stokes Cleveland VAMC, Cleveland, OH, USA.
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Droutsas K, Papaconstantinou D, Georgalas I, Kymionis G, Andreanos K, Stamou E, Mamas N. Equine pericardium for tectonic globe repair. Int Ophthalmol 2017; 39:225-230. [DOI: 10.1007/s10792-017-0788-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 12/11/2017] [Indexed: 12/18/2022]
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Brunette I, Roberts CJ, Vidal F, Harissi-Dagher M, Lachaine J, Sheardown H, Durr GM, Proulx S, Griffith M. Alternatives to eye bank native tissue for corneal stromal replacement. Prog Retin Eye Res 2017; 59:97-130. [DOI: 10.1016/j.preteyeres.2017.04.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 04/15/2017] [Accepted: 04/21/2017] [Indexed: 12/13/2022]
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Choi H, Phillips C, Oh JY, Stock EM, Kim DK, Won JK, Fulcher S. Comprehensive Modeling of Corneal Alkali Injury in the Rat Eye. Curr Eye Res 2017. [DOI: 10.1080/02713683.2017.1317817] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Hosoon Choi
- Department of Basic Research, Central Texas Veterans Research Foundation, Temple, TX, USA
| | - Casie Phillips
- Department of Basic Research, Central Texas Veterans Research Foundation, Temple, TX, USA
| | - Joo Youn Oh
- Department of Ophthalmology, Seoul National University Hospital, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Eileen M. Stock
- Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Perry Point, MD, USA
| | - Dong-Ki Kim
- Institute for Regenerative Medicine, Texas A&M Health Science Center, College Station, TX, USA
| | - Jae-Kyung Won
- Department of Pathology, Seoul National University Hospital, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Samuel Fulcher
- Department of Surgery, Ophthalmology Section, Central Texas Veterans Health Care System, Temple, TX, USA
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Paschalis EI, Zhou C, Lei F, Scott N, Kapoulea V, Robert MC, Vavvas D, Dana R, Chodosh J, Dohlman CH. Mechanisms of Retinal Damage after Ocular Alkali Burns. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 187:1327-1342. [PMID: 28412300 PMCID: PMC5455067 DOI: 10.1016/j.ajpath.2017.02.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 02/06/2017] [Accepted: 02/14/2017] [Indexed: 01/01/2023]
Abstract
Alkali burns to the eye constitute a leading cause of worldwide blindness. In recent case series, corneal transplantation revealed unexpected damage to the retina and optic nerve in chemically burned eyes. We investigated the physical, biochemical, and immunological components of retinal injury after alkali burn and explored a novel neuroprotective regimen suitable for prompt administration in emergency departments. Thus, in vivo pH, oxygen, and oxidation reduction measurements were performed in the anterior and posterior segment of mouse and rabbit eyes using implantable microsensors. Tissue inflammation was assessed by immunohistochemistry and flow cytometry. The experiments confirmed that the retinal damage is not mediated by direct effect of the alkali, which is effectively buffered by the anterior segment. Rather, pH, oxygen, and oxidation reduction changes were restricted to the cornea and the anterior chamber, where they caused profound uveal inflammation and release of proinflammatory cytokines. The latter rapidly diffuse to the posterior segment, triggering retinal damage. Tumor necrosis factor-α was identified as a key proinflammatory mediator of retinal ganglion cell death. Blockade, by either monoclonal antibody or tumor necrosis factor receptor gene knockout, reduced inflammation and retinal ganglion cell loss. Intraocular pressure elevation was not observed in experimental alkali burns. These findings illuminate the mechanism by which alkali burns cause retinal damage and may have importance in designing therapies for retinal protection.
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MESH Headings
- Alkalies
- Animals
- Apoptosis/drug effects
- Apoptosis/physiology
- Burns, Chemical/drug therapy
- Burns, Chemical/etiology
- Burns, Chemical/metabolism
- Burns, Chemical/pathology
- Cornea/immunology
- Corneal Injuries/drug therapy
- Corneal Injuries/etiology
- Corneal Injuries/metabolism
- Corneal Injuries/pathology
- Disease Models, Animal
- Drug Evaluation, Preclinical/methods
- Eye Burns/drug therapy
- Eye Burns/etiology
- Eye Burns/metabolism
- Eye Burns/pathology
- Hydrogen-Ion Concentration
- Infliximab/pharmacology
- Infliximab/therapeutic use
- Mice, Inbred C57BL
- Mice, Knockout
- Neuroprotective Agents/pharmacology
- Neuroprotective Agents/therapeutic use
- Oxidation-Reduction
- Rabbits
- Receptors, Tumor Necrosis Factor, Type I/deficiency
- Receptors, Tumor Necrosis Factor, Type I/genetics
- Receptors, Tumor Necrosis Factor, Type II/deficiency
- Receptors, Tumor Necrosis Factor, Type II/genetics
- Retina/immunology
- Retina/injuries
- Retina/metabolism
- Retina/pathology
- Retinal Ganglion Cells/drug effects
- Retinal Ganglion Cells/pathology
- Sodium Hydroxide
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
- Tumor Necrosis Factor-alpha/metabolism
- Uvea/metabolism
- Uveitis, Anterior/chemically induced
- Uveitis, Anterior/metabolism
- Uveitis, Anterior/pathology
- Uveitis, Anterior/prevention & control
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Affiliation(s)
- Eleftherios I Paschalis
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Boston Keratoprosthesis Laboratory, Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts; Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
| | - Chengxin Zhou
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Boston Keratoprosthesis Laboratory, Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts; Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Fengyang Lei
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Boston Keratoprosthesis Laboratory, Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts; Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Nathan Scott
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Boston Keratoprosthesis Laboratory, Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts; Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Vassiliki Kapoulea
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Boston Keratoprosthesis Laboratory, Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts; Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Marie-Claude Robert
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Boston Keratoprosthesis Laboratory, Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts; Centre Hospitalier de l'Universite de Montreal, Hospital Notre-Dame, Montreal, Quebec, Canada
| | - Demetrios Vavvas
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Angiogenesis Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Reza Dana
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - James Chodosh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Claes H Dohlman
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Boston Keratoprosthesis Laboratory, Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts
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Gu J, Zhai J, Zhou S, Chen J. Boston Keratoprosthesis Outcomes in Severe Ocular Chemical Burns in Southern China: A Retrospective Study. Adv Ther 2016; 33:760-73. [PMID: 27126407 DOI: 10.1007/s12325-016-0330-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The objective of this study was to report clinical outcomes (functional and anatomic) of Boston keratoprosthesis (KPro) after severe chemical burns in Southern China. METHODS Nineteen patients (19 eyes) that sustained severe chemical injuries in Southern China were enrolled in this retrospective study in our hospital between May 2009 and June 2015. KPro implantation in these patients was performed by a single experienced surgeon (Jiaqi Chen). The parameters evaluated in this study included diagnosis, comorbidity, preoperative and postoperative visual acuity (VA), complications, KPro retention, histological and immunohistochemical results of retroprosthetic membrane (RPM) and mucous membrane over the optic cylinder. RESULTS The mean age of the patients was 42.7 ± 11.3 years (range 29-62 years). All patients were male. Of the 19 included eyes, nine had acid burns, and 10 had alkali burns. Ten patients had previously undergone failed penetrating keratoplasty. The mean follow-up time was 41.3 ± 5.5 months (range 36-56 months). Preoperatively, the VA of the patients ranged from hand movement to light perception. Postoperatively, 17 patients (89.4%) achieved at least 20/200 once, and 7 patients (36.8%) achieved at least 20/200 and maintained this acuity until the last follow-up. The initial KPro was retained in 14 (73.6%) eyes and successfully replaced in one eye. Postoperative complications included RPM in 10 eyes, glaucoma in 6 eyes, retinal detachment in 2 eyes, corneal melting in 5 eyes, ischemic optic neuropathy in 1 eye, and overgrowth of the mucous membrane over the optical cylinder in 2 eyes. The histological and immunohistochemical results of the RPM showed granulomatous disorders and mucous membrane over the optic cylinder of conjunctival origin. CONCLUSION KPro surgery can restore useful vision in patients suffering from severe chemical burns. However, postoperative VA declined with the development of complications, and ocular surface disorders caused by the chemical burns were associated with a greater incidence of KPro retention failure. The retention rate was comparable in patients using ipsilateral autologous corneal tissue with allograft corneal tissue. FUNDING Science and Technology Foundation of Guangdong Province of China, Grant Number 2014A020212714.
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Kılıç Müftüoğlu İ, Aydın Akova Y, Çetinkaya A. Clinical Spectrum and Treatment Approaches in Corneal Burns. Turk J Ophthalmol 2015; 45:182-187. [PMID: 27800229 PMCID: PMC5082238 DOI: 10.4274/tjo.99267] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 01/05/2015] [Indexed: 12/01/2022] Open
Abstract
Objectives: To evaluate the clinical findings, treatment modalities and long-term prognosis of chemical and thermal burns of the cornea. Materials and Methods: Twenty-one patients (27 eyes) who were followed at two centers for corneal chemical and thermal burns between 2001 and 2013 were included. Eyes were grouped into four grades according to the severity of burn using Roper-Hall classification. Age, gender, type of burn, follow-up duration, corrected visual acuity before and after treatment, treatment modalities and complications were recorded. Patients received medical treatment or combined surgical treatment including amniotic membrane transplantation (AMT), conjunctivolimbal autograft/allograft (CLAU/CLAL) transplantation, keratolimbal allograft (KLAL) or penetrating keratoplasty (PKP). Results: Patients had a mean age of 27.1±15.5 years (range, 6 months-56 years) and were followed for a mean 63.2±58.6 weeks (4-160 weeks). Significant improvement was achieved with medical treatment alone in patients with grade I (4 eyes) and 2 burns (8 eyes). Patients with grade III burns (11 eyes) underwent CLAU (6 eyes), combined AMT/CLAU (3 eyes), AMT/CLAL (1 eye), or CLAL+PKP (1 eye), while patients with grade IV burns (4 eyes) had keratectomy+CLAL/AMT (1 eye), keratectomy+CLAL+PKP after recurrence with CLAU/AMT (1 eye), CLAU+PKP (1 eye), and AMT/KLAL+PKP (1 eye). All patients except the latter showed ocular surface stabilization with these procedures. Conclusion: Ocular burns cause severe impairment of the ocular surface. It is possible to achieve good results with appropriate medical treatment and surgeries including ocular surface reconstruction.
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Bargagna-Mohan P, Lei L, Thompson A, Shaw C, Kasahara K, Inagaki M, Mohan R. Vimentin Phosphorylation Underlies Myofibroblast Sensitivity to Withaferin A In Vitro and during Corneal Fibrosis. PLoS One 2015; 10:e0133399. [PMID: 26186445 PMCID: PMC4506086 DOI: 10.1371/journal.pone.0133399] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 06/26/2015] [Indexed: 12/21/2022] Open
Abstract
Vimentin is a newly recognized target for corneal fibrosis. Using primary rabbit corneal fibroblasts and myofibroblasts we show that myofibroblasts, unlike fibroblasts, display impaired cell spreading and cell polarization, which is associated with increased levels of soluble serine-38 phosphorylated vimentin (pSer38Vim). This pSer38Vim isoform is inefficiently incorporated into growing vimentin intermediate filaments (IFs) of myofibroblasts during cell spreading, and as a result, myofibroblasts maintain higher soluble pSer38Vim levels compared to fibroblasts. Moreover, the soluble vimentin-targeting small molecule and fibrotic inhibitor withaferin A (WFA) causes a potent blockade of cell spreading selectively in myofibroblasts by targeting soluble pSer38Vim for hyperphosphorylation. WFA treatment does not induce vimentin hyperphosphorylation in fibroblasts. This hyperphosphorylated pSer38Vim species in WFA-treated myofibroblasts becomes complexed with adaptor protein filamin A (FlnA), and these complexes appear as short squiggles when displaced from focal adhesions. The extracellular-signal regulated kinase (ERK) is also phosphorylated (pERK) in response to WFA, but surprisingly, pERK does not enter the nucleus but remains bound to pSer38Vim in cytoplasmic complexes. Using a model of corneal alkali injury, we show that fibrotic corneas of wild type mice possess high levels of pERK, whereas injured corneas of vimentin-deficient (Vim KO) mice that heal with reduced fibrosis have highly reduced pERK expression. Finally, WFA treatment causes a decrease in pERK and pSer38Vim expression in healing corneas of wild type mice. Taken together, these findings identify a hereto-unappreciated role for pSer38Vim as an important determinant of myofibroblast sensitivity to WFA.
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Affiliation(s)
- Paola Bargagna-Mohan
- From the Department of Neuroscience, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Ling Lei
- From the Department of Neuroscience, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Alexis Thompson
- From the Department of Neuroscience, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Camille Shaw
- From the Department of Neuroscience, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Kousuke Kasahara
- Division of Biochemistry, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Masaki Inagaki
- Division of Biochemistry, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Royce Mohan
- From the Department of Neuroscience, University of Connecticut Health Center, Farmington, Connecticut, United States of America
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Mesenchymal stem cells improve healing of the cornea after alkali injury. Graefes Arch Clin Exp Ophthalmol 2015; 253:1121-35. [PMID: 26002143 DOI: 10.1007/s00417-015-3042-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 04/16/2015] [Accepted: 04/29/2015] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To evaluate the efficacy of mesenchymal stem cells (MSCs) to ameliorate the consequences of corneal alkali injuries. METHODS Corneal alkali injuries were created in 30 rabbit eyes. The MSC group (n = 15) were treated with intrastromal and subconjunctival injections of phosphate-buffered saline (PBS) containing 2 × 10(6) MSCs and topical application. The control group (n = 15) was treated with PBS by the same applications forms. Drops of standard treatment (ascorbate 10 %, citrate 10 %, tobramycin, dexamethasone, Cyclogyl) were instilled for 2 weeks. Rabbits underwent slit-lamp examination, fluorescein staining, photography, and were evaluated for corneal neovascularization, opacification, and epithelial defects. Tear secretion and IOP were also evaluated. Furthermore, the concentration of Serumglutamic-pyruvic transaminase (SGPT) and vascular endothelial factor (VEGF) were measured. Immunohistochemistry was also performed for a-SMA and Ki-67. RESULTS Eyes treated with MSCs showed better recovery. The mean neovascularized area was significantly smaller in the MSC group (p < 0.05). A significant difference in the degree of corneal opacification and re-epithelialization was also observed, as well as the IOP at 21 and 28 posttraumatic days (p < 0.05). Histology showed that MSCs resulted in almost normal architecture of eye tissues. After the MSCs infusion, SGPT and VEGF levels in cornea were significantly reduced. Immunohistochemistry demonstrated a reduction of a-SMA in the MSC group with higher mitotic-regenerative activity with the presence of Ki67. CONCLUSIONS Our study represents a first step in understanding the possibilities of the MSC approach to treatment of alkali injuries of the cornea and shows that such an approach improves clinical outcomes and leads to better prognosis.
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Boutin T, Jabbour S, Harissi-Dagher M. Improving management and outcomes of the Boston type 1 keratoprosthesis: lessons learned from available evidence. EXPERT REVIEW OF OPHTHALMOLOGY 2015. [DOI: 10.1586/17469899.2015.1023294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Yang QH, Chen B, Wang LQ, Peng GH, Li ZH, Huang YF. Evaluation of immersion 20 MHz B-scan ultrasonography in observing lens in the alkali burn eyes. Int J Ophthalmol 2014; 7:632-7. [PMID: 25161933 DOI: 10.3980/j.issn.2222-3959.2014.04.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 05/04/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To evaluate the accuracy of 20 MHz immersion B-scan ultrasonography in observing lens and to investigate the value of this noninvasive preoperative diagnosis method in alkali burn eyes. METHODS It was a comparative study. Fifty-six cases (56 eyes) of alkali burn eyes were examined by ultrasound biomicroscopy (UBM) and immersion 20 MHz B-scan ultrasonography from June 2011 to April 2013, the images were analyzed, and the ultrasonographic diagnosis compared with the operation results. RESULTS In 56 alkali burn eyes examined by UBM, the lens were not detected in 16 eyes; the IOL could be detected in 2 eyes; the anterior lens capsule surface or/and the front lens could be detected in 18 eyes, and lens opacification in 3 eyes of them; suspected abnormal lens were detected in the other 20 eyes. In all the same eyes examined by immersion 20 MHz B-scan ultrasonography, the lens were not detected in 16 eyes; the IOL could be detected in 2 eyes; 24 abnormal lens (opacity, lens expansion, shrinkage) and 14 normal lens were found. Compared with the intraoperative findings, the diagnostic accordance rate of the immersion 20 MHz B-scan appearance of lens was 100% (56/56), which was significantly higher than examined by UBM 57.14% (32/56) (χ(2)=30.55, P=0.0000). CONCLUSION Immersion 20 MHz B-scan ultrasonography can observe the lens accurately in alkali burn eyes. It has important clinical value to combine with UBM in eyes of alkali burn.
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Affiliation(s)
- Qing-Hua Yang
- Department of Ophthalmology, Chinese People's Liberation Army General Hospital, Beijing 100853,China
| | - Bing Chen
- Department of Ophthalmology, Chinese People's Liberation Army General Hospital, Beijing 100853,China
| | - Li-Qiang Wang
- Department of Ophthalmology, Chinese People's Liberation Army General Hospital, Beijing 100853,China
| | - Guang-Hua Peng
- Department of Ophthalmology, Chinese People's Liberation Army General Hospital, Beijing 100853,China
| | - Zhao-Hui Li
- Department of Ophthalmology, Chinese People's Liberation Army General Hospital, Beijing 100853,China
| | - Yi-Fei Huang
- Department of Ophthalmology, Chinese People's Liberation Army General Hospital, Beijing 100853,China
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Abstract
Eye injuries are common in warfare with an incidence of approximately 10%. They carry a high morbidity, as they can determine an injured person’s future independence and employability. The majority are a combination of primary and secondary blast mechanisms, though tertiary and quaternary types are common. There is some evidence of quinary types from toxic elements from the explosion. Eye protection significantly reduces the incidence and severity of ballistic eye injury but does not eliminate it. Thermal ocular burns are relatively common in warfare. The treatment goal is to minimise limbal stem cell damage. Human amniotic membrane can be used to promote this. Retinal and optic nerve injury following closed eye trauma are currently untreatable, but neuroprotective and neuroregenerative agents are being developed to improve outcomes. Sensory substitution of the sense of touch for sight can help orientate blinded individual in their surroundings. Ophthalmology has a major impact on the lives of the war wounded.
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Affiliation(s)
- Robert AH Scott
- Royal Centre for Defence Medicine, New Queen Elizabeth Hospital, Birmingham, UK
- Section of Neurotrauma and Neurodegeneration, School of Clinical and Experimental Medicine, University of Birmingham, UK
- Birmingham and Midland Eye Centre, Birmingham, UK
| | - Richard J Blanch
- Royal Centre for Defence Medicine, New Queen Elizabeth Hospital, Birmingham, UK
- Section of Neurotrauma and Neurodegeneration, School of Clinical and Experimental Medicine, University of Birmingham, UK
| | - Peter J Morgan-Warren
- Royal Centre for Defence Medicine, New Queen Elizabeth Hospital, Birmingham, UK
- Section of Neurotrauma and Neurodegeneration, School of Clinical and Experimental Medicine, University of Birmingham, UK
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Samarawickrama C, Leaney J, Watson S. Severe alkali burns from beer line cleaners warrant mandatory safety guidelines. Med J Aust 2014; 201:90. [DOI: 10.5694/mja13.00064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 06/02/2014] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Stephanie Watson
- Sydney Eye Hospital, Sydney, NSW
- Save Sight Institute, Sydney, NSW
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Busse C, Hartley C, Kafarnik C, Pivetta M. Ocular alkaline injury in four dogs - presentation, treatment, and follow-up - a case series. Vet Ophthalmol 2014; 18:127-34. [DOI: 10.1111/vop.12171] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Claudia Busse
- Comparative Ophthalmology unit; Animal Health Trust; Newmarket UK
| | - Claudia Hartley
- Comparative Ophthalmology unit; Animal Health Trust; Newmarket UK
| | - Christiane Kafarnik
- Comparative Ophthalmology unit; Animal Health Trust; Newmarket UK
- Ophthalmology Service; Davies Veterinary Specialists; Highham Gobion UK
| | - Mauro Pivetta
- Diagnostic Imaging unit; Animal Health Trust; Newmarket UK
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Löllgen RM, Lu VHJ, Middlebrook L, Gunja N, McCaskill M. Party bubbles: friend or foe? A conjunctival burn in a paediatric emergency department. Emerg Med Australas 2014; 26:314-5. [PMID: 24712444 DOI: 10.1111/1742-6723.12228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ruth M Löllgen
- Emergency Department, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Magalhães FP, Hirai FE, de Sousa LB, de Oliveira LA. Boston type 1 keratoprosthesis outcomes in ocular burns. Acta Ophthalmol 2013; 91:e432-6. [PMID: 23406295 DOI: 10.1111/aos.12083] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To report the outcomes of Boston type I keratoprosthesis (BKPro) in the management of ocular burn injuries. METHODS This was a prospective study including all cases of BKPro implantation for ocular burns at the External Diseases and Cornea Service of the Federal University of São Paulo, between February 2008 and February 2010. Ten patients (10 eyes) were enrolled. Procedures performed to manage ocular injury were identified, and data were collected regarding patients' ocular history, surgical procedure(s) performed, and postoperative outcomes, including visual acuity, retention, complications and required surgical procedures. RESULTS A total of 11 Type 1 BKPro were implanted in 10 eyes of 10 patients. The mean follow-up period was 25.7 ± 10.8 months. Preoperative best-corrected visual acuity (BCVA) ranged from count fingers to light perception. Postoperative BCVA was better than 20/200 in 90% of the patients and better than 20/60 in 60% of the patients. The overall BKPro retention rate was 90%. The most common complications were retroprosthetic membrane formation (50%) and persistent corneal epithelial defect evolving to corneal melting (40%). Patients who underwent ocular surface procedures such as limbal transplantation prior to BKPRo implantation had a lower incidence of corneal melting/thinning (p = 0.07), although this was not statistically significant. CONCLUSION The anatomical and functional results identified in this study support the use of BKPro in managing bilateral limbal stem cell deficiency secondary to ocular burns.
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Thomas PA, A Teresa P, Theodore J, Geraldine P. PCR for the molecular diagnosis of mycotic keratitis. Expert Rev Mol Diagn 2013; 12:703-18. [PMID: 23153238 DOI: 10.1586/erm.12.65] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mycotic keratitis, an infection of the cornea caused by fungi, is a medical emergency, with patients presenting with considerable pain and distress. For effective management of the condition, a specific diagnosis must be made rapidly to permit early initiation of antifungal therapy. Currently, direct microscopic examination and culture of corneal material constitute the 'gold standard' for diagnosis. However, rapid, sensitive yet specific tests are needed to detect a small number of, or nonviable, fungi. PCR has many potential advantages when used as a diagnostic aid for mycotic keratitis; the present review covers these advantages, and possible limitations. An expert assessment is also made of studies that have used PCR for the diagnosis of mycotic keratitis. The review concludes with a Five-year view of the potential impact of PCR in management of mycotic keratitis.
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Affiliation(s)
- Philip A Thomas
- Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirapalli 620001, India.
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Abstract
PURPOSE To describe the clinical features and treatment outcome of eye injuries sustained as a result of contact with artificial snow spray ("party foam"/"silly string") during 2 consecutive Israeli Independence Day celebrations. DESIGN Retrospective, multicenter, consecutive case series. SETTING Institutional. INTERVENTION/STUDY POPULATION: All patients who presented to 2 ophthalmology emergency services in 2007 and in 2008 with eye injury caused by contact with the foam. The medical records of the foam-induced eye injury cases were retrieved and analyzed. Data on injury type, comprehensive ophthalmic examination, and time to resolution were collected and analyzed. MAIN OUTCOME MEASURES The assessed variables included the number of cases per year, injury type, visual acuity, treatment, and outcome. RESULTS A total of 96 patients (135 eyes) had suffered from foam-induced ocular chemical injuries during the 2 celebrations. Sex and laterality were evenly distributed in the study population. The mean ± SD age was 12.8 ± 2.14 years (range, 7-17 years). All patients suffered from chemical conjunctivitis (100%) and superficial punctate keratopathy (79%), corneal erosion (27%), and conjunctival erosion (5%). More patients were seen during 2007 compared with 2008 [85 (117 eyes) and 11 (18 eyes), respectively]. This reduction was directly attributable to increased public awareness because of media coverage (newspapers, radio, and national TV). CONCLUSIONS Sprayed foam used in parties and public celebrations can cause mild-to-severe ocular surface injuries. Increased public awareness will inevitably reduce the use of this dangerous agent, but warnings need to be repeated yearly in the national media.
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Abstract
Purpose: To report the indications, outcomes, and complications of the Boston type I keratoprosthesis (KPro) from the first Jordanian study on the subject. Materials and Methods: A retrospective chart review was conducted on 20 eyes of 19 consecutive patients who had Boston type I KPro implantation at King Abdullah University Hospital. Surgeries were performed by the same surgeon (WS) from November 2007 to March 2010. Data collected included age, sex, primary indication, number of previous grafts, preoperative comorbidities, visual acuity before and after surgery, and complications. Results: The mean age of the participants was 51.7±19.9 years (range: 10–80 years). The mean follow-up was 18.1±9.5 months (range: 3–6 months). The most common primary corneal pathology was vascularized corneal opacity (40%). Best corrected visual acuity (BCVA) improved significantly in 85% of eyes; 65% had a BCVA of 20/200 or better and 25% had a BCVA of 20/50 or better. The most frequent complication was retroprosthesis membrane (RPM) formation, which occurred in 45% of eyes. Two eyes (10%) had implant extrusion and required further surgery. Conclusion: Boston Kpro offers a reasonably safe and effective solution for patients with corneal blindness in whom the prognosis for natural corneal grafting is poor.
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Affiliation(s)
- Wisam A Shihadeh
- Department of Ophthalmology, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan
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Sharma N, Singh D, Sobti A, Agarwal P, Velpandian T, Titiyal JS, Ghose S. Course and outcome of accidental sodium hydroxide ocular injury. Am J Ophthalmol 2012; 154:740-749.e2. [PMID: 22840487 DOI: 10.1016/j.ajo.2012.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 04/22/2012] [Accepted: 04/24/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the course and outcome of patients with accidental ocular alkali burns. DESIGN Prospective, interventional case series. METHODS Study of a cohort of 16 patients (31 eyes) who sustained concomitant accidental sodium hydroxide ocular burns and received appropriate treatment at a tertiary care eye hospital in India. The patients were followed up for 1 year, and parameters including best-corrected visual acuity, epithelial defect area, conjunctival and limbal involvement, and injury-related complications were evaluated. RESULTS Severe sodium hydroxide exposure of a mean duration of 12 ± 2.5 minutes and delay in specialist eye care caused moderate to severe injury (grade II, 19% [n = 6]; grade III, 19% [n = 6]; grade IV, 10% [n = 3]; and grade VI, 52% [n = 16]). Median best-corrected visual acuity at presentation was 1.0 logarithm of the minimal angle of resolution (logMAR) units (range, 0.3 to 1.9 logMAR units), and at 1 year, it was 1.0 logMAR units (range, 0 to 1.9 logMAR units; P = .121). The median initial epithelial defect was 100 mm(2) (range, 18 to 121 mm(2)), which healed in all eyes by 3.5 months. Initial median limbal involvement was 12 clock hours (range, 3 to 12 clock hours), resulting in a residual limbal stem cell deficiency of 6 clock hours (range, 0 to 12 clock hours) at 1 year. Most common complications were glaucoma and cataract. Corneal ulcers developed in 2 eyes, and keratolimbal graft was performed in 1 patient. Grade VI injuries had significantly worse outcome than the lower-grade injuries. CONCLUSIONS The course and outcome of ocular alkali burns depends on effective first aid (including a thorough eyewash), age, initial grade of injury, response to treatment, prevention of secondary infection, and control of glaucoma. Despite appropriate treatment, these eyes responded poorly and carried a guarded visual prognosis.
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Abstract
BACKGROUND Ocular surface burns can be caused by chemicals (alkalis and acids) or by direct heat. Amniotic membrane transplantation (AMT) performed in the acute phase (day 0 to day 7) of an ocular surface burn is reported to relieve pain, accelerate healing and reduce scarring and blood vessel formation. The surgery involves applying a patch of amniotic membrane (AM) over the entire ocular surface up to the eyelid margins. OBJECTIVES To assess the effects of AMT on the eyes of people having suffered acute ocular surface burns. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 6), MEDLINE (January 1946 to June 2012), EMBASE (January 1980 to June 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to June 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 11 June 2012. SELECTION CRITERIA We included randomised trials of medical therapy and AMT applied in the first seven days after an ocular surface burn compared to medical therapy alone. DATA COLLECTION AND ANALYSIS Two authors independently assessed the risk of bias of included studies and extracted relevant data. We contacted trial investigators for missing information. We summarised data using risk ratios (RRs) and mean differences (MDs) as appropriate. MAIN RESULTS We included one RCT of 100 participants with ocular burns that were randomised to treatment with AMT and medical therapy or medical therapy alone. A subset of patients (n = 68) who were treated within the first seven days of the injury met the inclusion criteria and were included in the analysis. The remaining 32 eyes were excluded. The included subset consisted of 36 moderate (Dua classification II-III) and 32 severe (Dua classification IV-VI) ocular burns from alkali, acid and thermal injuries. In the moderate category, 13/20 control eyes and 14/16 treatment eyes had complete epithelialisation by 21 days. The RR of failure of epithelialisation by day 21 was 0.18 in the treatment group (95% confidence interval (CI) 0.02 to 1.31; P = 0.09). Mean LogMAR final visual acuities were 0.06 (standard deviation (SD) 0.10) in the treatment group and 0.38 (SD 0.52) in the control group, representing a MD of -0.32 (95% CI -0.05 to -0.59). In the severe category, 1/17 treatment and 1/15 control eyes were epithelialised by day 21. The RR of failure of epithelialisation in the treatment group was 1.01 (95% CI 0.84 to 1.21; P = 0.93). Final visual acuity was 1.77 (SD 1.31) in the treated eyes and 1.64 (SD 1.48) in the control group (MD 0.13; 95% CI -0.88 to 1.14). The risks of performance and detection biases were high, because treating personnel and outcome assessors could not be masked to treatment. There was also a high risk of bias in the visual outcomes of the moderate category, since mean visual acuity was significantly worse at presentation in the control eyes. This reduced confidence in the study findings. AUTHORS' CONCLUSIONS Conclusive evidence supporting the treatment of acute ocular surface burns with AMT is lacking. Heterogeneity of disease presentation, variations in treatment, undefined criteria for treatment success and failure, and non-uniform outcome measures are some of the factors complicating the search for clear evidence regarding this treatment.
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Affiliation(s)
- Gerry Clare
- Ophthalmology and Visual Sciences, University of Nottingham, Nottingham, UK.
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Chen RN, Lee LW, Chen LC, Ho HO, Lui SC, Sheu MT, Su CH. Wound-healing effect of micronized sacchachitin (mSC) nanogel on corneal epithelium. Int J Nanomedicine 2012; 7:4697-706. [PMID: 22956870 PMCID: PMC3431972 DOI: 10.2147/ijn.s34530] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The extraction residue of the Ganoderma fruiting body, named sacchachitin, has been demonstrated to have the potential to enhance cutaneous wound healing by inducing cell proliferation. In this study, a nanogel formed from micronized sacchachitin (mSC) was investigated for the potential treatment of superficial chemical corneal burns. Reportedly, mSC has been produced successfully and its chemical properties confirmed, and physical and rheological properties characterized. An in vitro cell proliferation study has revealed that at the concentrations of 200, 300, and 400 μg/mL, mSC nanogel significantly increased Statens Seruminstitut rabbit corneal (SIRC) cell proliferation after 24 hours of incubation. In cell migration assay, migration of SIRC cell to wound closure was observed after 24 hours of incubation with the addition of 200 μg/mL mSC of nanogel. In an animal study, acceleration of corneal wound healing was probably due to the inhibition of proteolysis. In conclusion, the findings of this study substantiate the potential application of sacchachitin in the form of mSC nanogel for the treatment of superficial corneal injuries.
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Affiliation(s)
- Ray-Neng Chen
- Department of Cosmetic Science and Management, Mackay Medicine, Nursing and Management College, Taipei, Republic of China
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Crawford AZ, McGhee CNJ. Management of limbal stem cell deficiency in severe ocular chemical burns. Clin Exp Ophthalmol 2012; 40:227-9. [PMID: 22490111 DOI: 10.1111/j.1442-9071.2012.02775.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
PURPOSE The purpose of this study was to evaluate the incidence of glaucoma in eyes with severe chemical burn, before and after keratoprosthesis. METHODS A retrospective chart review of 28 eyes of 23 patients with severe ocular chemical burns who had undergone Boston Keratoprosthesis (BKPro) surgery at the Massachusetts Eye and Ear Infirmary, between 1990 and 2010. The incidence and severity of the outcome of glaucoma, preoperatively and postoperatively, were reviewed. Related issues, such as type of chemical burn; visual acuity (VA); device retention rate; number and nature of previous, concomitant, and subsequent procedures; and incidence of other postoperative complications, were reviewed for a median follow-up time of 57 months. RESULTS The number of eyes with a preoperative history or signs of glaucoma was 21, 9 of which had glaucoma progression after BKPro implantation. In addition, 2 more eyes developed glaucoma postoperatively. Preoperative vision was counting fingers or worse in all eyes. Best-corrected postoperative VA ranged from no light perception to 20/20. Seventeen eyes (61%) achieved 20/60 or better VA at some point during their follow-up, but only 9 (32%) maintained 20/60 at the last follow-up. Of the 28 eyes, 6 had the BKPro replaced once and 1 had it replaced twice. Superimposed, 8 of the most severely burned patients developed retinal detachment postoperatively. CONCLUSIONS Glaucoma is very common in eyes with severe chemical burns. A keratoprosthesis can rehabilitate vision, but postoperative glaucoma can be difficult to manage.
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Clare G, Suleman H, Bunce C, Dua H. Amniotic membrane transplantation for acute ocular burns. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [DOI: 10.1002/14651858.cd009379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Liu H, Wang K, Wang Q, Sun S, Ji Y. A modified surgical technique in the management of eyelid burns: a case series. J Med Case Rep 2011; 5:373. [PMID: 21843322 PMCID: PMC3212825 DOI: 10.1186/1752-1947-5-373] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Accepted: 08/15/2011] [Indexed: 11/29/2022] Open
Abstract
Introduction Contractures, ectropion and scarring, the most common sequelae of skin grafts after eyelid burn injuries, can result in corneal exposure, corneal ulceration and even blindness. Split-thickness or full-thickness skin grafts are commonly used for the treatment of acute eyelid burns. Plasma exudation and infection are common early complications of eyelid burns, which decrease the success rate of grafts. Case presentation We present the cases of eight patients, two Chinese women and six Chinese men. The first Chinese woman was 36 years old, with 70% body surface area second or third degree flame burn injuries involving her eyelids on both sides. The other Chinese woman was 28 years old, with sulfuric acid burns on her face and third degree burn on her eyelids. The six Chinese men were aged 21, 31, 38, 42, 44, and 55 years, respectively. The 38-year-old patient was transferred from the ER with 80% body surface area second or third degree flame burn injuries and third degree burn injuries to his eyelids. The other five men were all patients with flame burn injuries, with 7% to 10% body surface area third degree burns and eyelids involved. All patients were treated with a modified surgical procedure consisting of separation and loosening of the musculus orbicularis oculi between tarsal plate and septum orbital, followed by grafting a large full-thickness skin graft in three days after burn injury. The use of our modified surgical procedure resulted in 100% successful eyelid grafting on first attempt, and all our patients were in good condition at six-month follow-up. Conclusions This new surgical technique is highly successful in treating eyelid burn injuries, especially flame burn injuries of the eyelid.
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Affiliation(s)
- Haiying Liu
- Qingdao Central Hospital, Qingdao, Shandong Province 266042, PR China.
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Parikh T, Eisner N, Venugopalan P, Yang Q, Lam BL, Bhattacharya SK. Proteomic analyses of corneal tissue subjected to alkali exposure. Invest Ophthalmol Vis Sci 2011; 52:1819-31. [PMID: 20861482 PMCID: PMC3101685 DOI: 10.1167/iovs.10-5472] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 08/10/2010] [Accepted: 08/25/2010] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine whether exposure to alkaline chemicals results in predictable changes in corneal protein profile. To determine whether protein profile changes are indicative of severity and duration of alkali exposure. METHODS Enucleated bovine and porcine (n = 59 each) eyes were used for exposure to sodium, ammonium, and calcium hydroxide, respectively. Eyes were subjected to fluorescein staining, 5-bromo-2'-deoxy-uridine (BrdU) labeling. Excised cornea was subjected to protein extraction, spectrophotometric determination of protein amount, dynamic light scattering and SDS-PAGE profiling, mass spectrometric protein identification, and iTRAQ-labeled quantification. Select identified proteins were subjected to Western blot and immunohistochemical analyses. RESULTS Alkali exposure resulted in lower protein extractability from corneal tissue. Elevated aggregate formation was found with strong alkali exposure (sodium hydroxide>ammonium, calcium hydroxide), even with a short duration of exposure compared with controls. The protein yield after exposure varied as a function of postexposure time. Protein profiles changed because of alkali exposure. Concentration and strength of the alkali affected the profile change significantly. Mass spectrometry identified 15 proteins from different bands with relative quantification. Plexin D1 was identified for the first time in the cornea at a protein level that was further confirmed by Western blot and immunohistochemical analyses. CONCLUSIONS Exposure to alkaline chemicals results in predictable and reproducible changes in corneal protein profile. Stronger alkali, longer durations, or both, of exposure resulted in lower yields and significant protein profile changes compared with controls.
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Affiliation(s)
- Toral Parikh
- From the Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Natalie Eisner
- From the Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | | | | | - Byron L. Lam
- From the Bascom Palmer Eye Institute, University of Miami, Miami, Florida
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Traish AS, Chodosh J. Expanding Application of the Boston Type I Keratoprosthesis Due to Advances in Design and Improved Post-operative Therapeutic Strategies. Semin Ophthalmol 2010; 25:239-43. [DOI: 10.3109/08820538.2010.518895] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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