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Chaum E, Kim DB, Kane S, Swann FB, Waite A, Wade LR, Riemann CD, Snyder ME. Pilot Safety Study of a Microfabricated Device for Anterior Stromal Puncture to Treat Corneal Epithelial Disease in the Optical Axis. Cornea 2024:00003226-990000000-00640. [PMID: 39085991 DOI: 10.1097/ico.0000000000003651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/23/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE Anterior stromal puncture is an inexpensive and widely used technique at the slit lamp to treat recurrent corneal erosions (RCE), common sequelae of corneal abrasions, trauma, and epithelial basement membrane dystrophies (EBMDs). The purpose of this study was to determine safety of a novel anterior stromal micropuncture device (termed a "plexitome") for use in the optical axis of the cornea. METHODS We performed an IRB-approved clinical pilot study on 45 patients with diverse corneal pathologies to determine the safety of the plexitome device and examined corneal healing responses clinically for a minimum of 30 days after treatment. Follow on efficacy data was collected for treated patients with RCE. Micropuncture treatment was performed either through loose epithelial tissue or after debridement using a cotton tip at the slit lamp. After "imprinting," patients were treated with topical medications including antibiotics, hypertonic saline/ointment, bandage contact lenses, and/or patching according to the treating physician's routine care for the condition. RESULTS Micropuncture using the "plexitome" device did not create visible scars in the corneal stroma of the 45 patients treated and followed for at least 30 days. Photographic evidence of imprinting was seen at in 1 patient at 30 days. There were no significant adverse events associated with treatment. CONCLUSIONS Micropuncture of the cornea using the "plexitome" device does not create optically evident anterior stromal scarring after treatment. Micropuncture using the device may be an effective way of treating RCE and other corneal manifestations of EBMD in the optical axis, which is not currently possible using standard anterior stromal puncture methods.
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Affiliation(s)
- Edward Chaum
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | - Lloyd R Wade
- Department of Biomedical Engineering, University of Mississippi, Oxford, MS; and
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Muacevic A, Adler JR, Soultanidis M, Athanasiadis IK. Safety and Efficacy of Hypertonic Sodium Chloride 5% Ointment for Recurrent Corneal Erosion Syndrome. Cureus 2022; 14:e32796. [PMID: 36694530 PMCID: PMC9858893 DOI: 10.7759/cureus.32796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background In this study, we aimed to assess the safety and efficacy of hypertonic sodium chloride 5% ointment in the treatment of recurrent corneal erosion syndrome (RCES). Methodology A total of 21 eyes from 21 patients with RCES either following trauma or spontaneously due to underlying anterior basement membrane dystrophy (ABMD) were prospectively enrolled over a six-month period. The acute episode was managed with topical sodium chloride 5% ophthalmic ointment applied twice daily for 30 days. Patients were followed up at one month and six months with visual acuity and endothelial cell count (ECC) measurement. Results The mean age was 44.19 years (range = 17-87 years). All patients had unilateral involvement. The etiology was ABMD in 12 cases, while nine cases were post-traumatic. The mean best-corrected visual acuity (BCVA) at presentation was 0.32 logMAR units (SD = 0.18), and the mean ECC before treatment initiation was 2,720 cells/mm2 (SD ± 192). At the one-month follow-up, all patients had a full recovery with complete re-epithelization of the defective area and resolution of symptoms. The mean BCVA was 0.05 logMAR units (SD = 0.12), and the mean ECC was 2,703 cells/mm2 (SD = 205). At six months, only one recurrence was documented following another episode of trauma. The mean BCVA and ECC at six months were 0.01 logMAR units and 2,714 cells/mm2, respectively. Conclusions Sodium chloride 5% ophthalmic ointment applied twice daily for 30 days following the acute event seems to be a safe and effective treatment option for RCES from both traumatic and ABMD etiology.
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Zhang Y, Lin L, Zhu Y, Yang S, Huang X. Long-Term Clinical Outcome of Low-Temperature Plasma Ablation Treatment for Recurrent Corneal Erosions. J Clin Med 2022; 11:jcm11216280. [PMID: 36362507 PMCID: PMC9654815 DOI: 10.3390/jcm11216280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose: To observe the therapeutic effect of low-temperature plasma ablation in treating patients with recurrent corneal erosions (RCEs). Materials and Methods: From 2020 to 2022, 35 participants with unilateral RCEs voluntarily enrolled. Here, 35 eyes of 35 patients were treated with low-temperature plasma ablation (coblation). All surgeries were performed by the same doctor (X.H.). The coblation went back and forth over the entire erosion area around five times for about five minutes. After the operation, patients were scheduled for follow-up visits at the outpatient clinic after 1 month, 3 months, 6 months, and 12 months, and at the end of the trial. During every visit, each patient underwent an evaluation of their ocular symptoms utilizing the following: pain score, intraocular pressure, slit lamp biomicroscopic examination, dry eye analysis, corneal topography, and corneal in vivo confocal microscopy (IVCM). Results: The mean follow-up time was 12.4 ± 6.1 months, ranging from 6 to 29 months. Of the 35 patients who had low-temperature plasma ablation, 32 eyes (91.43%) were completely symptom-free and three (8.57%) eyes had repeated episodes of recurrent corneal erosions after the surgery, at 3, 10, and 12 months, respectively. The typical RCE morphologic abnormalities observed in IVCM included the deformation and relaxation of the corneal epithelium, disorganized stromal fibers, reduced nerve fiber density, and disordered organization. After low-temperature plasma ablation, the loose cysts disappeared, and the epithelium became solid and tight. There was no obvious difference in the intraocular pressure (p = 0.090) or corneal astigmatism (p = 0.175) before and after treatment. The mean pain score decreased significantly, with a preoperative score of 7.7 ± 2.4 and postoperative score of 1.1 ± 1.8 (p < 0.001). The mean corneal thickness decreased from 562.6 ± 42.2 mm to 549.6 ± 26.9 mm (p = 0.031). The mean non-invasive keratograph tear meniscus height (NIKTMH) decreased from 0.210 ± 0.054 mm to 0.208 ± 0.045 mm (p = 0.001), and the mean TBUT decreased from 6.191 ± 2.811 s to 5.815 ± 2.802 s (p < 0.001), which manifested as a slight worsening of dry eyes. In one case, the patient’s corneal astigmatism became more severe, which may be related to the high instantaneous energy when the operation did not flush in a timely manner, and it was recovered after 6 months. Conclusions: Low-temperature plasma ablation is an effective and safe procedure to treat patients with recurrent corneal erosions.
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Teh BL, Chua PYS, Reddy AR. Three-year outcomes of alcohol delamination of corneal epithelium for recurrent corneal erosions of traumatic etiology. Indian J Ophthalmol 2021; 69:2437-2440. [PMID: 34427239 PMCID: PMC8544076 DOI: 10.4103/ijo.ijo_3796_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Alcohol delamination of the corneal epithelium (ADCE) is a therapeutic option for patients with recurrent corneal erosion (RCE) who do not respond to nonsurgical management of lubricants and extended wear contact lens. The aim of the study is to report on three-year efficacy and safety of ADCE for RCE of traumatic etiology. Methods This is a retrospective review of consecutive patients who underwent ADCE for traumatic RCE in a local hospital between January 2010 and January 2020. The outcomes at a 3-year follow-up review are included. Nonsurgical therapy used; intra- and postoperative complications were recorded. ADCE was only offered to those who remained symptomatic despite maximum topical lubrications and/or extended wear contact lens. Success was defined as the absence of recurrence of corneal erosion. Results Twenty-six eyes of 26 patients with RCE caused by trauma underwent ADCE. The mean age of patients was 39 years. The follow-up period was a minimum of 36 months. Three eyes (11.5%) had recurrence of corneal erosion after ADCE at the 3-year follow-up. Recurrence was noted at months 2, 23, and 36 postoperatively in these patients. All patients reported significant improvement in symptoms associated with recurrent erosion. Ten eyes (38.5%) stopped all topical lubricants postoperatively. No intra- or postoperative complications were noted in our study. Conclusion This study documents the long-term safety and efficacy of alcohol delamination of corneal epithelium at 3 years for patients with RCE of traumatic origin.
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Affiliation(s)
- Boon Lin Teh
- Eye Clinic, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, United Kingdom
| | - Paul Y S Chua
- Eye Clinic, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, United Kingdom
| | - Aravind R Reddy
- Eye Clinic, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, United Kingdom
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Singh S, Das S, Kannabiran C, Jakati S, Chaurasia S. Macular Corneal Dystrophy: An Updated Review. Curr Eye Res 2021; 46:765-770. [PMID: 33171054 DOI: 10.1080/02713683.2020.1849727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/16/2020] [Accepted: 11/01/2020] [Indexed: 01/11/2023]
Abstract
Macular Corneal Dystrophy is an autosomal recessive form of corneal dystrophy due to a mutation in CHST6 gene, which results in abnormal proteoglycan synthesis. There is accumulation of abnormal glycosaminoglycans in the corneal stroma and endothelium. The deposition results in progressive loss of corneal transparency and visual acuity. The histopathology shows characteristic alcian blue positive deposits. Management in the cases with visual loss requires keratoplasty either full thickness or lamellar. The decision about the ideal type of keratoplasty depends on age and pre-operative clinical features. Although prognosis after keratoplasty is good, recurrences can occur. Future research should be targeted towards gene therapy in this condition.
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Affiliation(s)
- Shalini Singh
- Cornea and Anterior Segment Services, LVPEI, Hyderabad, India
| | - Sujata Das
- Cornea and Anterior Segment Services, LVPEI, Bhubneshwar, India
| | - Chitra Kannabiran
- Kallam Anji Reddy Molecular Genetics Laboratory, Prof Brien Holden Eye Research Centre, Hyderabad, India
| | - Saumya Jakati
- Ophthalmic Pathology Laboratory, LVPEI, Hyderabad, India
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Use of Acellular Umbilical Cord-Derived Tissues in Corneal and Ocular Surface Diseases. MEDICINES 2021; 8:medicines8020012. [PMID: 33572327 PMCID: PMC7916115 DOI: 10.3390/medicines8020012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/25/2022]
Abstract
Blood derived products have become a valuable source of tissue for the treatment of ocular surface diseases that are refractory to conventional treatments. These can be obtained from autologous or allogeneic sources (patient’s own blood or from healthy adult donors/umbilical cord blood, respectively). Allogeneic cord blood demonstrates practical advantages over alternatives and these advantages will be discussed herein. Umbilical cord blood (UCB) can be divided, generally speaking, into two distinct products: first, mononuclear cells, which can be used in regenerative ophthalmology, and second, the plasma/serum (an acellular fraction), which may be used in the form of eyedrops administered directly to the damaged ocular surface. The rationale for using umbilical cord serum (UCS) to treat ocular surface diseases such as severe dry eye syndrome (DES), persistent epithelial defects (PED), recurrent epithelial erosions, ocular chemical burns, graft versus host disease (GVHD), among others, is the considerably high concentration of growth factors and cytokines, mimicking the natural healing properties of human tears. Allogeneic serum also offers the opportunity for therapeutic treatment to patients who, due to poor heath, cannot provide autologous serum. The mechanism of action involves the stimulation of endogenous cellular proliferation, differentiation and maturation, which is highly efficient in promoting and enhancing corneal epithelial healing where other therapies have previously failed.
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Song MY, Chung JL, Kim KY, Hwang KY, Kwon YA, Song SW, Kim BY, Koh K. Combined Phototherapeutic Keratectomy and Peripheral Anterior Stromal Puncture for the Treatment of Recurrent Corneal Erosion Syndrome. KOREAN JOURNAL OF OPHTHALMOLOGY 2020; 34:297-303. [PMID: 32783422 PMCID: PMC7419241 DOI: 10.3341/kjo.2020.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/03/2020] [Accepted: 04/16/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To investigate the efficacy of the combined phototherapeutic keratectomy (PTK) and peripheral anterior stromal puncture (ASP) compared with that of PTK alone in patients with recurrent corneal erosion syndrome (RCES). METHODS The medical records of 25 patients (25 eyes) who underwent combined treatment of PTK and peripheral ASP for RCES from March 2016 to May 2017 were retrospectively reviewed. Twenty-three patients (23 eyes) treated with PTK alone from March 2015 to February 2016 served as a control group. All surgeries were performed by a single surgeon. This retrospective clinical study comprised 48 patients (48 eyes) who were followed up for more than 18 months. Clinical records of age, sex, laterality, etiology of RCES, and history of recurrence after treatment were evaluated. RESULTS Twenty-five eyes were treated with combined PTK and ASP, and 23 eyes were treated with PTK only. The mean follow-up period was 19.63 ± 2.97 and 19.75 ± 6.83 months, respectively. There were no differences in baseline parameters between the groups. In the combined treatment group, one patient experienced recurrence 6 months after the surgery. In the single treatment group, five patients showed recurrence at 4, 7, 8, 11, and 13 months after the surgery, respectively. Compared to the single treatment group, the combined treatment group showed significantly lower recurrence rate (p < 0.05). All recurred patients required no additional treatment except temporary therapeutic contact lenses and topical lubricants. CONCLUSIONS Our findings suggest that combined treatment of PTK and peripheral ASP is effective in alleviation of symptoms and prevention of recurrence in refractory RCES compared with treatment using PTK alone.
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Affiliation(s)
- Mi Yeon Song
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | | | - Kook Young Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Kyu Yeon Hwang
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Young A Kwon
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Sang Wroul Song
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Byung Yeop Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Kyungmin Koh
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea.
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Kang EYC, Chen HT, Hsueh YJ, Chen HC, Tan HY, Hsiao CH, Yeh LK, Wu WC. Corneal Sensitivity and Tear Function in Recurrent Corneal Erosion Syndrome. Invest Ophthalmol Vis Sci 2020; 61:21. [PMID: 32181797 PMCID: PMC7401482 DOI: 10.1167/iovs.61.3.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine the association of corneal sensitivity and tear functions on the prognosis of eyes after posttraumatic recurrent corneal erosion syndrome (RCES). Methods Patients were enrolled retrospectively and had unilateral RCES and a history of ocular surface trauma. A corneal sensitivity test and tear function test (tear break-up time and Schirmer test) were performed at three time points (month 1 to month 3, month 3 to month 6, and month 6 to month 12). Depending on the number of recurrences during the follow-up, patients were divided into group A (n > 2) or group B (n = 2). A comparison between diseased and normal fellow eyes in each patient was performed. Results A total of 31 patients were enrolled and divided into group A (n = 14) and group B (n = 17). The mean age was 40.3 ± 12.2 years, whereas the mean follow-up was 28.0 ± 3.6 months. During the study period, corneal sensitivity, tear break-up time, and the Schirmer test results were all lower in diseased eyes than in normal fellow eyes in both groups. Compared to the first time point, recovery of corneal sensitivity and the Schirmer test values were observed in diseased eyes in group B at the second and third time points. Conclusions Poor corneal sensitivity and tear function are associated with posttraumatic RCES. Recovery of corneal sensitivity and tear function may be associated with a reduction of recurrence in eyes with posttraumatic RCES.
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Nanba H, Mimura T, Mizuno Y, Matsumoto K, Hamano S, Ubukata S, Yamamoto M, Watanabe E, Mizota A. Clinical course and risk factors of recurrent corneal erosion: Observational study. Medicine (Baltimore) 2019; 98:e14964. [PMID: 31008925 PMCID: PMC6494251 DOI: 10.1097/md.0000000000014964] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Recurrent corneal erosion (RCE) is a common disorder causing ocular pain, tearing, photophobia, and visual impairments. Various factors such as ocular trauma, ocular surgery, corneal dystrophy, contact lens wear, and diabetes mellitus (DM) can cause RCE. The purpose of this study was to determine the causative factors and clinical course of RCE.We retrospectively examined 21 eyes of 21 patients with RCE and investigated the patients' background, type of treatments, and clinical course after the treatments. All patients were treated with eye drops, ocular lubrication, or contact lens bandage for the RCE.Among the 21 patients with RCE, 9 were caused by trauma (Trauma group), 8 by DM (DM group), 1 by bacterial corneal ulcer, 1 by lagophthalmus and bacterial corneal ulcer, 1 by bandkeratopathy, and 1 by eyelid tumor (one eye). The mean age of the patients was 57.8 years with a range 34-91 years. The mean duration from the trauma to the onset of RCE was 5.2 ± 5.0 months (mean ± SD). The time required for a complete recovery of RCE was longer in the DM group (10.3 ± 3.1 weeks) than in the Trauma group (2.7 ± 1.1 weeks, P < .01). The presence of DM was significantly associated with the recovery duration of RCE (r = 0.72; P < .01). Multivariate analyses showed that the recovery duration of RCE was associated with the presence of DM (odds ratio = 139.8, P = .04). On the other hand, the type of treatments had no effect on the recovery duration of RCE.These findings suggest that trauma and DM are important causes of RCE. Wound recovery after RCE may be delayed in patients with DM.
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Affiliation(s)
- Hisataka Nanba
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo 173-8605
| | - Tatsuya Mimura
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo 173-8605
- Department of Ophthalmology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Yoshinobu Mizuno
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo 173-8605
| | - Koichi Matsumoto
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo 173-8605
| | - Shigeki Hamano
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo 173-8605
| | - Shoko Ubukata
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo 173-8605
| | - Megumi Yamamoto
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo 173-8605
| | - Emiko Watanabe
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo 173-8605
| | - Atsushi Mizota
- Department of Ophthalmology, Teikyo University School of Medicine, Tokyo 173-8605
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Lin SR, Aldave AJ, Chodosh J. Recurrent corneal erosion syndrome. Br J Ophthalmol 2019; 103:1204-1208. [DOI: 10.1136/bjophthalmol-2019-313835] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/25/2019] [Indexed: 12/28/2022]
Abstract
Recurrent corneal erosion syndrome (RCES) is a disorder characterised by a dysfunctional epithelial ecosystem. It often begins after trauma, or in the setting of epithelial basement membrane degeneration or dystrophy. Historically, RCES has been understood as a structural derangement of the anterior corneal architecture. More recently, studies have demonstrated the important role of neuropeptides in corneal homoeostasis. Thus, RCES may also be understood as a disorder of corneal epithelial cell biology. Management of RCES can be challenging, but newer therapies have demonstrated improved efficacy for this condition. This review examines the aetiology and pathogenesis of RCES, and provides an update on current and emerging treatment modalities for the management of this disorder.
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Abstract
Purpose To comprehensively review the literature regarding recurrent corneal erosion (RCE) and to present treatment options and recommendations for management. Overview RCE usually presents with sharp, unilateral pain upon awakening, in an eye with an underlying basement membrane dystrophy, prior ocular trauma, stromal dystrophy or degeneration, or prior surgery for refractive errors, cataracts, or corneal transplantation. Making the correct diagnosis requires a careful slit-lamp examination of both eyes coupled with a high degree of suspicion. Several treatments are commonly used for RCE but new therapies have been introduced recently. Conservative treatment consists of antibiotic and preservative-free lubricating drops, with topical cycloplegics and oral analgesics to control pain. Patients who are unresponsive to these therapies may benefit from therapeutic bandage contact lenses (BCL). Newer therapies include oral matrix metalloproteinase (MMP) inhibitors, blood-derived eye drops, amniotic membrane graft application, and judicious application of topical corticosteroids. Once the epithelium is healed, a course of hypertonic saline solution and/or ointment can be used. Surgical procedures may be performed in patients who fail conservative therapy. Punctal occlusion with plugs increases the tear film volume. Epithelial debridement with diamond burr polishing (DBP), anterior stromal puncture (ASP), or alcohol delamination should be considered in selected patients. DBP can be used for patients with basement membrane dystrophies and is the preferred treatment overall due to a low recurrence rate. ASP can be used for erosions outside the central visual axis. Excimer laser phototherapeutic keratectomy is an attractive option in eyes with central RCE since it precisely removes tissue while preserving corneal transparency. In patients with RCE who are also candidates for refractive surgery, photorefractive keratectomy can be considered. Summary Newly introduced therapies for RCE enable therapy to be individualized and lower the recurrence rate.
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Affiliation(s)
- Darby D Miller
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL 32224, USA,
| | - Syed A Hasan
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL 32224, USA,
| | - Nathaniel L Simmons
- Department of Ophthalmology, University of Rochester, Rochester, NY 14642, USA
| | - Michael W Stewart
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL 32224, USA,
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Ma IH, Kuo BI, Hou YC. Recurrent corneal erosion caused by retained sutures in blepharoplasty. Int Ophthalmol 2018; 39:1387-1390. [DOI: 10.1007/s10792-018-0936-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 04/23/2018] [Indexed: 11/28/2022]
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Ganger A, Gupta N, Tomar AS, Vanathi M, Tandon R. Infective keratitis in Indian patients with corneal dystrophies. Trop Doct 2017; 48:199-206. [PMID: 29041837 DOI: 10.1177/0049475517736709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
All eight patients seen with various types of corneal dystrophy, a rare hereditary corneal disease, presented with infective keratitis. Unilateral microbial invasion was seen in all patients and the visual acuity of the affected eyes was <6/60 at presentation. We highlight our impression that microbial invasion can occur with all types of epithelial and stromal corneal dystrophy, including macular corneal dystrophy. Regular follow-up to maintain a healthy ocular surface is recommended to avert blindness in such patients.
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Affiliation(s)
- Anita Ganger
- 1 Senior Research Associate, Cornea, Cataract & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Noopur Gupta
- 2 Assistant Professor, Cornea, Cataract & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit S Tomar
- 3 Junior Resident, Cornea, Cataract & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Murugesan Vanathi
- 4 Professor, Cornea, Cataract & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- 5 Professor, Cornea, Cataract & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Lee WS, Lam CK, Manche EE. Phototherapeutic keratectomy for epithelial basement membrane dystrophy. Clin Ophthalmol 2016; 11:15-22. [PMID: 28031698 PMCID: PMC5179214 DOI: 10.2147/opth.s122870] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the long-term efficacy of phototherapeutic keratectomy (PTK) in treating epithelial basement membrane dystrophy (EBMD). Methods Preoperative and postoperative records were reviewed for 58 eyes of 51 patients with >3 months follow-up (range 3–170 months) treated for EBMD with PTK after failure of conservative medical treatment at Byers Eye Institute of Stanford University. Symptoms, clinical findings, and corrected distance visual acuity (CDVA) were assessed. The primary outcome measure was symptomatic recurrence as measured by erosions or visual complaints >3 months after successful PTK. Results For eyes with visual disturbances (n=30), preoperative CDVA waŝ20/32 (0.24 Log-MAR, SD 0.21) and postoperative CDVA was ~20/25 (0.07 LogMAR, SD 0.12; P<0.0001). Twenty-six eyes (86.7%) responded to treatment, with symptomatic recurrence in 6 eyes (23.1%) at an average of 37.7 months (SD 42.8). For eyes with painful erosions (n=29), preoperative CDVA was ~20/25 (0.12, SD 0.19) and postoperative CDVA was ~20/20 (0.05. SD 0.16; P=0.0785). Twenty-three eyes (79.3%) responded to treatment, with symptomatic recurrence in 3 eyes (13.0%) at an average of 9.7 months (SD 1.5). The probability of being recurrence free after a successful treatment for visual disturbances and erosions at 5 years postoperatively was estimated at 83.0% (95% confidence interval 68.7%–97.0%) and 88.0% (95% confidence interval 65.3%–96.6%), respectively. Conclusion The majority of visual disturbances and painful erosions associated with EBMD respond to PTK. For those with a treatment response, symptomatic relief is maintained over long-term follow-up.
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Affiliation(s)
- Wen-Shin Lee
- Department of Ophthalmology, Stanford University, Stanford, CA, USA
| | - Carson K Lam
- Department of Ophthalmology, Stanford University, Stanford, CA, USA
| | - Edward E Manche
- Department of Ophthalmology, Stanford University, Stanford, CA, USA
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Shen Y, Pfluger T, Ferreira F, Liang J, Navedo MF, Zeng Q, Reid B, Zhao M. Diabetic cornea wounds produce significantly weaker electric signals that may contribute to impaired healing. Sci Rep 2016; 6:26525. [PMID: 27283241 PMCID: PMC4901296 DOI: 10.1038/srep26525] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/04/2016] [Indexed: 12/26/2022] Open
Abstract
Wounds naturally produce electric signals which serve as powerful cues that stimulate and guide cell migration during wound healing. In diabetic patients, impaired wound healing is one of the most challenging complications in diabetes management. A fundamental gap in knowledge is whether diabetic wounds have abnormal electric signaling. Here we used a vibrating probe to demonstrate that diabetic corneas produced significantly weaker wound electric signals than the normal cornea. This was confirmed in three independent animal models of diabetes: db/db, streptozotocin-induced and mice fed a high-fat diet. Spatial measurements illustrated that diabetic cornea wound currents at the wound edge but not wound center were significantly weaker than normal. Time lapse measurements revealed that the electric currents at diabetic corneas lost the normal rising and plateau phases. The abnormal electric signals correlated significantly with impaired wound healing. Immunostaining suggested lower expression of chloride channel 2 and cystic fibrosis transmembrane regulator in diabetic corneal epithelium. Acute high glucose exposure significantly (albeit moderately) reduced electrotaxis of human corneal epithelial cells in vitro, but did not affect the electric currents at cornea wounds. These data suggest that weaker wound electric signals and impaired electrotaxis may contribute to the impaired wound healing in diabetes.
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Affiliation(s)
- Yunyun Shen
- Department of Dermatology, University of California, Davis, CA, USA.,Bioelectromagnetics Laboratory, Department of Occupational and Environmental Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Trisha Pfluger
- Department of Dermatology, University of California, Davis, CA, USA
| | - Fernando Ferreira
- Department of Dermatology, University of California, Davis, CA, USA.,Department of Biology, Centre of Molecular and Environmental Biology (CBMA), University of Minho, Braga, Portugal
| | - Jiebing Liang
- Department of Biology, California State University, Northridge, CA, USA
| | - Manuel F Navedo
- Department of Pharmacology, University of California, Davis, CA, USA
| | - Qunli Zeng
- Bioelectromagnetics Laboratory, Department of Occupational and Environmental Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Brian Reid
- Department of Dermatology, University of California, Davis, CA, USA
| | - Min Zhao
- Department of Dermatology, University of California, Davis, CA, USA.,Department of Ophthalmology and Vision Science, University of California, Davis, CA, USA
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Bae KH, Ahn M, Cho NC, You IC. Clinical Presentation and Treatment Outcomes of Recurrent Corneal Erosion. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.4.555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kyoung Hwa Bae
- Department of Ophthalmology, Chonbuk National University Medical School1, Jeonju, Korea
| | - Min Ahn
- Department of Ophthalmology, Chonbuk National University Medical School1, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
| | - Nam Chun Cho
- Department of Ophthalmology, Chonbuk National University Medical School1, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
| | - In Cheon You
- Department of Ophthalmology, Chonbuk National University Medical School1, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
- Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
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de Alba-Castilla MA, López-Rubio S, Rodríguez-García A. Síndrome erosivo corneal recurrente enmascarado como queratitis epitelial herpética. REVISTA MEXICANA DE OFTALMOLOGÍA 2015. [DOI: 10.1016/j.mexoft.2015.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Maharana PK, Dubey A, Jhanji V, Vajpayee RB. The diagnosis and management of recurrent corneal erosion syndrome. EXPERT REVIEW OF OPHTHALMOLOGY 2015. [DOI: 10.1586/17469899.2015.1076335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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El Sanharawi M, Sandali O, Basli E, Bouheraoua N, Ameline B, Goemaere I, Georgeon C, Hamiche T, Borderie V, Laroche L. Fourier-domain optical coherence tomography imaging in corneal epithelial basement membrane dystrophy: a structural analysis. Am J Ophthalmol 2015; 159:755-63. [PMID: 25579644 DOI: 10.1016/j.ajo.2015.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/02/2015] [Accepted: 01/06/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the features of corneal epithelial basement membrane dystrophy using spectral-domain optical coherence tomography (SD OCT) and to examine the reliability of SD OCT in distinguishing epithelial basement membrane dystrophy from the normal cornea. DESIGN Diagnostic test study. METHODS Forty-five individuals with epithelial basement membrane dystrophy and 45 age- and sex-matched controls with normal corneas were examined, and SD OCT scans of their corneas were performed. In vivo confocal microscopy was performed to confirm or rule out the diagnosis of epithelial basement membrane dystrophy. The structural corneal changes occurring in eyes with epithelial basement membrane dystrophy based on SD OCT findings were described. RESULTS Epithelial abnormalities were observed in 86 of 87 eyes with epithelial basement membrane dystrophy (45 patients) on SD OCT scans. The 2 main features were the presence of an irregular and thickened epithelial basement membrane duplicating or insinuating into the corneal epithelium layer, or both, and the presence of hyperreflective dots. In some cases, we detected hyporeflective spaces between the corneal epithelial layer and the Bowman layer similar to a corneal epithelial detachment. This corneal epithelial detachment sometimes was associated with a cleavage with a stair-step appearance within the corneal epithelial layer. We found a perfect correlation between in vivo confocal microscopy and SD OCT findings in the diagnosis of epithelial basement membrane dystrophy (κ = 0.98). CONCLUSIONS SD OCT provides an accurate assessment of the structural changes occurring in eyes with epithelial basement membrane dystrophy. These changes, visible on SD OCT scans, are easily detectable and permit an accurate diagnosis, especially in patients with no biomicroscopically visible corneal changes.
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Lassaline-Utter M, Cutler TJ, Michau TM, Nunnery CM. Treatment of nonhealing corneal ulcers in 60 horses with diamond burr debridement (2010-2013). Vet Ophthalmol 2014; 17 Suppl 1:76-81. [PMID: 24506287 DOI: 10.1111/vop.12148] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review the signalment, clinical characteristics, and outcome of horses with nonhealing corneal ulcers treated with diamond burr debridement (DBD); and to evaluate the role of ulcer duration, size and location, and bandage contact lens (BCL) placement on healing. ANIMALS From January 2012-April 2013, 60 horses were diagnosed with ulcers classified as nonhealing based on the presence of raised epithelial margins and duration of at least 7 days. PROCEDURE Retrospective record review. RESULTS Average age of included horses was 14.68 years, SD 8.17 years. There were three times as many males (45) as females (15), (χ12 = 15, P = 0.001). Forty-eight horses (80%) had nonhealing ulcers uncomplicated by associated corneal disease. In the remaining horses, associated corneal disease included esinophilic keratitis (10%), calcific band keratopathy (5%), endothelial decompensation (1.67%), habronemiasis(1.67%), and lid suture abrasion (1.67%). Average corneal ulcer duration prior to diamond burr debridement (DBD) was 29.0 days (n = 56). Ulcers occurred most commonly in the axial cornea (41%). Fifty-five of 60 horses (92%) healed with DBD. Healing time, defined as time to epithelialization following DBD, averaged 15.5 days, SD 9.32 days, and was not correlated with patient age or ulcer duration, location, or size prior to or following DBD. Healing time was significantly longer for eyes in which a BCL had been placed (n = 28, 19.0 days) than for eyes without a BCL (n = 32, 12.9 days), F(1,58) = 5.543, P = 0.02. DBD was considered a failure for five horses (8%). CONCLUSIONS DBD may be an effective treatment for nonhealing corneal ulcers in horses.
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Affiliation(s)
- Mary Lassaline-Utter
- New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA, USA
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McGrath LA, Lee GA. Techniques, indications and complications of corneal debridement. Surv Ophthalmol 2013; 59:47-63. [PMID: 24239444 DOI: 10.1016/j.survophthal.2013.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 03/24/2013] [Accepted: 03/26/2013] [Indexed: 11/18/2022]
Abstract
The cornea is the most exposed surface of the eye and, as such, is vulnerable to external trauma and the risk of infection. Many corneal diseases alter shape, surface, and transparency and thus result in reduced vision. The external position of the cornea, however, lends itself to diagnostic and therapeutic maneuvers that are commonly performed and readily done in the clinic. More sophisticated techniques require the use of complex equipment such as excimer and femtosecond laser. Complications that develop from poor healing and/or secondary infection are best avoided with appropriate technique, antisepsis, and modification of wound healing. We review corneal debridement in the management of corneal disease.
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Affiliation(s)
- Lindsay A McGrath
- City Eye Centre, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Graham A Lee
- City Eye Centre, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Ophthalmology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.
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Gosling AA, Labelle AL, Breaux CB. Management of spontaneous chronic corneal epithelial defects (SCCEDs) in dogs with diamond burr debridement and placement of a bandage contact lens. Vet Ophthalmol 2012; 16:83-8. [PMID: 22520040 DOI: 10.1111/j.1463-5224.2012.01026.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective To describe the outcome of canine spontaneous chronic corneal epithelial defects (SCCED) treated with diamond burr debridement (DBD) and bandage contact lens placement (BCL). Animal studied Forty eyes of 36 dogs presenting to a single private practice. Procedures A retrospective review of medical records was performed. Cases were eligible for inclusion if they were newly diagnosed with SCCED by a veterinary ophthalmologist and treated with DBD/BCL. All patients received a complete ocular examination followed by DBD using a battery-powered, handheld motorized burr (Algerbrush(®) , Alger Equipment Company, Lago Vista, TX, USA). A BCL was placed post-debridement in all patients. Data were analyzed for sex, age, breed, duration of clinical signs prior to DBD; number of debridements required before healing was achieved; contact lens retention, complications attributed to DBD, and additional surgical interventions were required to achieve healing. Results The median time to first recheck examination was 7 days (IQR 7-9 days) with 28/40 (70%) of cases healed at this examination. The mean time to second recheck examination was 15.5 ± 5.5 days with 37/40 (92.5%) healed by this examination. The median time to final recheck examination was 19 days (IQR 18-35.5 days) with a range of 18-52 days. All cases resolved by the third and final recheck examination. A second DBD/BCL was performed in 5/40 (12.5%) of cases. The BCL retention rate was 95% over all examination time points. No case required a keratectomy or other surgical intervention to achieve healing. The only complication observed was one case of suspected bacterial keratitis post-DBD/BCL. Conclusions Results suggest that DBD/BCL is safe and effective for treatment of canine SCCED.
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Affiliation(s)
- Allyson A Gosling
- WestVet Animal Emergency and Specialty Center, 5019 N. Sawyer Avenue, Garden City, ID 83714, USA
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Pal-Ghosh S, Pajoohesh-Ganji A, Tadvalkar G, Stepp MA. Removal of the basement membrane enhances corneal wound healing. Exp Eye Res 2011; 93:927-36. [PMID: 22067129 PMCID: PMC3443627 DOI: 10.1016/j.exer.2011.10.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Revised: 10/13/2011] [Accepted: 10/18/2011] [Indexed: 10/15/2022]
Abstract
Recurrent corneal erosions are painful and put patients' vision at risk. Treatment typically begins with debridement of the area around the erosion site followed by more aggressive treatments. An in vivo mouse model has been developed that reproducibly induces recurrent epithelial erosions in wild-type mice spontaneously within two weeks after a single 1.5 mm corneal debridement wound created using a dulled-blade. This study was conducted to determine whether 1) inhibiting MMP9 function during healing after dulled-blade wounding impacts erosion development and 2) wounds made with a rotating-burr heal without erosions. Oral or topical inhibition of MMPs after dulled-blade wounding does not improve healing. Wounds made by rotating-burr heal with significantly fewer erosions than dulled-blade wounds. The localization of MMP9, β4 integrin and basement membrane proteins (LN332 and type VII collagen), immune cell influx, and reinnervation of the corneal nerves were compared after both wound types. Rotating-burr wounds remove the anterior basement membrane centrally but not at the periphery near the wound margin, induce more apoptosis of corneal stromal cells, and damage more stromal nerve fibers. Despite the fact that rotating-burr wounds do more damage to the cornea, fewer immune cells are recruited and significantly more wounds resolve completely.
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Affiliation(s)
- Sonali Pal-Ghosh
- The George Washington University Medical Center, Department of Anatomy and Regenerative Biology, Washington, DC 20037
| | - Ahdeah Pajoohesh-Ganji
- The George Washington University Medical Center, Department of Anatomy and Regenerative Biology, Washington, DC 20037
| | - Gauri Tadvalkar
- The George Washington University Medical Center, Department of Anatomy and Regenerative Biology, Washington, DC 20037
| | - Mary Ann Stepp
- The George Washington University Medical Center, Department of Anatomy and Regenerative Biology, Washington, DC 20037
- The George Washington University Medical Center, Department of Ophthalmology, Washington, DC 20037
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Ko BY, Lee GW. Clinical Results of Phototherapeutic Keratectomy for Refractory Recurrent Corneal Erosion. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.4.392] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Byung Yi Ko
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
| | - Gun Woong Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
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Blackmore SJ. The use of contact lenses in the treatment of persistent epithelial defects. Cont Lens Anterior Eye 2010; 33:239-44. [DOI: 10.1016/j.clae.2010.06.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 05/10/2010] [Accepted: 06/07/2010] [Indexed: 11/26/2022]
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