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Lai HY, Lai HC, Kuo MT, Tsai YY, Lai IC. Corneal thickness and endothelial change after use of ocular hypotensive agents. Kaohsiung J Med Sci 2024. [PMID: 38804102 DOI: 10.1002/kjm2.12840] [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: 11/28/2023] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 05/29/2024] Open
Abstract
Corneal transplantation can restore visual function when visual impairment is caused by a corneal disease. However, this treatment is associated with the scarcity of cornea donors. The suitability of corneal donation from patients with glaucoma using ocular hypotensive agents (OHAs) is controversial. This study aimed to elucidate changes in corneal thickness, corneal endothelial cell density, and corneal endothelial cell hexagonality after OHA use in patients with primary open-angle glaucoma. We retrospectively reviewed the data of 53 glaucoma suspect eyes without OHA use and 106 primary open-angle glaucoma eyes under OHA use. All participants underwent corneal parameter assessment using SP-3000P (Topcon Corp., Tokyo, Japan) at the time of diagnosis and the final visit. The OHA dose and timing of use were recorded. The ocular hypotensive agents score (OHAS) was determined based on the number, formula, frequency, and duration of OHA use. Baseline data showed no significant differences between the two groups with and without OHA use. At the final visit, the OHA-treated group showed significantly lower corneal thickness and corneal endothelial cell density than those of the control group. A weak positive correlation between the OHAS and changes in corneal endothelial cell hexagonality was noted. However, no correlation was observed between the OHAS and changes in corneal thickness or endothelial cell density. In conclusion, patients with glaucoma and using OHAs should undergo the corneal structural properties examinations before donation to ensure the quality of donor cornea.
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Affiliation(s)
- Hung-Yin Lai
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Hung-Chi Lai
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Tse Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ing-Chou Lai
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Ophthalmology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
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2
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Kate A, Basu S. Corneal blindness in the developing world: The role of prevention strategies. F1000Res 2024; 12:1309. [PMID: 38618022 PMCID: PMC11009612 DOI: 10.12688/f1000research.141037.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/16/2024] Open
Abstract
Corneal blindness is an important contributor to the burden of global blindness and has a greater prevalence in low-income countries of the developing world where resources and infrastructure are limited. The causes of corneal blindness too are different from high-income countries and include infectious keratitis, ocular trauma, and xerophthalmia. Persons with these indications tend to have unfavourable outcomes after corneal transplantation, limiting their chances of benefitting from this sight-saving procedure. However, most causes of corneal blindness in the developing world are preventable. This highlights the importance of understanding the unique challenges in these regions and the need for targeted interventions. This article discusses various prevention strategies, including primordial, primary, and secondary prevention, aimed at reducing the burden of corneal blindness in low-income countries. These include capacity building, training, and awareness campaigns to reduce the risk factors of ocular trauma, infectious keratitis, and to improve access to first aid. It is also important to promote safe eye practices and tackle nutritional deficiencies through public health interventions and policy changes. Providing the required training to general ophthalmologists in the management of basic corneal surgeries and diseases and enhancing the accessibility of eye care services in rural areas will ensure early treatment and prevent sequelae. Current treatment modalities belong to the tertiary level of prevention and are largely limited to corneal transplantation. In developing nations, there is a scarcity of donor corneal tissue necessitating an urgent expansion of eye banking services. Alternative approaches to corneal transplantation such as 3D printed corneas, cultured stem cells, and biomaterials should also be explored to meet this demand. Thus, there is a need for collaborative efforts between healthcare professionals, policymakers, and communities to implement effective prevention strategies and reduce the prevalence of corneal blindness in the developing world.
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Affiliation(s)
- Anahita Kate
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Sayan Basu
- Centre for Ocular Regeneration (CORE), Prof. Brien Holden Eye Research Centre, Champalimaud Translational Centre for Eye Research, LV Prasad Eye Institute, Hyderabad, Telangana, India
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
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3
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Hadrian K, Cursiefen C. The role of lymphatic vessels in corneal fluid homeostasis and wound healing. J Ophthalmic Inflamm Infect 2024; 14:4. [PMID: 38252213 PMCID: PMC10803698 DOI: 10.1186/s12348-023-00381-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/16/2023] [Indexed: 01/23/2024] Open
Abstract
The cornea, essential for vision, is normally avascular, transparent, and immune-privileged. However, injuries or infections can break this privilege, allowing blood and lymphatic vessels to invade, potentially impairing vision and causing immune responses. This review explores the complex role of corneal lymphangiogenesis in health and diseases. Traditionally, the cornea was considered devoid of lymphatic vessels, a phenomenon known as "corneal (lymph)angiogenic privilege." Recent advances in molecular markers have enabled the discovery of lymphatic vessels in the cornea under certain conditions. Several molecules contribute to preserving both immune and lymphangiogenic privileges. Lymphangiogenesis, primarily driven by VEGF family members, can occur directly or indirectly through macrophage recruitment. Corneal injuries and diseases disrupt these privileges, reducing graft survival rates following transplantation. However, modulation of lymphangiogenesis offers potential interventions to promote graft survival and expedite corneal edema resolution.This review underscores the intricate interplay between lymphatic vessels, immune privilege, and corneal pathologies, highlighting innovative therapeutic possibilities. Future investigations should explore the modulation of lymphangiogenesis to enhance corneal health and transparency, as well as corneal graft survival, and this benefits patients with various corneal conditions.
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Affiliation(s)
- Karina Hadrian
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine (CMMC), University of Cologne, Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, University of Cologne, Cologne, Germany.
- Center for Molecular Medicine (CMMC), University of Cologne, Cologne, Germany.
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.
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Xue Q, Hu H, Wang W, Li Q, Ma L, Ma J, Ye C, Yang H, Zhang B. Liquid-Phase Integrated 3D Printed Biological Lenses for Lamellar Corneal Substitute. Adv Healthc Mater 2023; 12:e2300600. [PMID: 37543431 DOI: 10.1002/adhm.202300600] [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: 02/24/2023] [Revised: 06/25/2023] [Indexed: 08/07/2023]
Abstract
Compared to traditional biological lenses that are used to correct optical systems, such as contact lenses, vision correction surgery, and corneal and lens replacement, 3D printed biological lenses offer a customizable solutions. However, the layer-by-layer principle of 3D printing leads to a staircase effect, which cannot meet the critical requirements of surface quality during the manufacturing process of biological lens, particularly with soft materials. Here, a liquid-phase printing strategy and a surface tension-dependent (STD) post-processing method are proposed that use the surface tension of the liquid to reconstruct the air-liquid interface. This eliminates the staircase effect caused by the stacking of units during 3D printing. The coordinates of integrated printing enable high-accuracy shape control of soft materials. Using a typical biological lens as an example, this method improves the surface quality of printed lamellar corneal substitutes (LCS) from ±20.0 to ±0.2 µm and reduces thickness feature size from ±500 to ±150 µm. This approach can match human cornea curvature and thickness, achieving ≈85% visible light transmittance and biocompatibility. Liquid-phase 3D printed biological lenses outperform molded ones in animal experiments. This method can advance artificial biological lens printing research and holds promise for future clinical applications.
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Affiliation(s)
- Qian Xue
- State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, 310058, China
| | - Hanyi Hu
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, 310016, China
- School of Medicine, Zhejiang University, Hangzhou, 310058, China
| | - Weiwei Wang
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, 310016, China
- School of Medicine, Zhejiang University, Hangzhou, 310058, China
| | - Qi Li
- State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, 310058, China
| | - Liang Ma
- State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, 310058, China
| | - Jien Ma
- College of Electrical Engineering, Zhejiang University, Hangzhou, 310058, China
| | - Cathy Ye
- Institute of Biomedical Engineering, University of Oxford, Oxford, OX3 7DQ, UK
| | - Huayong Yang
- State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, 310058, China
| | - Bin Zhang
- State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, 310058, China
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5
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Sun D, Shi WY, Dou SQ. Single-cell RNA sequencing in cornea research: Insights into limbal stem cells and their niche regulation. World J Stem Cells 2023; 15:466-475. [PMID: 37342216 PMCID: PMC10277966 DOI: 10.4252/wjsc.v15.i5.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/28/2023] [Accepted: 04/17/2023] [Indexed: 05/26/2023] Open
Abstract
The corneal epithelium is composed of stratified squamous epithelial cells on the outer surface of the eye, which acts as a protective barrier and is critical for clear and stable vision. Its continuous renewal or wound healing depends on the proliferation and differentiation of limbal stem cells (LSCs), a cell population that resides at the limbus in a highly regulated niche. Dysfunction of LSCs or their niche can cause limbal stem cell deficiency, a disease that is manifested by failed epithelial wound healing or even blindness. Nevertheless, compared to stem cells in other tissues, little is known about the LSCs and their niche. With the advent of single-cell RNA sequencing, our understanding of LSC characteristics and their microenvironment has grown considerably. In this review, we summarized the current findings from single-cell studies in the field of cornea research and focused on important advancements driven by this technology, including the heterogeneity of the LSC population, novel LSC markers and regulation of the LSC niche, which will provide a reference for clinical issues such as corneal epithelial wound healing, ocular surface reconstruction and interventions for related diseases.
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Affiliation(s)
- Di Sun
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao 266000, Shandong Province, China
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266000, Shandong Province, China
| | - Wei-Yun Shi
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao 266000, Shandong Province, China
- Eye Hospital of Shandong First Medical University, Jinan 250000, Shandong Province, China
- School of Ophthalmology, Shandong First Medical University, Qingdao 266000, Shandong Province, China
| | - Sheng-Qian Dou
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao 266000, Shandong Province, China
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266000, Shandong Province, China
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The role of the osmosensitive transcription factor NFAT5 in corneal edema resorption after injury. Exp Mol Med 2023; 55:565-573. [PMID: 36869067 PMCID: PMC10073147 DOI: 10.1038/s12276-023-00954-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 03/05/2023] Open
Abstract
The osmosensitive transcription factor nuclear factor of activated T cells 5 (NFAT5; or tonicity-responsive enhancer binding protein; TonEBP) plays a key role in macrophage-driven regulation of cutaneous salt and water balance. In the immune-privileged and transparent cornea, disturbances in fluid balance and pathological edema result in corneal transparency loss, which is one of the main causes of blindness worldwide. The role of NFAT5 in the cornea has not yet been investigated. We analyzed the expression and function of NFAT5 in naive corneas and in an established mouse model of perforating corneal injury (PCI), which causes acute corneal edema and transparency loss. In uninjured corneas, NFAT5 was mainly expressed in corneal fibroblasts. In contrast, after PCI, NFAT5 expression was highly upregulated in recruited corneal macrophages. NFAT5 deficiency did not alter corneal thickness in steady state; however, loss of NFAT5 led to accelerated resorption of corneal edema after PCI. Mechanistically, we found that myeloid cell-derived NFAT5 is crucial for controlling corneal edema, as edema resorption after PCI was significantly enhanced in mice with conditional loss of NFAT5 in the myeloid cell lineage, presumably due to increased pinocytosis of corneal macrophages. Collectively, we uncovered a suppressive role for NFAT5 in corneal edema resorption, thereby identifying a novel therapeutic target to combat edema-induced corneal blindness.
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Liu C, Saeed HN. Disparities in Access to Corneal Tissue in the Developing World. Semin Ophthalmol 2023; 38:183-189. [PMID: 36537764 DOI: 10.1080/08820538.2022.2152714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Corneal disease is a leading cause of blindness worldwide. For most blinding corneal conditions, keratoplasty is the only way of restoring sight. Unfortunately, access to corneal transplantation is widely variable, most notably due to the lack of suitable donor material. There exists significant disparity between the developed and developing world when it comes to access to cornea tissue, with supply often inversely proportional to burden of disease. The purpose of this review is to identify the current disparities in supply and demand of corneal donor tissue, understand how to access corneal tissue, and propose solutions that promote equitable care for patients with severe corneal disease.
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Affiliation(s)
- Catherine Liu
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, United States
| | - Hajirah N Saeed
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, United States
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Yu T, Schuette F, Christofi M, Forrester JV, Graham GJ, Kuffova L. The atypical chemokine receptor-2 fine-tunes the immune response in herpes stromal keratitis. Front Immunol 2022; 13:1054260. [PMID: 36518752 PMCID: PMC9742518 DOI: 10.3389/fimmu.2022.1054260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/07/2022] [Indexed: 11/29/2022] Open
Abstract
Herpes stromal keratitis (HSK) is a blinding corneal disease caused by herpes simplex virus-1 (HSV-1), a common pathogen infecting most of the world's population. Inflammation in HSK is chemokine-dependent, particularly CXCL10 and less so the CC chemokines. The atypical chemokine receptor-2 (ACKR2) is a decoy receptor predominantly for pro-inflammatory CC chemokines, which regulates the inflammatory response by scavenging inflammatory chemokines thereby modulating leukocyte infiltration. Deletion of ACKR2 exacerbates and delays the resolution of the inflammatory response in most models. ACKR2 also regulates lymphangiogenesis and mammary duct development through the recruitment of tissue-remodeling macrophages. Here, we demonstrate a dose-dependent upregulation of ACKR2 during corneal HSV-1 infection. At an HSV inoculum dose of 5.4 x 105 pfu, but not at higher dose, ACKR2 deficient mice showed prolonged clinical signs of HSK, increased infiltration of leukocytes and persistent corneal neovascularization. Viral clearance and T cell activation were similar in ACKR2-/- and wild type mice, despite a transient diminished expression of CD40 and CD86 in dendritic cells. The data suggest that ACKR2 fine-tunes the inflammatory response and the level of neovascularization in the HSK.
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Affiliation(s)
- Tian Yu
- Division of Applied Medicine, Section of Immunity, Infection and Inflammation (Ocular Immunology), Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
- Department of Ophthalmology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Fabian Schuette
- Chemokine Research Group, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Maria Christofi
- Division of Applied Medicine, Section of Immunity, Infection and Inflammation (Ocular Immunology), Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - John V. Forrester
- Division of Applied Medicine, Section of Immunity, Infection and Inflammation (Ocular Immunology), Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
- Ocular Immunology Program, Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, WA, Australia
- Centre for Experimental Immunology, Lions Eye Institute, Perth, WA, Australia
| | - Gerard J. Graham
- Chemokine Research Group, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Lucia Kuffova
- Division of Applied Medicine, Section of Immunity, Infection and Inflammation (Ocular Immunology), Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
- Eye Clinic, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
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9
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Extracellular Vesicles in Corneal Fibrosis/Scarring. Int J Mol Sci 2022; 23:ijms23115921. [PMID: 35682600 PMCID: PMC9180085 DOI: 10.3390/ijms23115921] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
Communication between cells and the microenvironment is a complex, yet crucial, element in the development and progression of varied physiological and pathological processes. Accumulating evidence in different disease models highlights roles of extracellular vesicles (EVs), either in modulating cell signaling paracrine mechanism(s) or harnessing their therapeutic moiety. Of interest, the human cornea functions as a refractive and transparent barrier that protects the intraocular elements from the external environment. Corneal trauma at the ocular surface may lead to diminished corneal clarity and detrimental effects on visual acuity. The aberrant activation of corneal stromal cells, which leads to myofibroblast differentiation and a disorganized extracellular matrix is a central biological process that may result in corneal fibrosis/scarring. In recent years, understanding the pathological and therapeutic EV mechanism(s) of action in the context of corneal biology has been a topic of increasing interest. In this review, we describe the clinical relevance of corneal fibrosis/scarring and how corneal stromal cells contribute to wound repair and their generation of the stromal haze. Furthermore, we will delve into EV characterization, their subtypes, and the pathological and therapeutic roles they play in corneal scarring/fibrosis.
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Patil M, Lune A, Paranjape R, Naik K, Padmakumar V, Alapati A, Motwani D, Ahuja A, Dhore N, Kaul S. Qualitative and Quantitative Evaluation of Donor Corneal Tissue by Slit Lamp and Specular Microscopy. Cureus 2022; 14:e24700. [PMID: 35663649 PMCID: PMC9162098 DOI: 10.7759/cureus.24700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background In India, donor eye collection and promotion of eye banking are insufficient to meet the needs. By adequately evaluating donor corneas, eye banks can maximize the number of viable corneas for transplantation. This study evaluated donor corneal tissue based on age, lens status, and cause of death by their morphology and endothelial cell count via slit lamp and specular microscopy. Methods We conducted a prospective observational study of all eye bank donor corneas indicated for eye donation at a tertiary hospital and research center in Western Maharashtra between September 2019 to December 2021. We evaluated the corneoscleral discs by slit-lamp microscopy specular microscopy. We analyzed donor corneas quantitatively and qualitatively and graded them accordingly. We also collected blood samples for serological testing and the donor's behavioral and family medical histories. Results We collected 94 eyes from 47 donors; the mean age of the donor population was 48.2 years, and most donors were aged 41 to 80 years. Thirty-one donors (65.96%) were male, and 16 were female (34.04%. For preservation, we used Cornisol (Aurolab, Madurai, India) in 36 cases (77%) and McCarey-Kaufman medium in 11 cases (23%). We found a mean endothelial cell density (ECD) of 2214.40/mm2, with hexagonality of 53.05%, and a coefficient of variation of 38.01. Further, we observed that ECD and hexagonality of cells in phakic donors were significantly greater than that of pseudophakic (PP) donors. Moreover, ECD and hexagonality significantly decreased in donors with the chronic disease compared to those who had a sudden, unexpected death. Conclusion Corneal grafts from younger donors, phakic donors, and donors who experienced an acute cause of death were qualitatively and quantitatively significantly better than those of older donors, PP donors, and donors who experienced sudden, unexpected death. Therefore, eye bank specular examination can improve tissue utilization and transplantation success. Therefore, we strongly recommend that eye bank personnel evaluate their donor tissue with a specular microscope to enhance the quality of eye care.
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Affiliation(s)
- Mayur Patil
- Ophthalmology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Abhay Lune
- Ophthalmology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Radhika Paranjape
- Ophthalmology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Kunj Naik
- Ophthalmology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Vishakh Padmakumar
- Ophthalmology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Aparna Alapati
- Ophthalmology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Divya Motwani
- Ophthalmology: Pediatrics, L V Prasad Eye Institute, Hyderabad, IND
| | - Amod Ahuja
- Ophthalmology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Nilay Dhore
- Ophthalmology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Sucheta Kaul
- Ophthalmology, L V Prasad Eye Institute, Hyderabad, IND
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11
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Guo H, Koehler HS, Dix RD, Mocarski ES. Programmed Cell Death-Dependent Host Defense in Ocular Herpes Simplex Virus Infection. Front Microbiol 2022; 13:869064. [PMID: 35464953 PMCID: PMC9023794 DOI: 10.3389/fmicb.2022.869064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Herpes simplex virus type 1 (HSV1) remains one of the most ubiquitous human pathogens on earth. The classical presentation of HSV1 infection occurs as a recurrent lesions of the oral mucosa commonly refer to as the common cold sore. However, HSV1 also is responsible for a range of ocular diseases in immunocompetent persons that are of medical importance, causing vision loss that may result in blindness. These include a recurrent corneal disease, herpes stromal keratitis, and a retinal disease, acute retinal necrosis, for which clinically relevant animal models exist. Diverse host immune mechanisms mediate control over herpesviruses, sustaining lifelong latency in neurons. Programmed cell death (PCD) pathways including apoptosis, necroptosis, and pyroptosis serve as an innate immune mechanism that eliminates virus-infected cells and regulates infection-associated inflammation during virus invasion. These different types of cell death operate under distinct regulatory mechanisms but all server to curtail virus infection. Herpesviruses, including HSV1, have evolved numerous cell death evasion strategies that restrict the hosts ability to control PCD to subvert clearance of infection and modulate inflammation. In this review, we discuss the key studies that have contributed to our current knowledge of cell death pathways manipulated by HSV1 and relate the contributions of cell death to infection and potential ocular disease outcomes.
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Affiliation(s)
- Hongyan Guo
- Department of Microbiology and Immunology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, United States
- *Correspondence: Hongyan Guo,
| | - Heather S. Koehler
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, United States
- School of Molecular Biosciences, College of Veterinary Medicine, Biotechnology Life Sciences, Pullman, WA, United States
| | - Richard D. Dix
- Viral Immunology Center, Department of Biology, Georgia State University, Atlanta, GA, United States
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
| | - Edward S. Mocarski
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, United States
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12
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Zaghloul N, El Hoffy NM, Mahmoud AA, Elkasabgy NA. Cyclodextrin Stabilized Freeze-Dried Silica/Chitosan Nanoparticles for Improved Terconazole Ocular Bioavailability. Pharmaceutics 2022; 14:pharmaceutics14030470. [PMID: 35335847 PMCID: PMC8955295 DOI: 10.3390/pharmaceutics14030470] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/07/2022] [Accepted: 02/15/2022] [Indexed: 01/03/2023] Open
Abstract
This research assesses the beneficial effects of loading terconazole, a poorly water-soluble antifungal drug in silica/chitosan nanoparticles (SCNs) for ocular delivery. Nanoparticles were fabricated by the simple mixing of tetraethyl ortho silicate (TEOS) and chitosan HCl as sources of silica and nitrogen, respectively, along with alcoholic drug solution in different concentrations. Freeze-dried nanoparticles were fabricated using cyclodextrins as cryoprotectants. SCNs were assessed for their particle size, PDI, yield, drug loading and in vitro release studies. A 23.31 full factorial experimental design was constructed to optimize the prepared SCNs. DSC, XRD, FTIR, in addition to morphological scanning were performed on the optimized nanoparticles followed by an investigation of their pharmacokinetic parameters after topical ocular application in male Albino rabbits. The results reveal that increasing the water content in the preparations causes an increase in the yield and size of nanoparticles. On the other hand, increasing the TEOS content in the preparations, caused a decrease in the yield and size of nanoparticles. The optimized formulation possessed excellent mucoadhesive properties with potential safety concerning the investigated rabbit eye tissues. The higher Cmax and AUC0–24 values coupled with a longer tmax value compared to the drug suspension in the rabbits’ eyes indicated the potential of SCNs as promising ocular carriers for poorly water-soluble drugs, such as terconazole.
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Affiliation(s)
- Nada Zaghloul
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Future University in Egypt, Cairo 11835, Egypt; (N.Z.); (N.M.E.H.); (A.A.M.)
| | - Nada M. El Hoffy
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Future University in Egypt, Cairo 11835, Egypt; (N.Z.); (N.M.E.H.); (A.A.M.)
| | - Azza A. Mahmoud
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Future University in Egypt, Cairo 11835, Egypt; (N.Z.); (N.M.E.H.); (A.A.M.)
| | - Nermeen A. Elkasabgy
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini Street, Cairo 11562, Egypt
- Correspondence: or ; Tel.: +20-1141404144
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Rathi VM, Murthy SI, Vaddavalli PK, Khanna RC. Feasibility and Outcomes of Corneal Transplantation Performed at Rural Centers: An Extension of the Pyramidal Model of Enhanced Eye Care at Rural Outreach. Cornea 2022; 41:211-218. [PMID: 34320597 DOI: 10.1097/ico.0000000000002839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/15/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to report on the feasibility of setting up a system of corneal transplants at rural outreach centers and report the outcomes of the first 111 cases. METHODS Retrospective analysis of the outcomes of corneal transplantation performed on patients with optical indications between March 2016 and September 2019 at 4 secondary (rural) centers. The centers are a part of a network in the pyramidal model developed by L V Prasad Eye Institute. The graft clarity and best-corrected visual acuity (BCVA) at 1-year follow-up were analyzed. RESULTS Of the 111 patients, 34.23% underwent penetrating keratoplasty and 65.77% endothelial keratoplasty. The mean age was 59.4 ± 15.0 (range-17-86 years); 47.75% were men and 52.25% were women. The indications for surgery were bullous keratopathy (54.05%), corneal scar/adherent leukoma (23.42%), and repeat grafts (13.51%). At the end of 1 year, 69.37% grafts remained clear. Factors associated with graft failure included poor socioeconomic status and graft infiltrate in both univariate and multivariate analyses. Surgical technique of endothelial keratoplasty was associated with failure on multivariate analysis only. Of the 77 eyes with clear corneal grafts at 1 year, the preoperative mean logMAR BCVA was 1.91 ± 0.06, which improved to 0.90 ± 0.08 postoperatively. Overall, 84.4% had preoperative BCVA of <3/60. Postoperatively, 40% had BCVA of 6/18 or better. CONCLUSIONS Our study showed that close to 70% grafts remained clear at 1 year. Graft failure was associated with poor socioeconomic status and graft infiltrates. This study established a viable model for delivery of corneal transplant surgery and care in a rural setup.
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Affiliation(s)
- Varsha M Rathi
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, LV Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health and Economics (IHOPE) Research Centre, LVPEI, Hyderabad, Telangana, India
- Cornea Service, The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Somasheila I Murthy
- Cornea Service, The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Pravin K Vaddavalli
- Cornea Service, The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, LV Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health and Economics (IHOPE) Research Centre, LVPEI, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India ; and
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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A Review of Pediatric Corneal Transplants: Perioperative, Operative, and Postoperative Management. Int Ophthalmol Clin 2022; 62:15-31. [PMID: 34965223 DOI: 10.1097/iio.0000000000000398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Phacoemulsification in patients with corneal opacities using slit illumination of the surgical microscope. J Cataract Refract Surg 2021; 48:374-377. [PMID: 34924518 DOI: 10.1097/j.jcrs.0000000000000877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/12/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Performing phacoemulsification (PE) in eyes with corneal opacities is challenging even with expert surgeons. Several techniques have been described to improve intraoperative visualization through opacified corneas. This retrospective interventional case series included 10 eyes of 10 patients with coexisting senile cataract and corneal opacity who underwent PE with intraocular lens (IOL) implantation under slit illumination of the surgical microscope. Uneventful PE with IOL implantation was achieved in all eyes without intraoperative complications. Slit illumination reduces the light scattering and reflection from the corneal opacity, enhances the red reflex, and improves depth perception simultaneously in different steps of PE. Phacoemulsification can be safely performed in eyes with corneal opacity under slit illumination of the surgical microscope. It can be considered as a viable option for improving intraoperative visualization in patients with corneal opacities without additional instrumentation.
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Eidizadeh M, Ebadi-Soflou L, Khoushabi AS. Indications for penetrating keratoplasty in Iranian patients. Oman J Ophthalmol 2021; 14:144-148. [PMID: 34880573 PMCID: PMC8597823 DOI: 10.4103/ojo.ojo_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 06/12/2020] [Accepted: 10/09/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The outcome of penetration into keratoplasty (PK) related to corneal disease is responsible for corneal blindness. The aim of this study is to evaluate the indications and visual outcome of PK in Imam Khomeini Hospital in Kermanshah from March 2017 to March 2019. MATERIALS AND METHODS Data were reviewed from the medical records of 115 PK done in the Department of Ophthalmology, Imam Khomeini Hospital, Kermanshah, from March 2017 to March 2019. Data analysis done using paired Student's t-test for hypothesis testing of grouped values of preoperative and the last follow-up best-corrected visual acuity in cases of optical and therapeutic grafts. P <0.05 was considered statistically significant. RESULTS In this study, the data of 115 eyes of 108 patients were reviewed. The most common indication for keratoplasty was corneal scarring including adherent leucoma, 34 (29.56%). Therapeutic keratoplasty was done for 26 patients. One case of tectonic graft was included in therapeutic keratoplasty group for analysis. There was statistically significant difference (P = 0.0001) in best-corrected visual acuity improvement from 1.36 logMAR + 0.024 (standard deviation [SD]) preoperatively to 0.357 logMAR + 0.42 (SD) postoperatively and 1.4 logMAR + 0.000 (SD) preoperatively to 0.15 logMAR + 0.55 (SD) postoperatively for optical and therapeutic grafts, respectively. CONCLUSION Active or treated infectious keratitis was one of the most important indications for keratoplasty. Symptoms of poor prognosis were more pronounced in this part of the country. Patients' vision after corneal transplantation was encouraging, especially in cases of optical keratoplasty.
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Affiliation(s)
- Mojtaba Eidizadeh
- Department of Opthalmology, Imam Khomeini Hospital, Kermanshah University of Medical Sciences and Health Services, Kermanshah, Iran
| | - Leila Ebadi-Soflou
- Department of Opthalmology, Imam Khomeini Hospital, Kermanshah University of Medical Sciences and Health Services, Kermanshah, Iran
| | - Aashkan Safarzadeh Khoushabi
- Department of Opthalmology, Imam Khomeini Hospital, Kermanshah University of Medical Sciences and Health Services, Kermanshah, Iran
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Han X, Zhang Y, Zhu Y, Zhao Y, Yang H, Liu G, Ai S, Wang Y, Xie C, Shi J, Zhang T, Huang G, He X. Quantification of biomechanical properties of human corneal scar using acoustic radiation force optical coherence elastography. Exp Biol Med (Maywood) 2021; 247:462-469. [PMID: 34861122 PMCID: PMC8943333 DOI: 10.1177/15353702211061881] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Biomechanical properties of corneal scar are strongly correlated with many corneal diseases and some types of corneal surgery, however, there is no elasticity information available about corneal scar to date. Here, we proposed an acoustic radiation force optical coherence elastography system to evaluate corneal scar elasticity. Elasticity quantification was first conducted on ex vivo rabbit corneas, and the results validate the efficacy of our system. Then, experiments were performed on an ex vivo human scarred cornea, where the structural features, the elastic wave propagations, and the corresponding Young's modulus of both the scarred region and the normal region were achieved and based on this, 2D spatial distribution of Young's modulus of the scarred cornea was depicted. Up to our knowledge, we realized the first elasticity quantification of corneal scar, which may provide a potent tool to promote clinical research on the disorders and surgery of the cornea.
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Affiliation(s)
- Xiao Han
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang 330063, P. R. China
| | - Yubao Zhang
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang 330063, P. R. China
| | - Yirui Zhu
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang 330063, P. R. China
| | - Yanzhi Zhao
- The Third Affiliated Hospital of Nanchang University, Nanchang 330008, P. R. China
| | - Hongwei Yang
- The Third Affiliated Hospital of Nanchang University, Nanchang 330008, P. R. China
| | - Guo Liu
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang 330063, P. R. China
| | - Sizhu Ai
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang 330063, P. R. China
| | - Yidi Wang
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang 330063, P. R. China
| | - Chengfeng Xie
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang 330063, P. R. China
| | - Jiulin Shi
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang 330063, P. R. China
| | - Tianyu Zhang
- Key Laboratory of Geophysical Exploration Equipment, Ministry of Education, College of Instrumentation & Electrical Engineering, 12510Jilin University, Changchun 130012, P. R. China
| | - Guofu Huang
- The Third Affiliated Hospital of Nanchang University, Nanchang 330008, P. R. China
| | - Xingdao He
- Key Laboratory of Opto-Electronic Information Science and Technology of Jiangxi Province and Jiangxi Engineering Laboratory for Optoelectronics Testing Technology, Nanchang Hangkong University, Nanchang 330063, P. R. China
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Sharifi S, Sharifi H, Akbari A, Koza D, Dohlman CH, Paschalis EI, Chodosh J. Photo-cross-linked Gelatin Glycidyl Methacrylate/N-Vinylpyrrolidone Copolymeric Hydrogel with Tunable Mechanical Properties for Ocular Tissue Engineering Applications. ACS APPLIED BIO MATERIALS 2021; 4:7682-7691. [PMID: 35006715 DOI: 10.1021/acsabm.1c00905] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Corneal transplantation is currently the primary treatment for corneal blindness. However, severe global scarcity of donor corneas is driving the scientific community to find novel solutions. One potential solution is to replace the damaged tissue with a biocompatible artificial cornea. Here, gelatin glycidyl methacrylate (GM) and N-vinylpyrrolidone (VP) were cocrosslinked to afford a hybrid bicomponent copolymeric hydrogel with excellent mechanical, structural, and biological properties. Our studies showed that the GM/VP ratio can be adjusted to generate a construct with high tensile modulus and strength of 1.6 and 1.0 MPa, respectively, compared to 14 and 7.5 MPa for human cornea. The construct can tolerate up to 22.4 kPa pressure before retention sutures can tear through it. Due to the presence of a synthetic component, it has a significantly higher stability against collagenase induced degradation, yet it is biocompatible and promotes cellular adhesion, proliferation, and migration under in vitro settings.
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Affiliation(s)
- Sina Sharifi
- Disruptive Technology Laboratory, Massachusetts Eye and Ear and Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Hannah Sharifi
- Disruptive Technology Laboratory, Massachusetts Eye and Ear and Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Ali Akbari
- Solid Tumor Research Center, Research Institute for Cellular and Molecular Medicine, Urmia University of Medical Sciences, 57147, Urmia, Iran
| | - Darrell Koza
- Department of Physical Sciences, Eastern Connecticut State University, Willimantic, Connecticut 06226, United States
| | - Claes H Dohlman
- Disruptive Technology Laboratory, Massachusetts Eye and Ear and Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Eleftherios I Paschalis
- Disruptive Technology Laboratory, Massachusetts Eye and Ear and Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts 02114, United States
| | - James Chodosh
- Disruptive Technology Laboratory, Massachusetts Eye and Ear and Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts 02114, United States
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Litvin G, Klein I, Litvin Y, Klaiman G, Nyska A. CorNeat KPro: Ocular Implantation Study in Rabbits. Cornea 2021; 40:1165-1174. [PMID: 34351873 PMCID: PMC8330828 DOI: 10.1097/ico.0000000000002798] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 04/26/2021] [Accepted: 05/06/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate surgical feasibility and long-term integration of the CorNeat Keratoprosthesis (KPro), a novel synthetic cornea, in rabbits. METHODS The CorNeat KPro is a synthetic corneal implant designed to treat corneal blindness by using a polymeric scaffold for biointegration, consequently assimilating synthetic optics within ocular tissues. Eight New Zealand White rabbits were implanted unilaterally with the CorNeat KPro and observed for 6 months. Animals were regularly monitored by a certified ophthalmologist using slit-lamp biomicroscopy. One animal developed postoperative endophthalmitis and was removed from the study 7 weeks postsurgery. At termination, eyes were enucleated and evaluated histologically to assess local tissue integration and inflammatory response. RESULTS The surgical procedure was found feasible. The CorNeat KPro integrated into all operated eyes, resulting in a retention rate of 87.5% at the conclusion of the 6-month follow-up period. We observed minimal-to-mild conjunctival and iridial congestion and did not find additional inflammatory indicators, such as anterior chamber fibrin, flare, or cells. The optical element of the device remained clear with zero incidence of retroprosthetic membrane formation. Histopathological evaluation revealed comparable tissue and cellular reaction in all eyes, consisting of the presence of fibroblasts and associated collagen fibrils within the device's skirt component. Some eyes showed a mild foreign body reaction surrounding the skirt. CONCLUSIONS Clinical and histological findings indicate the integration of the implanted device into the surrounding tissue, evident by the retention rate and the diffuse infiltration of fibroblasts with collagen deposition among the device's fibrils. These data hold promise for clinical application in humans.
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Affiliation(s)
| | - Ido Klein
- CorNeat Vision Ltd, Raanana, Israel;
| | - Yoav Litvin
- Independent Scientific Consultant, Bellingham, WA
| | - Guy Klaiman
- Envigo CRS (Israel), Ness Ziona, Israel; and
| | - Abraham Nyska
- Sackler School of Medicine, Consultant in Toxicologic Pathology, Timrat and Tel Aviv University, Israel.
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Role Played by Receptors for Advanced Glycosylation End Products in Corneal Endothelial Cells after HSV-1 Infection. Int J Mol Sci 2021; 22:ijms22115833. [PMID: 34072468 PMCID: PMC8199122 DOI: 10.3390/ijms22115833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
Senescence, sterile inflammation, and infection cause dysfunction of corneal endothelial cells, leading to visual morbidity that may require corneal transplantation. With increasing age, the extracellular matrix is modified by non-enzymatic glycation forming advanced glycation end products (AGEs). The modifications are primarily sensed by the receptors for the AGEs (RAGE) and are manifested as a type I interferon response. Interestingly, in our study, human corneal endothelial cells (HCEn) cells did not respond to the typical RAGE ligands, including the AGEs, high mobility group box 1 (HMGB1), and serum amyloid-A (SAA). Instead, HCEn cells responded exclusively to the CpG DNA, which is possessed by typical corneal pathogen, herpes simplex virus-1 (HSV-1). Upon HSV-1 infection, the surface expression of RAGE was increased, and endocytosed HSV-1 was associated with RAGE and CpG DNA receptor, TLR9. RAGE DNA transfection markedly increased interferon-β secretion by CpG DNA or HSV-1 infection. HSV-1 infection-induced interferon-β secretion was abolished by TLR9 inhibition and partially by RAGE inhibition. Global transcriptional response analysis confirmed that RAGE and TLR9 were both significantly involved in type I interferon responses. We conclude that RAGE is a sensor of HSV-1 infection and provokes a type I interferon response.
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21
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Farooqui JH, Acharya M, Schunder I, Hinesley R, Das A. Practical use of rubric for assessment of eye bank professionals for eye retrieval and its role in improving eye retrieval process in eye banks: An Indo-American experience. Indian J Ophthalmol 2021; 68:1037-1039. [PMID: 32461425 PMCID: PMC7508069 DOI: 10.4103/ijo.ijo_1482_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose: To study the practical use of the Rubric for Assessment of Eye Bank Professionals for Eye Retrieval (RAEPER) as a competency assessment tool by organizing a workshop in two eye banks – one in India and other in America. Methods: Two-day workshop was conducted in two eye banks – named Shroff’s Charity Eye Hospital (SCEH) in India and Miracles in Sight (MIS) in America. Day 1 of workshop comprised of didactic lectures and discussions and day 2 was eye retrieval assessment done on human eyes in a wet lab setting. Assessment was done using RAEPER by two independent senior eye bank managers. Results: MIS had 27 participants, 15 males and 12 females (mean age: 38.8 years, range: 28-55) and SCEH had 11 participants, 10 males and 1 female (mean age: 48 years, range: 22–68). All participants were in house technicians, who had a minimal experience of at least 150 eye retrievals. At MIS, step 19 (crystalline lens check) got a score of 3 (Competent) 93.5% of the time. At SCEH, step 6 (conjunctival removal) and step 4 (Irrigation of cornea with sterile saline) were high scoring with 90.11% and 72.7% scoring 3, respectively. Conclusion: India’s cornea blind population is expected to reach 10 million by 2020. Steps need to be taken to improve cornea retrieval rates in the country and make various eye banks self-sufficient. Incorporating such training modules not only improves the cornea utilization rates, but also helps standardize the entire eye banking process.
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Affiliation(s)
- Javed Hussain Farooqui
- Department of Cornea, Cataract and Refractive Surgery, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Manisha Acharya
- Department of Cornea, Cataract and Refractive Surgery, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | | | | | - Animesh Das
- Manager Eye Bank, Dr. Shroff's Charity Eye Hospital, New Delhi, India
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Ulag S, Ilhan E, Demirhan R, Sahin A, Yilmaz BK, Aksu B, Sengor M, Ficai D, Titu AM, Ficai A, Gunduz O. Propolis-Based Nanofiber Patches to Repair Corneal Microbial Keratitis. Molecules 2021; 26:molecules26092577. [PMID: 33925130 PMCID: PMC8125036 DOI: 10.3390/molecules26092577] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 11/20/2022] Open
Abstract
In this research, polyvinyl-alcohol (PVA)/gelatin (GEL)/propolis (Ps) biocompatible nanofiber patches were fabricated via electrospinning technique. The controlled release of Propolis, surface wettability behaviors, antimicrobial activities against the S. aureus and P. aeruginosa, and biocompatibility properties with the mesenchymal stem cells (MSCs) were investigated in detail. By adding 0.5, 1, and 3 wt.% GEL into the 13 wt.% PVA, the morphological and mechanical results suggested that 13 wt.% PVA/0.5 wt.% GEL patch can be an ideal matrix for 3 and 5 wt.% propolis addition. Morphological results revealed that the diameters of the electrospun nanofiber patches were increased with GEL (from 290 nm to 400 nm) and Ps addition and crosslinking process cause the formation of thicker nanofibers. The tensile strength and elongation at break enhancement were also determined for 13 wt.% PVA/0.5 wt.% GEL/3 wt.% Ps patch. Propolis was released quickly in the first hour and arrived at a plateau. Cell culture and contact angle results confirmed that the 3 wt.% addition of propolis reinforced mesenchymal stem cell proliferation and wettability properties of the patches. The antimicrobial activity demonstrated that propolis loaded patches had antibacterial activity against the S. aureus, but for P. aeruginosa, more studies should be performed.
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Affiliation(s)
- Songul Ulag
- Center for Nanotechnology & Biomaterials Application and Research (NBUAM), Marmara University, 34722 Istanbul, Turkey; (S.U.); (E.I.); (R.D.); (M.S.)
- Metallurgical and Materials Engineering, Institute of Pure and Applied Sciences, Marmara University, 34722 Istanbul, Turkey
| | - Elif Ilhan
- Center for Nanotechnology & Biomaterials Application and Research (NBUAM), Marmara University, 34722 Istanbul, Turkey; (S.U.); (E.I.); (R.D.); (M.S.)
- Department of Bioengineering, Institute of Pure and Applied Sciences, Marmara University, 34722 Istanbul, Turkey
| | - Ramazan Demirhan
- Center for Nanotechnology & Biomaterials Application and Research (NBUAM), Marmara University, 34722 Istanbul, Turkey; (S.U.); (E.I.); (R.D.); (M.S.)
| | - Ali Sahin
- Department of Biochemistry, Faculty of Medicine, Marmara University, 34718 Istanbul, Turkey; (A.S.); (B.K.Y.)
- Genetic and Metabolic Diseases Research and Investigation Center, Marmara University, 34722 Istanbul, Turkey
| | - Betul Karademir Yilmaz
- Department of Biochemistry, Faculty of Medicine, Marmara University, 34718 Istanbul, Turkey; (A.S.); (B.K.Y.)
- Genetic and Metabolic Diseases Research and Investigation Center, Marmara University, 34722 Istanbul, Turkey
| | - Burak Aksu
- Department of Medical Microbiology, Marmara University School of Medicine, 34854 Istanbul, Turkey;
| | - Mustafa Sengor
- Center for Nanotechnology & Biomaterials Application and Research (NBUAM), Marmara University, 34722 Istanbul, Turkey; (S.U.); (E.I.); (R.D.); (M.S.)
- Metallurgical and Materials Engineering Faculty of Technology, Marmara University, 34722 Istanbul, Turkey
| | - Denisa Ficai
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania;
- National Centre for Micro- and Nanomaterials, University Politehnica of Bucharest, 060042 Bucharest, Romania
| | - Aurel Mihail Titu
- Industrial Engineering and Management Department, Faculty of Engineering, Lucian Blaga University of Sibiu, 550025 Sibiu, Romania;
- Academy of Romanian Scientists, 050094 Bucharest, Romania
| | - Anton Ficai
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania;
- National Centre for Micro- and Nanomaterials, University Politehnica of Bucharest, 060042 Bucharest, Romania
- Academy of Romanian Scientists, 050094 Bucharest, Romania
- Correspondence: (A.F.); (O.G.)
| | - Oguzhan Gunduz
- Center for Nanotechnology & Biomaterials Application and Research (NBUAM), Marmara University, 34722 Istanbul, Turkey; (S.U.); (E.I.); (R.D.); (M.S.)
- Metallurgical and Materials Engineering Faculty of Technology, Marmara University, 34722 Istanbul, Turkey
- Correspondence: (A.F.); (O.G.)
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Chen X, Li T, Qi X, Shi W, Gao H. Clinical Characteristics and Outcomes of Short-term Repeat Corneal Transplantation. Ocul Immunol Inflamm 2021; 30:855-863. [PMID: 33555976 DOI: 10.1080/09273948.2020.1838557] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To explore the primary indications, direct causes and graft survival of short-term repeat keratoplasty. METHODS An analytical cross-sectional study. RESULTS The primary indications for keratoplasty were infectious keratitis (67.9%) and immune keratopathy (12.8%). The direct causes of graft failure were infectious ulcer (43.6%) and recurrence (30.8%). Pre-operative hypopyon (P = 0.017, HR = 1.757) and use of decellularized porcine corneas as grafts (P = 0.005, HR = 2.690) were independent risk factors for graft failure. The Kaplan-Meier analysis revealed that the 1-year survival rate of 88 repeat grafts was 85.2%, and the 5-year survival rate was 79.2%. The survival rates of the repeat grafts were significantly higher than those of the first grafts (P < 0.001). CONCLUSION Infectious keratitis is the most common indication of short-term graft failure and is often failed by infectious ulcer and keratitis recurrence. While the decellularized porcine cornea is a promising application in developing countries, certain difficulties, such as graft melting, remain unresolved.
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Affiliation(s)
- Xiunian Chen
- Medical College of Qingdao University, Qingdao, China.,Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Ting Li
- Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Xiaolin Qi
- Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Weiyun Shi
- Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
| | - Hua Gao
- Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
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Wang Z, Kapadia W, Li C, Lin F, Pereira RF, Granja PL, Sarmento B, Cui W. Tissue-specific engineering: 3D bioprinting in regenerative medicine. J Control Release 2021; 329:237-256. [DOI: 10.1016/j.jconrel.2020.11.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022]
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Kusumesh R, Ambastha A, Sinha BP, Bhasker G, Mohan N, Kumar S. Long-Term Visual Outcome in Surgical Management of Cataract Coexistent With Corneal Opacity in One-Eyed Patients. Asia Pac J Ophthalmol (Phila) 2020; 9:412-419. [PMID: 31996566 DOI: 10.1097/01.apo.0000617948.13052.a1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To determine the visual outcome and safety of cataract surgery alone and compare with the long-term visual outcome of triple procedure in one-eyed patients. DESIGN Retrospective study. METHODS This study reviewed 44 one-eyed patients with cataract coexistent with corneal opacity. The patients who underwent cataract surgery alone (group A, n = 25) were compared with patients managed by triple procedure (group B, n = 19). Outcome measures were the improvement of best corrected visual acuity (BCVA) and period of maintained ambulatory vision. Institutional ethics committee approval was obtained. RESULTS The most common etiology of corneal opacity was fungal and the commonest cause of permanent visual loss in other eye was phthisis bulbi. Mean age was 61.2 ± 8.1 years and 62.5 ± 6.9 years in groups A and B, respectively. At each follow-up, the mean postoperative BCVA was found significantly better than the preoperative vision in both groups and at the end of 3 years, mean postoperative vision of group A was better than that of group B (P = 0.012). Group A had longer (33.36 ± 11.97 months) mean period of maintained ambulatory vision than that of group B (26.5 ± 13.5 months) (P = 0.245) and showed less risk of losing ambulatory vision. Limited visual outcome was due to continuing presence of corneal opacity in group A, and graft infection and graft rejection in group B. CONCLUSIONS Cataract surgery with intraocular lens (IOL) implantation alone can be considered as an alternative or temporary option to provide stable ambulatory vision in one-eyed patients.
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Affiliation(s)
- Rakhi Kusumesh
- Cornea Services, Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Anita Ambastha
- Community Ophthalmology, Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Bibhuti Prassan Sinha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Gyan Bhasker
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Nilesh Mohan
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Shishir Kumar
- Department of Biostatistics, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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Di Zazzo A, Antonini M, Fernandes M, Varacalli G, Sgrulletta R, Coassin M. A global perspective of pediatric non-viral keratitis: literature review. Int Ophthalmol 2020; 40:2771-2788. [PMID: 32500305 DOI: 10.1007/s10792-020-01451-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 05/23/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE This focused review aims to explore pediatric non-viral keratitis and to compare associated risk factors, etiologies, antibiotic susceptibilities, empiric treatments and outcomes. METHODS The authors performed a literature research for articles, published on PubMed, Google Scholar, Scopus and Embase online library, relevant to pediatric keratitis etiology, risk factors, antibiotic susceptibilities, treatment and outcomes. From the bibliography of selected articles, additional relevant articles were also considered. Of 34 articles identified, 21 were suitable for the purpose of this review. RESULTS Several risk factors are noted in the field of pediatric keratitis. Trauma is the most common in developing countries, while contact lenses wear is seen in developed economies. Previous ocular conditions and systemic diseases also contribute. Associated malnourishment and vitamin A deficit are fraught with a catastrophic prognosis. Among causative organisms, bacteria are more common than fungi and protozoa. Gram-positive organisms are predominant where contact lenses use is infrequent. Pseudomonas aeruginosa is often the leading pathogen in developed countries and is strongly associated with contact lens wear or malnourishment. Fungi are common in the tropics and associated with trauma. Levofloxacin seems the more effective empirical treatment when bacteria are suspected, but there is no agreement on a standard of care. CONCLUSION There are differences in etiologic patterns between developing and developed countries and different regions globally. Risk factors follow the same trend; however, there is no standard regimen being followed for empirical treatment of pediatric infectious keratitis. Associated malnourishment and vitamin A deficiency result in poorer outcomes.
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Affiliation(s)
- Antonio Di Zazzo
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Marco Antonini
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Merle Fernandes
- Cornea and Anterior Segment Services, LV Prasad Eye Institute, GMR Varalakshmi Campus, Hanumanthawaka Jn, Visakhapatnam, Andhra Pradesh, 530040, India.
| | - Giuseppe Varacalli
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Roberto Sgrulletta
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Marco Coassin
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
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Han Y, Li C, Cai Q, Bao X, Tang L, Ao H, Liu J, Jin M, Zhou Y, Wan Y, Liu Z. Studies on bacterial cellulose/poly(vinyl alcohol) hydrogel composites as tissue-engineered corneal stroma. Biomed Mater 2020; 15:035022. [DOI: 10.1088/1748-605x/ab56ca] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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López-Paniagua M, Nieto-Miguel T, Galindo S, García-Posadas L, de la Mata A, Corrales RM, Calonge M, Diebold Y. Optimization of Human Limbal Stem Cell Culture by Replating a Single Limbal Explant. Methods Mol Biol 2020; 2145:39-49. [PMID: 32542599 DOI: 10.1007/978-1-0716-0599-8_4] [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] [Indexed: 06/11/2023]
Abstract
Cultured limbal epithelial stem cell transplantation is a clinical procedure used to regenerate the corneal epithelium in patients with limbal stem cell deficiency. The protocols used to expand limbal epithelial cells in vitro need to be optimized, since the scarcity of human ocular tissue donors is limiting the potential use of this procedure. Here, we describe a method to consecutively expand a single human limbal explant. With this method it is possible to obtain up to three limbal epithelial primary cultures from the same explant, thus increasing the efficiency of the in vitro cell culture.
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Affiliation(s)
- Marina López-Paniagua
- Grupo de Superficie Ocular, Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN). Instituto de Salud Carlos III, Madrid, Spain
- Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y León, , Valladolid, Spain
| | - Teresa Nieto-Miguel
- Grupo de Superficie Ocular, Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN). Instituto de Salud Carlos III, Madrid, Spain
| | - Sara Galindo
- Grupo de Superficie Ocular, Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN). Instituto de Salud Carlos III, Madrid, Spain
| | - Laura García-Posadas
- Grupo de Superficie Ocular, Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
| | - Ana de la Mata
- Grupo de Superficie Ocular, Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN). Instituto de Salud Carlos III, Madrid, Spain
- Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y León, , Valladolid, Spain
| | - Rosa M Corrales
- Grupo de Superficie Ocular, Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN). Instituto de Salud Carlos III, Madrid, Spain
| | - Margarita Calonge
- Grupo de Superficie Ocular, Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN). Instituto de Salud Carlos III, Madrid, Spain
| | - Yolanda Diebold
- Grupo de Superficie Ocular, Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain.
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN). Instituto de Salud Carlos III, Madrid, Spain.
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Xiong S, Gao H, Qin L, Jia YG, Ren L. Engineering topography: Effects on corneal cell behavior and integration into corneal tissue engineering. Bioact Mater 2019; 4:293-302. [PMID: 31709312 PMCID: PMC6829100 DOI: 10.1016/j.bioactmat.2019.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/23/2019] [Accepted: 10/07/2019] [Indexed: 12/13/2022] Open
Abstract
Cell-material interactions are important to tissue engineering. Inspired by the natural topographic structures on the extracellular matrix, a growing number of studies have integrated engineering topography into investigations of cell behavior on biomaterials. Engineering topography has a significant influence on cell behaviors. These cell-topography interactions play an important role in regenerative medicine and tissue engineering. Similarly, cell-topography interactions are important to corneal reconstruction and regeneration. In this review, we primarily summarized the effects of topographic cues on the behaviors of corneal cells, including cell morphology, adhesion, migration, and proliferation. Furthermore, the integration of engineering surface topography into corneal tissue engineering was also discussed.
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Affiliation(s)
- Sijia Xiong
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, 510641, China
- National Engineering Research Centre for Tissue Restoration and Reconstruction, Guangzhou, 510006, China
| | - HuiChang Gao
- School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Lanfeng Qin
- National Engineering Research Centre for Tissue Restoration and Reconstruction, Guangzhou, 510006, China
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou, 510006, China
| | - Yong-Guang Jia
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, 510641, China
- National Engineering Research Centre for Tissue Restoration and Reconstruction, Guangzhou, 510006, China
| | - Li Ren
- School of Materials Science and Engineering, South China University of Technology, Guangzhou, 510641, China
- National Engineering Research Centre for Tissue Restoration and Reconstruction, Guangzhou, 510006, China
- Sino-Singapore International Joint Research Institute, Guangzhou, 510555, China
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A new approach to extend the storage of donor corneas after 28 days of corneal culture in an Italian eye bank. Cell Tissue Bank 2019; 21:47-55. [PMID: 31782073 DOI: 10.1007/s10561-019-09795-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022]
Abstract
This study aimed to evaluate the possibility to extend the storage of unused organ-cultured donor corneas. After 28 days of corneal culture in TISSUE-C (AL.CHI.MI.A. S.R.L., Italy) and 5-day storage in transport/deswelling medium CARRY-C (AL.CHI.MI.A. S.R.L., Italy), 25 corneas that were deemed suitable for transplantation were transferred in fresh TISSUE-C at 31 °C for additional 7 days and then in fresh CARRY-C at room temperature for 24 h. Tissues were assessed for endothelial cell density (ECD), endothelial mortality and morphology after the standard and the extended corneal storage. In addition, the effect of donor age < 85 years and ≥ 85 years on corneal characteristics was assessed. After the extended storage, 6 out of 25 tested corneas (24%) showed ECD values below the acceptance limit (< 2000 cells/mm2). 19 corneas (76%) were still suitable for transplantation and showed a 5.9% loss in ECD, which was not statistically significant (P = 0.0949) compared to standard storage period. The two donor age groups did not show statistically significant differences in any tested parameter, although a trend for lower ECD and higher mortality in Descemet's folds after standard storage was observed in the ≥ 85 age donor group. Thus, the attempt of the current study to provide new sight-restorative options for unused tissues and increasing the availability of corneas in case of shortage gave encouraging results. Although a higher vulnerability of corneas from very old donors could not be statistically demonstrated in the present study, higher sample size could be required for prolonging the shelf life of these tissues.
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Mathews PM, Fogla R, Samayoa E, VanCourt S, Akpek EK. Long-term clinical outcomes of keratoplasty using gamma-irradiated corneal lenticules. BMJ Open Ophthalmol 2019; 4:e000396. [PMID: 31799412 PMCID: PMC6861079 DOI: 10.1136/bmjophth-2019-000396] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 11/19/2022] Open
Abstract
Objective To report long-term clinical outcomes of gamma-irradiated corneal lenticules in partial and full-thickness keratoplasty. Methods and Analysis This multicentre, retrospective case series includes 23 patients who underwent surgery at three centres (India, Guatemala, and USA) between May 2009 and March 2018. The main outcome measures were epithelialization and retention for therapeutic keratoplasty and best spectacle-corrected visual acuity (BSCVA) for optical keratoplasty. Results Patients were categorised according to primary aetiology requiring corneal transplantation: non-inflammatory conditions, infectious keratitis and sterile keratolysis. Nine patients with non-inflammatory conditions underwent anterior lamellar keratoplasty (n=7) and Boston type 1 keratoprosthesis (n=2). All nine grafts remained intact and epithelialized during follow-up (median 24 months). In the seven patients who underwent anterior keratoplasty, the graft stayed optically clear during follow-up (median 12 months), with BSCVA between 20/20 and 20/40 in all but one patient who developed cataract. Nine patients with severe infectious keratitis had emergency patch grafting. Six of those grafts epithelialized and remained intact over a median of 30 months, providing tectonic support until optical keratoplasty with fresh tissue could be performed. Three grafts had recurrent infectious keratitis 1–3 months postoperatively, two of which underwent tectonic keratoplasty with fresh tissue which also eventually became infected during follow-up. In five additional patients with sterile keratolysis who underwent lamellar patch graft, two grafts remained intact during follow-up (median 36 months). Two patients had recurrent corneal melt within 1 month, and both had subsequent corneal surgery with fresh tissue which also failed. There were no donor-related complications. Conclusion Gamma-irradiated sterile corneal stromal lenticules can be considered as a viable alternative to fresh tissue in various clinical settings.
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Affiliation(s)
- Priya M Mathews
- Cornea and External Diseases, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rajesh Fogla
- Cornea Clinic, Apollo Hospitals, Hyderabad, India
| | - Erik Samayoa
- Hospital de la Familia, Nuevo Progreso, Guatemala
| | - Shanna VanCourt
- Cornea and External Diseases, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Esen K Akpek
- Cornea and External Diseases, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Balgos JD, Amesty MA, Rodriguez AE, Al-Shymali O, Abumustafa S, Alio JL. Keratopigmentation combined with strabismus surgery to restore cosmesis in eyes with disabling corneal scarring and squint. Br J Ophthalmol 2019; 104:785-789. [PMID: 31527061 DOI: 10.1136/bjophthalmol-2019-314539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Therapeutic corneal pigmentation has modernly evolved into different sophisticated techniques to camouflage cosmetically disabling corneal opacities and scars with good reported outcomes. Blind eyes frequently suffer from strabismus which further deteriorates the cosmesis of the patient. Combined keratopigmentation (KTPG) with strabismus surgery may be an option for these patients. METHODS A total of 72 consecutive patients were retrospectively reviewed in this investigation. Main outcome measures were postoperative residual squint, and cosmesis evaluated by an independent observer, patient satisfaction, reoperation rates for KTPG and squint, and complications. RESULTS A total of 72 consecutive patients and 73 eyes that underwent KTPG and strabismus surgery were included in this study. Mean follow-up time was 2.5±3 years. Patient age ranged from 5 to 83 years, with 93% having visual acuity worse than 0.1. 14 eyes (24.5%) underwent repeated KTPG, 24 (42.1%) had repeated strabismus surgery. 14 patients (19.4%) had a repeat muscle surgery, although 55 (76.4%) of the 72 patients achieved orthotropia or had deviations within 10 prism dioptres at the end of the follow-up period. Corneal microperforation was encountered in two (2.8%) patients and conjunctival staining in 10 eyes. Cosmesis was good for all patients. Patients who required repeat KTPG or strabismus surgery, or those in whom orthotropia was not totally restored, considered their cosmetic appearance sufficiently improved. CONCLUSION Corneal KTPG combined with strabismus surgery provides good cosmesis for patients with corneal scarring and strabismus with minimal complications. Reoperation rates are relatively high in the short term to accomplish an optimal cosmetic result.
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Affiliation(s)
- Joan D Balgos
- Research & Development Department and Cornea and Ocular Surface Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Alicante, Spain
| | - Maria A Amesty
- Ocular, Plastic, Reconstructive, Lacrimal and Orbital Surgery Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Alicante, Spain
| | - Alejandra E Rodriguez
- Research & Development Department and Cornea and Ocular Surface Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Alicante, Spain
| | - Olena Al-Shymali
- Research & Development Department and Cornea and Ocular Surface Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Alicante, Spain
| | - Sabat Abumustafa
- Department of Ophthalmology, Ahmadi Hospital Kuwait, Kuwait City, Kuwait
| | - Jorge L Alio
- Refractive Surgery Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Alicante, Spain .,Department of Ophthalmology, Universidad Miguel Hernández de Elche, Elche, Alicante, Spain
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Bocheux R, Pernot P, Borderie V, Plamann K, Irsch K. Quantitative measures of corneal transparency, derived from objective analysis of depth-resolved corneal images, demonstrated with full-field optical coherence tomographic microscopy. PLoS One 2019; 14:e0221707. [PMID: 31461476 PMCID: PMC6713351 DOI: 10.1371/journal.pone.0221707] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/13/2019] [Indexed: 11/18/2022] Open
Abstract
Loss of corneal transparency, as occurs with various pathologies, infections, immune reactions, trauma, aging, and surgery, is a major cause of visual handicap worldwide. However, current means to assess corneal transparency are extremely limited and clinical and eye-bank practice usually involve a subjective and qualitative observation of opacities, sometimes with comparison against an arbitrary grading scale, by means of slit-lamp biomicroscopy. Here, we describe a novel objective optical data analysis-based method that enables quantifiable and standardized characterization of corneal transparency from depth-resolved corneal images, addressing the demand for such a means in both the laboratory and clinical ophthalmology setting. Our approach is based on a mathematical analysis of the acquired optical data with respect to the light attenuation from scattering processes in the corneal stroma. Applicable to any depth-resolved corneal imaging modality, it has been validated by means of full-field optical coherence tomographic microscopy (FF-OCT or FF-OCM). Specifically, our results on ex-vivo corneal specimens illustrate that 1) in homogeneous tissues, characterized by an exponential light attenuation with stromal depth (z), the computation of the scattering mean-free path (ls) from the rate of exponential decay allows quantification of the degree of transparency; 2) in heterogeneous tissues, identified by significant deviations from the normal exponential z -profile, a measure of exponential-decay model inadequacy (e.g., by computation of the Birge ratio) allows the estimation of severity of stromal heterogeneity, and the associated depth-dependent variations around the average ls enables precise localization of the pathology.
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Affiliation(s)
- Romain Bocheux
- Laboratoire d'Optique et Biosciences (LOB)–École polytechnique, CNRS UMR 7645, INSERM U 1182, Institut polytechnique de Paris, and LOA–ENSTA ParisTech, École polytechnique, CNRS UMR 7639, Institut polytechnique de Paris, Palaiseau, France
- Vision Institute / Quinze-Vingts National Eye Hospital / GRC32 / CIC1423 –Sorbonne University, CNRS UMR 7210, INSERM U 968, Paris, France
| | - Pascal Pernot
- Laboratoire de Chimie Physique–Université Paris-Sud, CNRS UMR 8000, Orsay, France
| | - Vincent Borderie
- Vision Institute / Quinze-Vingts National Eye Hospital / GRC32 / CIC1423 –Sorbonne University, CNRS UMR 7210, INSERM U 968, Paris, France
| | - Karsten Plamann
- Laboratoire d'Optique et Biosciences (LOB)–École polytechnique, CNRS UMR 7645, INSERM U 1182, Institut polytechnique de Paris, and LOA–ENSTA ParisTech, École polytechnique, CNRS UMR 7639, Institut polytechnique de Paris, Palaiseau, France
| | - Kristina Irsch
- Vision Institute / Quinze-Vingts National Eye Hospital / GRC32 / CIC1423 –Sorbonne University, CNRS UMR 7210, INSERM U 968, Paris, France
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Fenton OS, Paolini M, Andresen JL, Müller FJ, Langer R. Outlooks on Three-Dimensional Printing for Ocular Biomaterials Research. J Ocul Pharmacol Ther 2019; 36:7-17. [PMID: 31211652 PMCID: PMC6985767 DOI: 10.1089/jop.2018.0142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022] Open
Abstract
Given its potential for high-resolution, customizable, and waste-free fabrication of medical devices and in vitro biological models, 3-dimensional (3D) bioprinting has broad utility within the biomaterials field. Indeed, 3D bioprinting has to date been successfully used for the development of drug delivery systems, the recapitulation of hard biological tissues, and the fabrication of cellularized organ and tissue-mimics, among other applications. In this study, we highlight convergent efforts within engineering, cell biology, soft matter, and chemistry in an overview of the 3D bioprinting field, and we then conclude our work with outlooks toward the application of 3D bioprinting for ocular research in vitro and in vivo.
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Affiliation(s)
- Owen S. Fenton
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Marion Paolini
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Jason L. Andresen
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Florence J. Müller
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Robert Langer
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Harvard and MIT Division of Health Science and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts
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Zhang B, Xue Q, Li J, Ma L, Yao Y, Ye H, Cui Z, Yang H. 3D bioprinting for artificial cornea: Challenges and perspectives. Med Eng Phys 2019; 71:68-78. [PMID: 31201014 DOI: 10.1016/j.medengphy.2019.05.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/26/2019] [Accepted: 05/13/2019] [Indexed: 12/13/2022]
Abstract
Corneal disease is one of the most important causes of blindness worldwide. Currently, the dominating treatment of corneal blindness is corneal transplantation. However, the main source of cornea for transplantation is based on donations which is far from enough to meet the requirement (less than 1:70 of cases). The severe shortage of donor cornea promotes the studies of effective corneal alternatives. However, many problems remain and can't be solved in current researches, such as original geometry reconstruction and ocular optical function restoring. 3D bioprinting can be a promising approach for corneal substitution. The advantages of this technology in corneal regeneration enable personalized corneal implant and single or multi-layer corneal equivalents with controllable structure and designed refractive ability. In this review, the progress, applications and limitations of most influential works among current keratoprosthesis and tissue-engineering cornea researches are discussed. Then the applications of 3D bioprinting in manufacturing multi-layered structures and surface are mentioned. Further, the potential, advantages in current research of 3D bioprinting single or multi-layer corneal equivalents and alternatives are discussed. Finally, an insight into the technical challenges and prospective facing the future research of 3D bioprinting corneal alternatives in vivo and in vitro is provided.
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Affiliation(s)
- Bin Zhang
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou (310058), People's Republic of China; School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, People's Republic of China
| | - Qian Xue
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou (310058), People's Republic of China; School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, People's Republic of China
| | - Jintao Li
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou (310058), People's Republic of China; School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, People's Republic of China
| | - Liang Ma
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou (310058), People's Republic of China; School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, People's Republic of China.
| | - Yufeng Yao
- Department of Ophthalmology, Sir Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qingchun Road East Hangzhou 310016, Zhejiang Province, People's Republic of China
| | - Hua Ye
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, OX1 3PJ, UK
| | - Zhanfeng Cui
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, OX1 3PJ, UK
| | - Huayong Yang
- State Key Laboratory of Fluid Power and Mechatronic Systems, Zhejiang University, Hangzhou (310058), People's Republic of China; School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, People's Republic of China
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Menko AS, Walker JL, Stepp MA. Fibrosis: Shared Lessons From the Lens and Cornea. Anat Rec (Hoboken) 2019; 303:1689-1702. [PMID: 30768772 PMCID: PMC6697240 DOI: 10.1002/ar.24088] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/23/2018] [Accepted: 09/04/2018] [Indexed: 12/13/2022]
Abstract
Regenerative repair in response to wounding involves cell proliferation and migration. This is followed by the reestablishment of cell structure and organization and a dynamic process of remodeling and restoration of the injured cells' extracellular matrix microenvironment and the integration of the newly synthesized matrix into the surrounding tissue. Fibrosis in the lungs, liver, and heart can lead to loss of life and in the eye to loss of vision. Learning to control fibrosis and restore normal tissue function after injury repair remains a goal of research in this area. Here we use knowledge gained using the lens and the cornea to provide insight into how fibrosis develops and clues to how it can be controlled. The lens and cornea are less complex than other tissues that develop life‐threatening fibrosis, but they are well characterized and research using them as model systems to study fibrosis is leading toward an improved understanding of fibrosis. Here we summarize the current state of the literature and how it is leading to promising new treatments. Anat Rec, 2019. © 2019 The Authors. The Anatomical Record published by Wiley Periodicals, Inc. on behalf of American Association of Anatomists.
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Affiliation(s)
- A Sue Menko
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Janice L Walker
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mary Ann Stepp
- Department of Anatomy and Cell Biology, George Washington University, Washington, District of Columbia
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Abstract
PURPOSE Severe corneal disease contributes significantly to the global burden of blindness. Corneal allograft surgery remains the most commonly used treatment, but does not succeed long term in every patient, and the odds of success fall with each repeated graft. The Boston keratoprosthesis type I has emerged as an alternative to repeat corneal allograft. However, cost limits its use in resource-poor settings, where most corneal blind individuals reside. METHODS All aspects of the Boston keratoprosthesis design process were examined to determine areas of potential modification and simplification, with dual goals to reduce cost and improve the cosmetic appearance of the device in situ. RESULTS Minor modifications in component design simplified keratoprosthesis manufacturing. Proportional machinist time could be further reduced by adopting a single axial length for aphakic eyes, and a single back plate diameter. The cosmetic appearance was improved by changing the shape of the back plate holes from round to radial, with a petaloid appearance, and by anodization of back plate titanium to impute a more natural color. CONCLUSIONS We have developed a modified Boston keratoprosthesis type I, which we call the "Lucia." The Lucia retains the 2 piece design and ease of assembly of the predicate device, but would allow for manufacturing at a reduced cost. Its appearance should prove more acceptable to implanted patients. Successful keratoprosthesis outcomes require daily medications for the life of the patient and rigorous, frequent, postoperative care. Effective implementation of the device in resource-poor settings will require further innovations in eye care delivery.
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Xiong S, Gao H, Qin L, Jia Y, Gao M, Ren L. Microgrooved collagen-based corneal scaffold for promoting collective cell migration and antifibrosis. RSC Adv 2019; 9:29463-29473. [PMID: 35528407 PMCID: PMC9071845 DOI: 10.1039/c9ra04009a] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/19/2019] [Indexed: 02/04/2023] Open
Abstract
Microgrooved collagen membrane can effectively promote the epithelialization of corneal epithelial cells and inhibit the fibrosis of corneal stromal cells.
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Affiliation(s)
- Sijia Xiong
- School of Materials Science and Engineering
- South China University of Technology
- Guangzhou 510641
- China
- National Engineering Research Centre for Tissue Restoration and Reconstruction
| | - Huichang Gao
- School of Medicine
- South China University of Technology
- Guangzhou 510006
- China
| | - Lanfeng Qin
- National Engineering Research Centre for Tissue Restoration and Reconstruction
- Guangzhou 510006
- China
- Guangdong Province Key Laboratory of Biomedical Engineering
- South China University of Technology
| | - Yongguang Jia
- School of Materials Science and Engineering
- South China University of Technology
- Guangzhou 510641
- China
- National Engineering Research Centre for Tissue Restoration and Reconstruction
| | - Meng Gao
- School of Materials Science and Engineering
- South China University of Technology
- Guangzhou 510641
- China
- National Engineering Research Centre for Tissue Restoration and Reconstruction
| | - Li Ren
- School of Materials Science and Engineering
- South China University of Technology
- Guangzhou 510641
- China
- National Engineering Research Centre for Tissue Restoration and Reconstruction
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Optical Coherence Tomography-Guided Transepithelial Phototherapeutic Keratectomy for Central Corneal Opacity in the Pediatric Population. J Ophthalmol 2018; 2018:3923617. [PMID: 30671257 PMCID: PMC6323485 DOI: 10.1155/2018/3923617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/30/2018] [Accepted: 12/05/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To report the outcomes of optical coherence tomography- (OCT-) guided transepithelial phototherapeutic keratectomy (PTK) for central corneal opacity in the pediatric population. Methods The charts of 10 eyes of 8 children aged 9 to 17 with central corneal opacity from various pathologies who underwent a standardized OCT-guided transepithelial PTK technique at a single private practice institution were retrospectively reviewed. The corneal topographic findings, OCT measurements, and visual results with refractive outcomes were analyzed 6 months after the PTK treatment. Results All 10 eyes tolerated the procedure well without any significant intraoperative or postoperative complications. Uncorrected and best spectacle-corrected visual acuity (BSCVA) significantly improved postoperatively (p < 0.0001 and p=0.0045, respectively). The absolute value of spherical equivalent on cycloplegic refraction significantly improved postoperatively as well (p=0.0014), but there were no significant changes in topographic measurements. Seven out of the 10 eyes had complete resolution of the central corneal opacity on OCT imaging. None of the subjects lost any lines of BSCVA and developed recurrence of the corneal opacity from the primary disease condition or required keratoplasty during the follow-up period. Conclusions OCT-guided transepithelial PTK can provide excellent visual outcomes in pediatric patients with central corneal opacities.
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Etiology of Global Corneal Blindness and Current Practices of Corneal Transplantation: A Focused Review. Cornea 2018; 37:1198-1203. [PMID: 29912039 DOI: 10.1097/ico.0000000000001666] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this focused review was to explore the etiologies of corneal blindness worldwide and compare them with the indications and type of keratoplasties (eg, full-thickness penetrating keratoplasty, anterior lamellar keratoplasty, or endothelial keratoplasty) performed. METHODS A literature search of the articles published in the top 10 journals (based on the Altmetrics score) relevant to corneal transplantation within the past 20 years was performed to determine how the focus within corneal transplantation has changed over time. These data were compared with the prevalence and etiology of corneal blindness in each respective region worldwide. RESULTS The leading etiologies of corneal blindness worldwide are primarily due to anterior corneal pathology with a normal endothelium, and the prevalence is highest in developing countries. In addition, the number and type of corneal transplantations performed globally indicate that current practices are disproportionately skewed in favor of endothelial keratoplasty, which is targeted for the pathology prevalent in developed countries. Despite the large number of individuals who would benefit from anterior lamellar keratoplasty, this technique seems to be infrequently performed. CONCLUSIONS Most corneal blindness worldwide is secondary to anterior corneal pathology because of infections and trauma. However, this does not align with the current trends and practices in the field of corneal transplantation. We discuss potential solutions to address the current leading causes of global corneal blindness, including increasing the number of anterior lamellar keratoplasties performed, using long-term preserved corneas by trained surgeons, and improving eye bank handling and distribution of procured tissues.
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Mazlin V, Xiao P, Dalimier E, Grieve K, Irsch K, Sahel JA, Fink M, Boccara AC. In vivo high resolution human corneal imaging using full-field optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2018; 9:557-568. [PMID: 29552393 PMCID: PMC5854058 DOI: 10.1364/boe.9.000557] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/29/2017] [Accepted: 01/04/2018] [Indexed: 05/18/2023]
Abstract
We present the first full-field optical coherence tomography (FFOCT) device capable of in vivo imaging of the human cornea. We obtained images of the epithelial structures, Bowman's layer, sub-basal nerve plexus (SNP), anterior and posterior stromal keratocytes, stromal nerves, Descemet's membrane and endothelial cells with visible nuclei. Images were acquired with a high lateral resolution of 1.7 µm and relatively large field-of-view of 1.26 mm x 1.26 mm - a combination, which, to the best of our knowledge, has not been possible with other in vivo human eye imaging methods. The latter together with a contactless operation, make FFOCT a promising candidate for becoming a new tool in ophthalmic diagnostics.
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Affiliation(s)
- Viacheslav Mazlin
- Institute Langevin, ESPCI PARIS, PSL Research University, 1 Rue Jussieu, Paris, 75005, France
| | - Peng Xiao
- Institute Langevin, ESPCI PARIS, PSL Research University, 1 Rue Jussieu, Paris, 75005, France
| | - Eugénie Dalimier
- LLTech SAS, 29 Rue du Faubourg Saint Jacques, Paris, 75014, France
| | - Kate Grieve
- Vision Institute/CIC 1423, UPMC-Sorbonne Universities, UMR_S 968/INSERM, U968/CNRS, UMR_7210, 17 Rue Moreau, Paris, 75012, France
- Quinze-Vingts National Eye Hospital, 28 Rue de Charenton, Paris, 75012, France
| | - Kristina Irsch
- Vision Institute/CIC 1423, UPMC-Sorbonne Universities, UMR_S 968/INSERM, U968/CNRS, UMR_7210, 17 Rue Moreau, Paris, 75012, France
- Quinze-Vingts National Eye Hospital, 28 Rue de Charenton, Paris, 75012, France
- Laboratory of Ophthalmic Instrument Development, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD 21287, USA
| | - José-Alain Sahel
- Vision Institute/CIC 1423, UPMC-Sorbonne Universities, UMR_S 968/INSERM, U968/CNRS, UMR_7210, 17 Rue Moreau, Paris, 75012, France
- Quinze-Vingts National Eye Hospital, 28 Rue de Charenton, Paris, 75012, France
- Department of Ophthalmology, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15213, USA
| | - Mathias Fink
- Institute Langevin, ESPCI PARIS, PSL Research University, 1 Rue Jussieu, Paris, 75005, France
| | - A. Claude Boccara
- Institute Langevin, ESPCI PARIS, PSL Research University, 1 Rue Jussieu, Paris, 75005, France
- LLTech SAS, 29 Rue du Faubourg Saint Jacques, Paris, 75014, France
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Nguyen KN, Bobba S, Richardson A, Park M, Watson SL, Wakefield D, Di Girolamo N. Native and synthetic scaffolds for limbal epithelial stem cell transplantation. Acta Biomater 2018; 65:21-35. [PMID: 29107055 DOI: 10.1016/j.actbio.2017.10.037] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 10/22/2017] [Accepted: 10/25/2017] [Indexed: 12/13/2022]
Abstract
UNLABELLED Limbal stem cell deficiency (LSCD) is a complex blinding disease of the cornea, which cannot be treated with conventional corneal transplants. Instead, a stem cell (SC) graft is required to replenish the limbal epithelial stem cell (LESC) reservoir, which is ultimately responsible for regenerating the corneal epithelium. Current therapies utilize limbal tissue biopsies that harbor LESCs as well as tissue culture expanded cells. Typically, this tissue is placed on a scaffold that supports the formation of corneal epithelial cell sheets, which are then transferred to diseased eyes. A wide range of biological and synthetic materials have been identified as carrier substrates for LESC, some of which have been used in the clinic, including amniotic membrane, fibrin, and silicon hydrogel contact lenses, each with their own advantages and limitations. This review will provide a brief background of LSCD, focusing on bio-scaffolds that have been utilized in limbal stem cell transplantation (LSCT) and materials that are being developed as potentially novel therapeutics for patients with this disease. STATEMENT OF SIGNIFICANCE The outcome of patients with corneal blindness that receive stem cell grafts to restore eye health and correct vision varies considerably and may be due to the different biological and synthetic scaffolds used to deliver these cells to the ocular surface. This review will highlight the positive attributes and limitations of the myriad of carriers developed for clinical use as well as those that are being trialled in pre-clinical models. The overall focus is on developing a standardized therapy for patients, however due to the multiple causes of corneal blindness, a personal regenerative medicine approach may be the best option.
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Affiliation(s)
- Kim N Nguyen
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Samantha Bobba
- Prince of Wales Hospital Clinical School, Sydney, Australia
| | | | - Mijeong Park
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | | | - Denis Wakefield
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Nick Di Girolamo
- School of Medical Sciences, University of New South Wales, Sydney, Australia.
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González-Andrades M, Mata R, González-Gallardo MDC, Medialdea S, Arias-Santiago S, Martínez-Atienza J, Ruiz-García A, Pérez-Fajardo L, Lizana-Moreno A, Garzón I, Campos A, Alaminos M, Carmona G, Cuende N. A study protocol for a multicentre randomised clinical trial evaluating the safety and feasibility of a bioengineered human allogeneic nanostructured anterior cornea in patients with advanced corneal trophic ulcers refractory to conventional treatment. BMJ Open 2017; 7:e016487. [PMID: 28947445 PMCID: PMC5623476 DOI: 10.1136/bmjopen-2017-016487] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION There is a need to find alternatives to the use of human donor corneas in transplants because of the limited availability of donor organs, the incidence of graft complications, as well as the inability to successfully perform corneal transplant in patients presenting limbal deficiency, neo-vascularized or thin corneas, etc. We have designed a clinical trial to test a nanostructured fibrin-agarose corneal substitute combining allogeneic cells that mimics the anterior human native cornea in terms of optical, mechanical and biological behaviour. METHODS AND ANALYSIS This is a phase I-II, randomised, controlled, open-label clinical trial, currently ongoing in ten Spanish hospitals, to evaluate the safety and feasibility, as well as clinical efficacy evidence, of this bioengineered human corneal substitute in adults with severe trophic corneal ulcers refractory to conventional treatment, or with sequelae of previous ulcers. In the initial phase of the trial (n=5), patients were sequentially recruited, with a safety period of 45 days, receiving the bioengineered corneal graft. In the second phase of the trial (currently ongoing), subjects are block randomised (2:1) to receive either the corneal graft (n=10), or amniotic membrane (n=5), as the control treatment. Adverse events, implant status, infection signs and induced neovascularization are evaluated as determinants of safety and feasibility of the bioengineered graft (main outcomes). Study endpoints are measured along a follow-up period of 24 months, including 27 post-implant assessment visits according to a decreasing frequency. Intention to treat, and per protocol, and safety analysis will be performed. ETHICS AND DISSEMINATION The trial protocol received written approval by the corresponding Ethics Committee and the Spanish Regulatory Authority and is currently recruiting subjects. On completion of the trial, manuscripts with the results of phases I and II of the study will be published in a peer-reviewed journal. TRIAL REGISTRATION CT.gov identifier: NCT01765244 (Jan2013). EudraCT number: 2010-024290-40 (Dec2012).
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Affiliation(s)
- Miguel González-Andrades
- Department of Ophthalmology Service, University Hospital Complex of Granada (San Cecilio and Virgen de las Nieves Hospitals), Granada, Spain
- Tissue Engineering Group, Department of Histology, University of Granada, Granada, Spain
- Department of Ophthalmology, Schepens Eye Research Institute of Massachusetts, Harvard Medical School, Boston, Massachusetts, USA
| | - Rosario Mata
- Andalusian Initiative for Advanced Therapies, Junta de Andalucía, Seville, Spain
| | - María del Carmen González-Gallardo
- Department of Ophthalmology Service, University Hospital Complex of Granada (San Cecilio and Virgen de las Nieves Hospitals), Granada, Spain
| | - Santiago Medialdea
- Department of Ophthalmology Service, University Hospital Complex of Granada (San Cecilio and Virgen de las Nieves Hospitals), Granada, Spain
| | - Salvador Arias-Santiago
- Cell Therapy and Tissue Engineering Unit, University Hospital Complex of Granada (Virgen de las Nieves Hospital), Granada, Spain
| | | | - Antonio Ruiz-García
- Cell Therapy and Tissue Engineering Unit, University Hospital Complex of Granada (Virgen de las Nieves Hospital), Granada, Spain
- PhD program Clinical Medicine and Public Health, University of Granada, Granada, Spain
| | - Lorena Pérez-Fajardo
- Andalusian Initiative for Advanced Therapies, Junta de Andalucía, Seville, Spain
| | - Antonio Lizana-Moreno
- Cell Therapy and Tissue Engineering Unit, University Hospital Complex of Granada (Virgen de las Nieves Hospital), Granada, Spain
| | - Ingrid Garzón
- Tissue Engineering Group, Department of Histology, University of Granada, Granada, Spain
| | - Antonio Campos
- Tissue Engineering Group, Department of Histology, University of Granada, Granada, Spain
| | - Miguel Alaminos
- Tissue Engineering Group, Department of Histology, University of Granada, Granada, Spain
| | - Gloria Carmona
- Andalusian Initiative for Advanced Therapies, Junta de Andalucía, Seville, Spain
- PhD program Clinical Medicine and Public Health, University of Granada, Granada, Spain
| | - Natividad Cuende
- Andalusian Initiative for Advanced Therapies, Junta de Andalucía, Seville, Spain
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Jabbour S, Harissi-Dagher M. Plugging the gap: could frozen Boston keratoprosthesis grafts end the cornea donor shortage? EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1379902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Samir Jabbour
- Ophthalmology, Centre Hospitalier de l’Université de Montréal (CHUM), Hôpital Notre-Dame, Montréal, QC, Canada
| | - Mona Harissi-Dagher
- Ophthalmology, Centre Hospitalier de l’Université de Montréal (CHUM), Hôpital Notre-Dame, Montréal, QC, Canada
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Transient Ingrowth of Lymphatic Vessels into the Physiologically Avascular Cornea Regulates Corneal Edema and Transparency. Sci Rep 2017; 7:7227. [PMID: 28775329 PMCID: PMC5543160 DOI: 10.1038/s41598-017-07806-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 06/29/2017] [Indexed: 01/17/2023] Open
Abstract
Lymphangiogenesis is essential for fluid homeostasis in vascularized tissues. In the normally avascular cornea, however, pathological lymphangiogenesis mediates diseases like corneal transplant rejection, dry eye disease, and allergy. So far, a physiological role for lymphangiogenesis in a primarily avascular site such as the cornea has not been described. Using a mouse model of perforating corneal injury that causes acute and severe fluid accumulation in the cornea, we show that lymphatics transiently and selectively invade the cornea and regulate the resolution of corneal edema. Pharmacological blockade of lymphangiogenesis via VEGFR-3 inhibition results in increased corneal thickness due to delayed drainage of corneal edema and a trend towards prolonged corneal opacification. Notably, lymphatics are also detectable in the cornea of a patient with acute edema due to spontaneous Descemet´s (basement) membrane rupture in keratoconus, mimicking this animal model and highlighting the clinical relevance of lymphangiogenesis in corneal fluid homeostasis. Together, our findings provide evidence that lymphangiogenesis plays an unexpectedly beneficial role in the regulation of corneal edema and transparency. This might open new treatment options in blinding diseases associated with corneal edema and transparency loss. Furthermore, we demonstrate for the first time that physiological lymphangiogenesis also occurs in primarily avascular sites.
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Wei S, Zhang C, Zhang S, Xu Y, Mu G. Treatment Results of Corneal Collagen Cross-Linking Combined with Riboflavin and 440 Nm Blue Light for Bacterial Corneal Ulcer in Rabbits. Curr Eye Res 2017. [PMID: 28644681 DOI: 10.1080/02713683.2017.1332767] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Shufang Wei
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- Department of Ophthalmology, Liaocheng People’s Hospital, Liaocheng, China
| | - Cuiying Zhang
- Department of Ophthalmology, Liaocheng People’s Hospital, Liaocheng, China
| | - Shaoru Zhang
- Department of Ophthalmology, Liaocheng People’s Hospital, Liaocheng, China
| | - Yanyun Xu
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Guoying Mu
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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Wound-Healing Studies in Cornea and Skin: Parallels, Differences and Opportunities. Int J Mol Sci 2017; 18:ijms18061257. [PMID: 28604651 PMCID: PMC5486079 DOI: 10.3390/ijms18061257] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/24/2017] [Accepted: 05/31/2017] [Indexed: 02/06/2023] Open
Abstract
The cornea and the skin are both organs that provide the outer barrier of the body. Both tissues have developed intrinsic mechanisms that protect the organism from a wide range of external threats, but at the same time also enable rapid restoration of tissue integrity and organ-specific function. The easy accessibility makes the skin an attractive model system to study tissue damage and repair. Findings from skin research have contributed to unravelling novel fundamental principles in regenerative biology and the repair of other epithelial-mesenchymal tissues, such as the cornea. Following barrier disruption, the influx of inflammatory cells, myofibroblast differentiation, extracellular matrix synthesis and scar formation present parallel repair mechanisms in cornea and skin wound healing. Yet, capillary sprouting, while pivotal in proper skin wound healing, is a process that is rather associated with pathological repair of the cornea. Understanding the parallels and differences of the cellular and molecular networks that coordinate the wound healing response in skin and cornea are likely of mutual importance for both organs with regard to the development of regenerative therapies and understanding of the disease pathologies that affect epithelial-mesenchymal interactions. Here, we review the principal events in corneal wound healing and the mechanisms to restore corneal transparency and barrier function. We also refer to skin repair mechanisms and their potential implications for regenerative processes in the cornea.
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Design and evaluation of artificial cornea with core–skirt design using polyhydroxyethyl methacrylate and graphite. Int Ophthalmol 2017; 38:1225-1233. [DOI: 10.1007/s10792-017-0586-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 06/05/2017] [Indexed: 11/26/2022]
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49
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PROPORTION OF CORNEAL BLINDNESS IN BLIND PATIENTS ATTENDING FOR BLIND CERTIFICATES IN REGIONAL EYE HOSPITAL, KURNOOL. ACTA ACUST UNITED AC 2017. [DOI: 10.14260/jemds/2017/519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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50
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McKay TB, Karamichos D. Quercetin and the ocular surface: What we know and where we are going. Exp Biol Med (Maywood) 2017; 242:565-572. [PMID: 28056553 PMCID: PMC5685256 DOI: 10.1177/1535370216685187] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Flavonoids are a class of plant and fungus secondary metabolites that serve functional roles in protecting against UV-induced oxidative stress, mediating auxin signaling, and promoting microbial defense. Flavonoids are extremely abundant in nature where their potent antioxidant capacity and very low toxicity makes them highly attractive as potential therapeutic agents. In terms of clinical applications, neither the Food and Drug Administration (FDA) nor the European Food Safety Authority (EFSA) has approved any health claims or drugs related to the use of flavonoids for therapeutic purposes. Quercetin is a common flavonol that has been shown to have potent antioxidant, anti-inflammatory, and anti-fibrotic activities both in vitro and in vivo in various tissues. Recently, the application of quercetin as a therapeutic has been gaining attention in the ocular surface scientific community in the study of dry eye, keratoconus, inflammation, and neovascularization of the cornea. This review will discuss the latest findings and the use of quercetin for the treatment of dystrophies of the ocular surface. Impact statement The eye represents a small portion of the human body, accounting for one decimal fraction of the anterior body surface. The cornea is an avascular, transparent tissue that acts as a primary barrier against mechanical and infectious damaging agents, protecting the internal structures of the eye. Corneal survival and function are affected by a number of factors including but not limited to injury, trauma, infection, genetics, and environment. Corneal injury, or trauma, often leads to loss of corneal transparency and even blindness. The concept of "curing" corneal opacity has been discussed in published form for over 200 years. Currently, full corneal transplant is the only treatment option. There is a strong interest in developing natural therapeutic products that come with minimum side effects. A novel antioxidant flavonoid, quercetin, has been gaining traction as a potential therapeutic to prevent the injured cornea. This review discusses the potential of this antioxidant.
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Affiliation(s)
- Tina B McKay
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104,USA
| | - Dimitrios Karamichos
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104,USA
- Department of Ophthalmology, Dean McGee Eye Institute, Oklahoma City, OK 73104, USA
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