Proteinases of the cornea and preocular tear film

Corneal stromal ulcerations in a referral population of dogs and cats in the Netherlands (2012-2019): Bacterial isolates and antibiotic resistance

OBJECTIVE

To evaluate bacterial isolates from corneal stromal ulcerations in dogs and cats in the Netherlands, review their antibiotic susceptibility, determine whether recent topical treatment affected bacterial culture results, and investigate whether (multi-drug) resistance patterns changed over time.

ANIMALS STUDIED

Client-owned dogs and cats were diagnosed with corneal stromal ulceration at the Utrecht University Clinic for Companion Animals between 2012 and 2019.

PROCEDURES

Retrospective analysis.

RESULTS

In total, 163 samples were collected from 122 dogs (130 samples) and 33 cats. Positive cultures were obtained from 76 canine and 13 feline samples (59% and 39%, respectively) and included Staphylococcus (42 in dogs, 8 in cats), Streptococcus (22 in dogs, 2 in cats), and Pseudomonas (9 in dogs, 1 in cats) species. Significantly fewer positive cultures were found in dogs and cats previously treated with topical antibiotics (χ2  = 6.52, p = .011 and χ2  = 4.27, p = .039, respectively). Bacterial resistance to chloramphenicol was more common in dogs previously treated with chloramphenicol (χ2  = 5.24, p = .022). The incidence of acquired antibiotic resistance did not increase significantly over time. In dogs, the incidence of multi-drug-resistant isolates increased significantly between 2012-2015 and 2016-2019 (9.4% vs. 38.6%, p = .0032).

CONCLUSIONS

Staphylococcus, Streptococcus, and Pseudomonas species were the most common bacteria associated with canine and feline corneal stromal ulcerations. Previous treatment with antibiotics affected bacterial culture results and antibiotic sensitivity. Although the overall incidence of acquired antibiotic resistance did not change over time, the incidence of multi-drug-resistant isolates in dogs increased over an 8-year period.

Use of Biologics and Stem Cells in Equine Ophthalmology

Regenerative therapy and biologics have the promise to treat equine ocular surface diseases, including corneal ulceration or immune-mediated keratitis, or intraocular diseases such as uveitis. The use of blood-derived products such as serum or platelet-rich plasma, mesenchymal stem cells, or amniotic membrane grafts may be beneficial for the treatment of ulcerative and chronic keratitis in horses. Furthermore, the use of stem cells or gene therapy has promise for the treatment of Intraocular diseases such as equine recurrent uveitis by providing efficacious, practical, and long-term therapy for these blinding diseases.

Progressive ulcerative keratitis in dogs in the United Kingdom: Microbial isolates, antimicrobial sensitivity, and resistance patterns

OBJECTIVES

The objective of the study was to identify bacterial pathogens and their antimicrobial sensitivity profile associated with cases of canine progressive ulcerative keratitis.

MATERIALS AND METHODS

Analysis of microbial culture and sensitivity results from dogs with progressive ulcerative keratitis presenting to a UK referral practice between December 2018 and August 2020.

RESULTS

Positive bacterial cultures were obtained from 80/148 (54%) of the canine ulcers sampled with 99 bacterial isolates cultured. Streptococcus canis (n = 29), Pseudomonas aeruginosa (n = 19), and Staphylococcus pseudintermedius (n = 16) were the most common isolates. Pseudomonas aeruginosa was more likely to be isolated whether the ulcer was clinically malacic at the time of sampling (OR = 10.1, p < .001). Ulcers treated prior to culture with fusidic acid were 7.6 times more likely to be positive than those treated with any other antimicrobial(s). Bacterial isolates demonstrated resistance against neomycin (85%), fusidic acid (78%), and tetracycline (68%). Conversely, isolates were most likely to be sensitive to gentamicin (88%), ofloxacin (77%), ciprofloxacin (73%), and chloramphenicol (64%). Antimicrobial combinations of chloramphenicol or gentamicin with a fluoroquinolone (ofloxacin or ciprofloxacin) or chloramphenicol combined with gentamicin were the most effective on in vitro analysis (over 90% susceptibility of all isolates).

CONCLUSION

The most common bacterial species associated with canine progressive ulcerative keratitis in a UK referral population were S. canis, P. aeruginosa, and S. pseudintermedius. Combination antimicrobial therapy is recommended pending culture and sensitivity results given the varied antimicrobial susceptibility profiles and significant bacterial in vitro resistance to antimicrobial monotherapy.

Latanoprost PF vs. Bimatoprost PF: Which Treats the Ocular Surface Better?

(1) Background: The current study aimed to compare two of the most frequently prescribed preservative-free (PF) antiglaucoma drops, (Latanoprost PF vs. Bimatoprost PF) in promoting OSD in patients with POAG. (2) Methods: In this prospective study, 44 eyes from 44 participants were included. In the control group we enrolled 24 eyes, 11 eyes treated only with Latanoprost PF were enrolled in the Latanoprost PF group, and 9 eyes treated only with Bimatoprost PF in the Bimatoprost PF group. In all eyes, we evaluated the ocular levels of MMP-9 using the InflammaDry kit. We also performed Schirmer's test and the TBUT test. (3) Results: We found elevated ocular levels of MMP-9 (>40 ng/mL) in the Bimatoprost PF group (88.89% of the participants) compared to the control (8.33%) and the Latanoprost PF group (27.27%), and the difference was statistically significant (p < 0.001). The Schirmer's test values were statistically significantly lower in the Bimatoprost PF group compared to the other two groups. Additionally, the TBUT values were lower in the Bimatoprost PF group compared to the control group, and the difference was statistically significant. (4) Conclusions: Latanoprost PF eye drops treat the ocular surface better and they do not induce overexpression of MMP-9, a molecule that is related to OSD.

Predatory bacteria can reduce Pseudomonas aeruginosa induced corneal perforation and proliferation in a rabbit keratitis model

PURPOSE

Pseudomonas aeruginosa keratitis is a severe ocular infection that can lead to perforation of the cornea. In this study we evaluated the role of bacterial quorum sensing in generating corneal perforation and bacterial proliferation and tested whether co-injection of the predatory bacteria Bdellovibrio bacteriovorus could alter the clinical outcome. P. aeruginosa with lasR mutations were observed among keratitis isolates from a study collecting samples from India, so an isogenic lasR mutant strain of P. aeruginosa was included.

METHODS

Rabbit corneas were intracorneally infected with P. aeruginosa strain PA14 or an isogenic ΔlasR mutant and co-injected with PBS or B. bacteriovorus. After 24 h, eyes were evaluated for clinical signs of infection. Samples were analyzed by scanning electron microscopy, optical coherence tomography, sectioned for histology, and corneas were homogenized for CFU enumeration and for inflammatory cytokines.

RESULTS

We observed that 54% of corneas infected by wild-type PA14 presented with a corneal perforation (n = 24), whereas only 4% of PA14 infected corneas that were co-infected with B. bacteriovorus perforate (n = 25). Wild-type P. aeruginosa proliferation was reduced 7-fold in the predatory bacteria treated eyes. The ΔlasR mutant was less able to proliferate compared to the wild-type, but was largely unaffected by B. bacteriovorus.

CONCLUSION

These studies indicate a role for bacterial quorum sensing in the ability of P. aeruginosa to proliferate and cause perforation of the rabbit cornea. Additionally, this study suggests that predatory bacteria can reduce the virulence of P. aeruginosa in an ocular prophylaxis model.

Multidirectional corneoconjunctival transposition in the treatment of large keratomalacia in 7 dogs and 5 cats

OBJECTIVE

To describe the use of multidirectional corneoconjunctival transposition (CCT) as a surgical treatment for large keratomalacia.

METHOD

A prospective study including dogs and cats initially presenting with keratomalacia larger than 6 × 6 mm and affecting more than half of the corneal thickness. Signalment, concurrent eye diseases, ulcer size, bacterial culture and susceptibility testing results, follow-up, and outcome were recorded. The surgery consisted of harvesting of two or three opposite corneoconjunctival grafts, after removal of the malacic tissue using a square-edge keratectomy. The medical treatment consisted of administration of topical and systemic antibiotics, topical atropine, and N-acetylcysteine. Follow-up examinations were performed at D7, D14, D21, and D28, and then at various time points. The corneal clarity score (CCS) was recorded upon completion of the follow-up period.

RESULTS

Seven dogs and five cats were included. Brachycephalic dogs were overrepresented, with no breed predisposition in cats. Concurrent eye diseases were corneal pigmentation in three dogs, hypopyon in two dogs, nictitating membrane wound in one dog, and corneal perforation in one cat. The size of the keratomalacia ranged from 6 × 6 to 9.5 × 11.5 mm. The short-term complications were suture dehiscence (two of 12) and progression of the keratomalacia (one of 12). The long-term complications were corneal pigmentation (10 of 12), corneal epithelial inclusion cyst (two of 12), and marginal synechiae (one of 12). All animals were sighted at the last follow-up. The median CCS was G3 (range G2-G4).

CONCLUSION

Multidirectional CCT is an effective surgical treatment for large keratomalacia in dogs and cats.

Predatory Bacteria can Reduce Pseudomonas aeruginosa Induced Corneal Perforation and Proliferation in a Rabbit Keratitis Model

Purpose

Pseudomonas aeruginosa keratitis is a severe ocular infection that can lead to perforation of the cornea. In this study we evaluated the role of bacterial quorum sensing in generating corneal perforation and bacterial proliferation and tested whether co-injection of the predatory bacteria Bdellovibrio bacteriovorus could alter the clinical outcome. P. aeruginosa with lasR mutations were observed among keratitis isolates from a study collecting samples from India, so an isogenic lasR mutant strain of P. aeruginosa was included.

Methods

Rabbit corneas were intracorneally infected with P. aeruginosa strain PA14 or an isogenic Δ lasR mutant and co-injected with PBS or B. bacteriovorus . After 24 h, eyes were evaluated for clinical signs of infection. Samples were analyzed by scanning electron microscopy, optical coherence tomography, sectioned for histology, and corneas were homogenized for CFU enumeration and for inflammatory cytokines.

Results

We observed that 54% of corneas infected by wild-type PA14 presented with a corneal perforation (n=24), whereas only 4% of PA14 infected corneas that were co-infected with B. bacteriovorus perforate (n=25). Wild-type P. aeruginosa proliferation was reduced 7-fold in the predatory bacteria treated eyes. The Δ lasR mutant was less able to proliferate compared to the wild-type, but was largely unaffected by B. bacteriovorus .

Conclusion

These studies indicate a role for bacterial quorum sensing in the ability of P. aeruginosa to proliferate and cause perforation of the rabbit cornea. Additionally, this study suggests that predatory bacteria can reduce the virulence of P. aeruginosa in an ocular prophylaxis model.

The Underlying Relationship between Keratoconus and Down Syndrome

Keratoconus (KC) is one of the most significant corneal disorders worldwide, characterized by the progressive thinning and cone-shaped protrusion of the cornea, which can lead to severe visual impairment. The prevalence of KC varies greatly by ethnic groups and geographic regions and has been observed to be higher in recent years. Although studies reveal a possible link between KC and genetics, hormonal disturbances, environmental factors, and specific comorbidities such as Down Syndrome (DS), the exact cause of KC remains unknown. The incidence of KC ranges from 0% to 71% in DS patients, implying that as the worldwide population of DS patients grows, the number of KC patients may continue to rise significantly. As a result, this review aims to shed more light on the underlying relationship between KC and DS by examining the genetics relating to the cornea, central corneal thickness (CCT), and mechanical forces on the cornea, such as vigorous eye rubbing. Furthermore, this review discusses KC diagnostic and treatment strategies that may help detect KC in DS patients, as well as the available DS mouse models that could be used in modeling KC in DS patients. In summary, this review will provide improved clinical knowledge of KC in DS patients and promote additional KC-related research in these patients to enhance their eyesight and provide suitable treatment targets.

Identification of Key Genes and Molecular Pathways in Keratoconus: Integrating Text Mining and Bioinformatics Analysis

Purpose. To identify the potential key genes and molecular pathways associated with keratoconus and allergic disease. Methods. The pubmed2ensembl database was used to identify the text mining genes (TMGs) collectively involved in keratoconus and allergic disease. The GeneCodis program was used to perform the Gene Ontology (GO) biological process and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis of TMGs. The protein-protein interaction (PPI) network of the TMGs was established by STRING; the significant gene modules and hub genes of PPI were further performed using the Cytoscape software. The DAVID database was used to perform the GO and KEGG analyses of the significant module. Results. In total, 98 TMGs collectively involved in keratoconus and allergic disease were identified. 19 enriched biological processes including 71 genes and 25 enriched KEGG pathways including 59 genes were obtained. A TMG PPI network was constructed, and 51 genes/nodes were identified with 110 edges; 3 most significant modules and 12 hub genes were chosen from the PPIs. GO enrichment analysis showed that the TMGs were primarily associated with collagen catabolic process, extracellular matrix organization and disassembly, cell adhesion and migration, collagen-containing extracellular matrix, extracellular matrix, and structure organization. KEGG pathway analysis showed that these DEGs were mainly involved in the IL-17 signaling pathway, inflammatory bowel disease, rheumatoid arthritis, allograft rejection, T cell receptor signaling pathway, cytokine-cytokine receptor interaction, and TNF signaling pathway. Conclusions. The results revealed that IL10, IL6, MMP9, MMP1, HGF, VEGFA, MMP3, MMP2, TGFB1, IL4, IL2, and IFNG were potential key genes involved in keratoconus. IL-17 signaling pathway was the potential pathways accounting for pathogenesis and development of keratoconus.

In vitro antifungal susceptibility of Fusarium species and Aspergillus fumigatus cultured from eleven horses with fungal keratitis

PURPOSE

To examine the relationship between Minimum Inhibitory Concentration (MICs) and response to therapy of 6 Fusarium spp. and 5 Aspergillus fumigatus isolated from equine ulcerative keratitis cases.

PROCEDURE

Fungi were identified by morphology and Internal Transcribed Spacer (ITS) polymerase chain reaction (PCR) with sequencing and evaluated at the University of Texas Fungal Testing Laboratory for susceptibility to three azole antifungals (miconazole, voriconazole, posaconazole), natamycin, and two echinocandins (anidulafungin, caspofungin). A Mann-Whitney rank sum test was used for the comparison of time to heal between infections of different fungal genera and in vitro susceptibility to the drug administered.

RESULTS

Fusarium spp. were resistant to azole antifungals in 6/6 cases (100%). Fusarium spp. were susceptible to echinocandins and natamycin in all cases. A. fumigatus was resistant to anidulafungin in 1/5 cases (20%) and posaconazole in 1/5 cases (20%) The remainder of A. fumigatus isolates were susceptible to all antifungal agents tested. Fusarium isolates were treated with antifungals to which they were not susceptible; however, all cases of A. fumigatus were treated with antifungals to which they were susceptible. All Fusarium cases and A. fumigatus cases experienced clinical resolution, regardless of surgical intervention. There was no statistical correlation between fungal genus and time to heal (p < .082).

CONCLUSIONS

The in vitro susceptibility indicated that all cases of Fusarium spp. were resistant to azole antifungal drugs which were used as treatment. Clinical outcomes, however, showed that all cases healed despite resistance to antifungals.

Comparison of corneal culture results obtained using the ESwab™ and Amies charcoal swab in canine and feline patients

OBJECTIVE

The objective of the study was to compare corneal culture results using the ESwab™ and Amies charcoal swab.

ANIMALS STUDIED

One hundred fourteen canine and fifteen feline eyes.

PROCEDURES

Retrospective analysis of Dick White Referrals bacterial and fungal corneal culture data was conducted. Results were included from canine and feline patients, which presented with suspected infectious keratitis that had samples taken using an Amies charcoal swab followed by an ESwab™ in the same eye. In respect to positive and negative cultures, a McNemar test was conducted comparing instances of disagreement between swab types, and the Kappa coefficient (κ) was calculated to assess the level of agreement between swab types.

RESULTS

The ESwab™ produced more positive corneal cultures (71/129 [55.0%]) than the Amies charcoal swab (41/129 [31.8%]). 2/129 eyes produced positive fungal cultures. Considering 37/129 eyes in which both swab types detected a positive corneal culture, the same bacterial species were cultured from each swab type in 34/37 (91.9%) eyes, and an additional bacterial species was cultured by the ESwab™ in 3/37 (8.1%) eyes. In 34/38 (89.5%), instances of disagreement between swab types, the ESwab™ showed a positive culture, and the Amies charcoal swab showed a negative culture from the same eye, and this difference was significant (p < 0.0001). There was a moderate level of agreement between results from both swab types (κ = 0.432).

CONCLUSIONS

ESwab™ sampling alone may be superior to Amies charcoal swabs for detecting presence of bacteria in suspected infectious keratitis in cats and dogs.

Equine ulcerative keratitis in Belgium: Associated bacterial isolates and in vitro antimicrobial resistance in 200 eyes

PURPOSE

To describe bacterial isolates and associated antibiotic resistance from horses with ulcerative keratitis in Belgium.

METHODS

Medical records from horses with ulcerative keratitis presented to the ophthalmology service of the Veterinary teaching hospital of Liege, Belgium, between 2014 and 2021 were evaluated. Bacterial isolates were identified and VITEK^® 2 (Biomérieux) provided antimicrobial susceptibility testing and resistance detection.

RESULTS

Two hundred eyes of 196 horses were sampled. Ninety-seven eyes had a positive bacterial culture (48.5%) and 139 bacterial isolates were identified. Staphylococcus (63/139: 45.3%) and Streptococcus (33/139: 23.7%) were the most frequent genus isolated. Staphylococcus aureus (21/139: 15.1%) was the most frequent species isolated of which half were methicillin-resistant (MRS). Streptococcus equi subsp. zooepidemicus (19/139: 13.7%) was the second most identified bacterial isolate. Only two Pseudomonas species were isolated (2/139: 1.4%). The overall resistance of all bacterial isolates against chloramphenicol (12.4%) and fluoroquinolones (14.3%) was low. Resistance against tobramycin, polymyxin B, gentamicin, fusidic acid, tetracycline, and neomycin ranged from 40.8% to 58.6%. When separating the MRS from the other staphylococci, a significant difference was noted in percentage of resistance to gentamicin (p = .00026) and tetracycline (p = .00015). MRS were highly resistant to gentamicin (75%) and tetracycline (100%), whereas the remaining staphylococci were significantly less resistant to gentamicin (17%) and tetracycline (40.4%).

CONCLUSION

Although Pseudomonas species has been rarely cultured, our results are roughly consistent with previous studies. Multiple drug resistance was high and resistance to first-choice antibiotics in ulcerative keratitis was noted. These results warrant continued monitoring of susceptibility profile.

French Bulldogs differ to other dogs in the UK in propensity for many common disorders: a VetCompass study

Background

The French Bulldog is a highly popular dog breed but is linked with many serious health issues. A holistic view of breed health in French Bulldogs would assist efforts to appreciate the overall health strengths and weaknesses in the French Bulldog and to take appropriate steps to mitigate these.

Based on random sampling of French Bulldogs and non-French Bulldogs under primary veterinary care during 2016 within the VetCompass Programme, a cohort study design was used to estimate the one-year (2016) period prevalence of the most commonly diagnosed disorders in each group. Risk factor analysis used multivariable logistic regression modelling methods.

Results

The analysis included 2,781 French Bulldogs and 21,850 non-French Bulldogs. French Bulldogs were younger (1.51 years, IQR 0.86 – 2.77 vs. 4.48 years, IQR 1.94 – 8.14) (p < 0.001) and lighter (12.45 kg, IQR 11.00 – 14.03 versus 13.80 kg, IQR 8.10 – 25.12) (p < 0.001) than non-French Bulldogs. Of 43 common specific-level disorders across both groups, French Bulldogs had significantly increased adjusted odds of 20/43 (46.5 %) disorders and significantly reduced adjusted odds of 11/43 (25.6 %) disorders compared to non-French Bulldogs. Highly predisposed disorders in French Bulldogs included stenotic nares (OR 42.14; 95 % CI 18.50 to 95.99; p < 0.001), Brachycephalic Obstructive Airway Syndrome (OR 30.89; 95 % CI 20.91 to 45.64; p < 0.001), aural discharge (OR 14.40; 95 % CI 9.08 to 22.86; p < 0.001), skin fold dermatitis (OR 11.18; 95 % CI 7.19 to 17.40; p < 0.001) and dystocia (OR 9.13; 95 % CI 5.17 to 16.13; p < 0.001). At a grouped-level of diagnostic precision, French Bulldogs had increased adjusted odds of 12/32 (37.5 %) disorders and reduced adjusted odds of 6/32 (18.8 %) disorders compared to non-French Bulldogs.

Conclusions

These results identified ultra-predispositions with worryingly higher odds in French Bulldogs for several disorders, suggesting that the health of French Bulldogs has diverged substantially from, and may be lower than, the health of the wider non-French Bulldog population. Many of these predispositions are closely associated with the conformational extremes that define the French Bulldog breed. Shifting the typical conformation of the French Bulldog population towards a more moderate phenotype is proposed as a logical opportunity to reduce the serious health issues endemic in the French Bulldog breed.

The French Bulldog is currently a hugely popular dog breed in the UK. However, the breed is linked with a range of serious health issues. Using veterinary clinical data from the VetCompass Programme at the Royal Veterinary College, this study aimed to compare the frequency of common disorders in French Bulldogs against that of all remaining dogs to identify health strengths and weaknesses in French Bulldogs. This overall view of breed health can assist owners, breeders and veterinarians to take appropriate actions to improve the health of French Bulldogs.

From an overall population of 905,544 dogs, random samples of 2,781 French Bulldogs and 21,850 non-French Bulldogs were included in the analysis. French Bulldogs were younger (1.51 years versus 4.48 years) and lighter (12.45 kg versus 13.80 kg) than non-French Bulldogs. French Bulldogs had increased risk of 20/43 (46.5 %) specific disorders and decreased risk of 11/43 (25.6 %) specific disorders compared to non-French Bulldogs. The disorders with greatest relative risk in French Bulldogs compared to non-French Bulldogs were narrowed nostrils (x 42.14), Brachycephalic Obstructive Airway Syndrome (x 30.89), ear discharge (x 14.40), skin fold dermatitis (x 11.18) and difficulty giving birth [dystocia] (x 9.13). When the disorders were grouped into broad disease categories, French Bulldogs had increased risk of 12/32 (37.5 %) disorder groups and reduced risk of 6/32 (18.8 %) disorder groups compared to non-French Bulldogs.

This study suggests that the health of French Bulldogs is very different, and largely much poorer, that the health of the wider non-French Bulldog population. Many of these differences are closely associated with the extreme body shape that defines the French Bulldog breed. Shifting the body shape of French Bulldogs to become more moderate, and hence less extreme, is proposed as a logical opportunity to reduce the current serious and common health issues in the French Bulldog breed.

Prolidase activity in aqueous and serum samples of cataract cases with Pseudoexfoliation syndrome

Pseudoexfoliation syndrome (PEX) represents an age-related systemic disease that is characterized by the accumulation of extracellular matrix material in ocular tissues and visceral organs. Abnormal matrix remodeling is thought to be one of the important factors in the etiopathogenesis of the disease. Prolidase represents an enzyme, which takes a significant part in collagen biosynthesis and remodeling of the extracellular matrix. The purpose of the current research was to assess the prolidase enzyme activity in the aqueous and serum samples of subjects with PEX. The study population consisted of 66 subjects, involving 33 subjects with age-related cataract among patients with PEX and 33 subjects with age-related cataract without PEX. The prolidase activity measurement was performed using the modified Chinard's method. Significantly increased aqueous prolidase activity was detected in the group with PEX (p < 0.01). Despite about a three times higher increase in the serum prolidase activity of the group with PEX in comparison with the control group, the two groups did not differ statistically significantly (p > 0.05). The high prolidase enzyme activity in the aqueous samples of subjects with PEX suggests that the collagen cycle and the remodeling of the extracellular matrix are accelerated. These results can be a guide for understanding the formation mechanisms of PEX.

The role of topical N-acetylcysteine in ocular therapeutics

N-acetylcysteine (NAC) was first discovered as a mucolytic agent in 1960. We investigate the role of topical NAC in ocular therapeutics, including its mechanism of action, current applications, and adverse effects. A systematic search of peer-reviewed articles identified 106 references including in vitro, in vivo and clinical studies on the use of NAC in the treatment of ocular diseases. NAC can be synthetically manufactured, and its mechanisms of action include mucolysis, scavenging hydroxyl radicals, and modulation of inflammatory cascades. These unique properties contribute to the diverse applications of NAC, including its steroid-sparing potential. NAC has been used topically in the treatment of corneal wounds, chemical injuries, keratitis, dry eye disease and meibomian gland dysfunction. The clinical benefits of NAC are evident over a wide range of concentrations, the most common being 5-10% topical NAC applied four times daily. Adverse effects such as corneal necrosis are rare, but have been reported with higher doses. NAC also has potential applications in laser epithelial keratomileusis, diabetic eye disease, retinitis pigmentosa, senile nuclear cataracts, macular degeneration, and cigarette smoke-induced corneal damage. Recently, chitosan-NAC has been used as a nanocarrier for the topical administration of medications to the ocular surface. Owing to its potent antioxidant, anti-inflammatory and mucolytic properties, topical NAC has had extensive use in the treatment of ocular pathology.

Integration and remodelling of a collagen anterior lamellar keratoplasty graft in an animal model - A preliminary report

There is an international shortage of donor corneas for transplantation to treat the 1.5-2.0 million new cases of blindness secondary to corneal disease. Research has therefore been directed towards the development of artificial corneas using alternative materials such as collagen. The biocompatibility of an acellular collagen-based scaffold for anterior lamellar keratoplasty was investigated in vivo in a rabbit model. This scaffold has previously shown promise as a corneal substitute in vitro. Slit-lamp and Optical Coherence Tomography examinations were carried out at 2 weeks, 1, 2, 3, and 6 months post-operatively. Graft-host integration was investigated using immunohistochemistry of the cornea at 6 months. Results showed that the graft was biocompatible, supported corneal re-epithelialisation, and showed no signs of rejection. Migration of stromal cells into areas of the graft was observed, however this was accompanied by extensive graft digestion. Whilst the scaffold was biocompatible, further modifications to the material or supplementation with matrix metalloproteinase inhibitors are required to bring us closer to a stable and fully integrated corneal substitute.

Surgical treatment of canine and feline descemetoceles, deep and perforated corneal ulcers with autologous buccal mucous membrane grafts

Objectives

To report the surgical technique and postoperative outcome of corneal repair with autologous buccal mucous membrane grafts in dogs and cats with descemetoceles, deep corneal ulcers, and perforated corneal ulcers with or without iris prolapse.

Animal studied

Twelve cats (13 eyes) and fourteen dogs (14 eyes) were treated.

Procedures

Grafts were harvested from the unpigmented superior labial mucosa using a biopsy punch. The corneal lesion was carefully debrided and cleaned. The graft was secured to the healthy cornea with a combination of simple interrupted and continuous 9–0 polyglycolic acid sutures. In 25/27 treated eyes, an overlying pedicle conjunctival graft was also performed. A temporary nictitating membrane flap was used in all cases. The pedicle conjunctival graft was trimmed about 10–20 days postoperatively. The median follow‐up period was 549.2 days (range 14–2691 days).

Results

No surgical intra‐operative complications were observed. The ulcers healed and the integrity of the globe was restored in 24/27 treated eyes. Different grades of corneal fibrosis and/or vascularization and/or pigmentation were observed in all cases at the long‐term follow‐up. In two cases, enucleation was performed due to postoperative complications and one animal developed phthisis bulbi. A total of 22/27 treated eyes appeared to have regained effective visual function at the last clinical evaluation.

Conclusions

Autologous buccal mucous membrane grafts appear to successfully manage severe corneal ulcers in dogs and cats, providing a useful and economical alternative to other corneal grafts.

Determining MMP-2 and MMP-9 reductive activities of bovine and equine amniotic membranes homogenates using fluorescence resonance energy transfer

INTRODUCTION

Matrix metalloproteinases (MMPs)-2 and -9 are present in corneal ulcers, and an imbalance between MMPs and tissue inhibitors of metalloproteinases (TIMPs) leads to further corneal degradation. Amniotic membrane homogenate (AMH) has proteolytic properties beneficial for corneal healing, but it is unknown whether AMH possesses TIMPs or effectively inhibits MMP-2 and MMP-9 activity.

OBJECTIVE

To determine if bovine and equine AMH reduce in vitro MMP-2 and MMP-9 activities associated with the presence of TIMPs.

PROCEDURES

Undiluted and diluted twofold series (0-fold to 16-fold dilutions) of equine amniotic membrane homogenates (EAMH, n = 8) and bovine amniotic membrane homogenates (BAMH, n = 8) were subjected to fluorescence resonance energy transfer, and the fluorescence emitted was recorded over time. Average fluorescence was calculated versus recombinant concentration. Enzyme-linked immunosorbent assays for TIMPs 1-4 were applied to quantify TIMPs in the samples.

RESULTS

AMH from both species were able to inhibit MMP-2 and MMP-9 activities in vitro, and the inhibition efficacy decreased gradually with dilution. BAMH was significantly more effective than EAMH at inhibiting MMP-2 and MMP-9 in vitro. TIMPs -2 and -3 were present in EAMH and BAMH. TIMP-1 was detected only in BAMH, and TIMP-4 was not detected in any samples.

CONCLUSION

Both EAMH and BAMH directly inhibited MMP-2 and MMP-9 in vitro without dilution, and BAMH showed better inhibition of MMP-2 and MMP-9 before and after dilution compared to EAMH.

Melting corneal ulcers (keratomalacia) in dogs: A 5-year clinical and microbiological study (2014-2018)

OBJECTIVES

To identify bacterial microorganisms associated with canine keratomalacia, review their antimicrobial sensitivity, and evaluate clinical outcomes compared to results of microbial culture.

METHODS

Retrospective analysis of clinical records of dogs diagnosed with a melting corneal ulcer presented to a referral hospital in Hertfordshire, UK between 2014 and 2018.

RESULTS

One hundred and ten melting corneal ulcers were sampled in 106 dogs. The most common pure bacterial isolate was Pseudomonas aeruginosa (n = 26) followed by β-hemolytic Streptococcus (n = 12). Melting corneal ulcers that cultured coagulase-positive Staphylococcus, coliform bacteria, Pasteurella multocida, Enterococcus, and Streptococcus viridans presented in smaller numbers and were analyzed together (n = 16). Multiple cultures were identified in nine cases (n = 9). Forty-seven cultures yielded no bacterial growth (n = 47). The susceptibility to fluoroquinolones remained high with the exception of β-hemolytic Streptococci. There was no significant difference in the ulcer severity at presentation in regard to the cultured bacteria. Overall, 63 eyes (57%) received surgical grafting in addition to medical treatment. In 14 cases (13%), the progression of corneal melting despite medical ± surgical treatment resulted in enucleation. Fifty-seven percent (8/14) of the enucleated eyes cultured pure Pseudomonas aeruginosa isolates. In contrast, all β-hemolytic Streptococcus-associated ulcers healed.

CONCLUSIONS

The most common bacterial species associated with canine keratomalacia were Pseudomonas aeruginosa and β-hemolytic Streptococcus. Because of the variation in antibacterial sensitivity between these two species, bacterial culture and sensitivity testing should be performed in all dogs presenting with keratomalacia. Melting corneal ulcers associated with pure Pseudomonas infection were significantly more likely to result in globe loss than melting corneal ulcers associated with other cultures.

Pathophysiology and Treatment of Diffuse Lamellar Keratitis

PURPOSE

To review cytokine- and chemokine-mediated mechanisms of diffuse lamellar keratitis (DLK) after lamellar corneal surgical procedures.

METHODS

Review of the basic science and clinical literature.

RESULTS

DLK can occur early or late (months to decades) after all lamellar corneal surgeries, including laser in situ keratomileusis, small incision lenticule extraction, anterior lamellar keratoplasty, and Descemet's stripping automated endothelial keratoplasty. It is most commonly triggered by epithelial injury during or after lamellar surgery, which leads to the release of interleukin (IL)-1α, IL-1β, and tumor necrosis factor (TNF)-α from the epithelium and into the stroma. These chemokines directly attract inflammatory cells into the cornea from the limbal blood vessels and also bind to receptors on keratocytes and corneal fibroblasts where myriad chemokines are upregulated that also chemotactically attract monocytes, macrophages, granulocytes, lymphocytes, and other bone marrow-derived cells into the corneal stroma. Other factors that can trigger DLK include retained blood in the interface, endotoxins and other toxins, and excessive keratocyte necrosis caused by femtosecond lasers. Infiltrating cells show a preference to enter any lamellar interface in the cornea, regardless of the time since surgery, because of the ease of movement toward the chemotactic attractants relative to the surrounding stroma with intact collagen lamellae and stromal cells that serve as relative barriers impeding motility. The mainstay of treatment is topical corticosteroids, but severe cases may also be treated with flap lift irrigation and systemic corticosteroids.

CONCLUSIONS

DLK can occur early or late after any lamellar corneal surgical procedure and is most commonly triggered by epithelial-stromal-bone marrow-derived cellular interactions mediated by corneal cytokines and chemokines. [J Refract Surg. 2020;36(2):124-130.].

Corneoconjunctival transposition with and without ACell® for deep corneal ulcer repair in 18 dogs

OBJECTIVE

To document a case series using corneoconjunctival transposition (CCT) surgery with and without bioscaffolding matrix (ACell^® ) to repair deep corneal ulcers and perforations in dogs.

ANIMALS STUDIED

Eighteen dogs of various breeds that presented with deep or perforating corneal ulcers.

PROCEDURES

Corneoconjunctival transposition grafts with or without ACell^® were sutured using a simple interrupted 8-0 or 9-0 polyglactin 910 pattern.

RESULTS

A total of eighteen dogs (19 eyes) were diagnosed with deep corneal ulcers (n = 7) and perforating corneal ulcers (n = 12). A CCT was performed in all eyes, with ten of them additionally receiving an ACell^® graft. The majority of lesions were located axially in 14/19 (81%) eyes. Grafts were harvested from dorsal (n = 8), temporal (n = 5), ventral (n = 4), or nasal (n = 2) quadrants. Brachycephalic breeds (13/18) were over-represented. Keratoconjunctivitis sicca was present in 10/19 eyes (52.6%). Bacterial isolates were cultured from 8/19 eyes. Post-operative therapy included topical antibiotics, plasma, cycloplegics, oral antibiotics, and oral nonsteroidal anti-inflammatory drugs. CCT integration with and without ACell^® occurred at a median of 20 days (range 7-38 days) post-operatively with no significant difference between groups. Median follow-up time was 188 days. Short-term post-operative complications included granulation tissue formation (19/19), corneal edema (4/19), graft retraction (4/19), and anterior synechia (1/19). Long-term complications in 14 eyes with follow-up >30 days included superficial corneal pigmentation (6/14) and epithelial inclusion cysts (5/14). Two eyes were nonvisual at last follow-up due to cataract formation.

CONCLUSIONS

Corneoconjunctival transposition with ACell^® can be utilized for corneal ulcer repair in dogs.

Outcome of medical therapy for keratomalacia in dogs

OBJECTIVES

To evaluate the clinical and visual outcomes following intensive medical therapy for keratomalacia in dogs.

MATERIALS AND METHODS

Medical records were screened to identify dogs with corneal ulcers and keratomalacia. All patients were given the same topical treatment protocol with frequent administrations of tobramycin in combination with equine serum. Surgical treatment during the first 15 days of follow-up was considered as medical treatment failure.

RESULTS

We report on 57 ulcers with keratomalacia from 53 dogs. Medical treatment was successful in 31 of 57 ulcers with a median healing time of 5 days (range 2 to 15 days). At 60 days after epithelialisation, 14/15 medically-treated eyes were visual. In one case, corneal perforation was observed 1 month after healing and required surgical stabilisation.

CLINICAL SIGNIFICANCE

Intensive medical therapy has the potential to achieve healing of some ulcers with keratomalacia. Surgical stabilisation in response to progression of stromal loss was required in less than half of the cases.

In vitro assessment of the long-term stability of the inhibitory effects of canine and feline plasma on MMP 2 and 9

PURPOSE

To evaluate the effect of increasing storage time on the inhibitory effects of canine and feline plasma on matrix metalloproteinases (MMP) 2 and 9 in vitro.

METHODS

Matrix metalloproteinases 2 and 9 activity in the presence of canine plasma stored for 57, 155, 222, 316, 367, and 438 days, and feline plasma stored for 17, 198, 565, and 954 days was assayed using a commercially available colorimetric assay kit.

RESULTS

For canine plasma, the MMP 2 activity for older samples was not significantly different than the 57-day sample (P = 0.2025-0.9033). Two canine samples had significantly lower MMP 9 activity than the 57-day sample (367 days: P = 0.0099, 438 days: P = 0.0348, others P = 0.0778-0.9928). For feline plasma, storage time did not significantly affect inhibition of MMP 2 and MMP 9 activity (ANOVA, P = 0.2688 and P = 0.2404, respectively).

CONCLUSIONS

Increasing storage time does not significantly decrease the inhibiting activity of plasma on MMP 2 and 9 for up to 14 months in dogs and 31 months in cats.

Matrix metalloproteinase-2 and matrix metalloproteinase-9 in mice with ocular toxocariasis

In ocular toxocariasis, Toxocara canis-induced inflammatory reaction can lead to eye destruction and granuloma, which is formed by immune cell infiltration and concurrent extensive remodeling tissue. Herein, the histomorphology of granuloma and proteinase production in the eye of T. canis-infected BALB/c mice were investigated. Pathological effects substantially increased after the infection culminated in a severe leukocyte infiltration and granuloma formation from days 4 to 56 post-inoculation. The matrix metalloproteinase (MMP)-2 and MMP-9 activities remarkably increased, compared with those of uninfected control, by gelatin zymography and Western blot analysis in ocular toxocariasis. Granuloma formation had a remarkably positive correlation with MMP-2 and MMP-9 levels. We suggested that T. canis larvae and leukocytes infiltrated from blood vessel both migrated into corpus adiposum orbitae. Activated leukocytes secreted MMP-2 and MMP-9, leading to fibronectin degradation. The imbalance of MMP-2/TIMP-2 and MMP-9/TIMP-1 may play a role in inflammatory cell infiltration and extracellular matrix degradation, forming granuloma, in ophthalmological pathogenesis of T. canis infection.

Tranilast inhibits TGF-β-induced collagen gel contraction mediated by human corneal fibroblasts

AIM

To determine if tranilast affects human corneal fibroblast (HCFs) contraction.

METHODS

HCFs cultured in a three-dimensional type I collagen gel were treated with or without transforming growth factor beta (TGF-β) or tranilast. Gel diameter was measured as an indicator for collagen contraction. Immunoblot was performed to evaluate myosin light chain (MLC) and paxillin phosphorylation. Confocal microscopy was employed to examine the focal adhesions and actin stress fiber formation. Immunoblot analysis and gelatin zymography were performed to detect tissue inhibitors of metalloproteinases and matrix metalloproteinases (MMPs) in supernatant.

RESULTS

The inhibitory effect of tranilast on HCFs-mediated collagen gel contraction induced by TGF-β was dose-dependent. The significant effect of tranilast was started from 100 µmol/L and maximized at 300 µmol/L. The peak effect of 300 µmol/L tranilast also relied on the duration of treatment, which showed statistical significance from day 2. TGF-β-induced paxillin and MLC phosphorylation, stress fiber formation, focal adhesions, and MMP-1, MMP-2, and MMP-3 secretion in HCFs were also inhibited by tranilast.

CONCLUSION

Tranilast suppresses the HCFs-cultured collagen gel contraction induced by TGF-β. It attenuates actin stress fibers formation, focal adhesions, and the secretion of MMPs, with these actions likely contributing to the inhibitory effect on HCF contractility. By attenuating the contractility of corneal fibroblasts, tranilast treatment may inhibit corneal scarring.

Proteomics Unravels the Regulatory Mechanisms in Human Tears Following Acute Renouncement of Contact Lens Use: A Comparison between Hard and Soft Lenses

Contact lenses (CLs) provide a superior alternative to spectacles. Although beneficial, the global burden of ocular dysfunctions attributed to regular use of CLs remains a topic of much challenge in ophthalmic research owing to debilitating clinical repercussions on the ocular surface, which are often manifested as breach in tear film integrity. This study elucidated the intricate tear proteome changes attributed to the use of different CLs (hard and soft) and unravelled, for the first time, the restorative mechanisms of several protein clusters following acute renouncement of CL use employing the label-free mass spectrometry-based quantitative proteomics approach. The expression patterns of certain proteins clusters were specific to the use of a particular lens type and a large majority of these actively regulates cell death and survival and, modulates cellular movement on the ocular surface. Noteworthy, CL use also evoked a significant upregulation of glycolytic enzymes associated with hypoxia and corresponding cognate metabolic pathways, particularly glucose metabolism and FXR/RXR pathways. Importantly, the assessment of CL renouncement unravelled the restorative properties of several clusters of proteins involved mainly in organismal injury and abnormalities and, cellular function and maintenance. These proteins play key roles in restoring tear homeostasis and wound-healing mechanisms post-CL use-elicited injury.

Evaluation of microbial contamination of canine plasma eyedropper bottles following clinical use in canine patients

OBJECTIVE

To investigate microbial contamination of canine plasma eye drops when used clinically and to compare the effect of two different eyedropper bottles on contamination rate.

METHODS

Forty-six bottles containing plasma were randomly dispensed for use on 42 dogs with ulcerative keratitis. Of these, 23 were standard eyedropper bottles and 23 were Novelia^® bottles designed to prevent contamination. After use for up to 2 weeks, samples for bacterial culture were obtained from a drop of plasma, the bottle tip, the plasma inside the bottle, and the corneal surface. Fungal culture was performed from a drop of plasma.

RESULTS

The overall microbial contamination rate was 17.4% (8/46 bottles); however, only one bottle had growth from the plasma inside the bottle. There was a lower contamination rate of Novelia^® bottles (3/23 = 13.0%) compared to standard bottles (5/23 = 21.7%), but this difference was not statistically significant (P = .57). There were also no significant differences in contamination rate of bottles used greater than 7 days compared to less than or equal to 7 days, or in bottles used greater than 4 times daily compared to 4 times daily or less. Three corneal samples (6.5%) had bacterial growth, but none matched contamination from the bottles.

CONCLUSIONS

Novelia^® bottles may decrease contamination of plasma eye drops used clinically. However, while microbial contamination of plasma bottles was documented, no clinically relevant complications were observed. This study supports safe use of plasma eye drops for up to 2 weeks when refrigerated and dispensed from either Novelia^® or standard eyedropper bottles.

Bilateral bullous keratopathy secondary to melting keratitis in a Suri alpaca (Vicugna pacos)

An young alpaca was evaluated for bilateral progressive melting corneal ulcers and developped secondary bullous keratopathy during hospitalization. The tragic progression of melting ulcers in both eyes observed in our case leads us to recommend a rapid intensive medical therapy in young and debilitated alpacas presenting a corneal ulcer.

Effects of topically applied heterologous serum on reepithelialization rate of superficial chronic corneal epithelial defects in dogs

OBJECTIVE To assess the effects of topical application of undiluted heterologous serum on time to corneal reepithelialization in dogs with superficial chronic corneal epithelial defects (SCCEDs). DESIGN Multicenter, randomized, double-masked, controlled clinical trial. ANIMALS 41 client-owned dogs. PROCEDURES After collection of baseline clinical and historical data, dogs were randomly assigned to receive topically applied undiluted heterologous serum (n = 22) or isotonic saline (0.9% NaCl) solution (19) along with tobramycin and atropine. Epithelial debridement (at all visits) and grid keratotomy (at visits 2, 3, and 4) of SCCEDs were performed. Ophthalmic examination including fluorescein application was performed once weekly for 4 weeks or until corneal reepithelialization. Clinicians and owners were masked to treatment group. RESULTS No differences in baseline data were detected between treatment groups. No difficulties with medication administration, noncompliance, or adverse reactions were noted. All SCCEDs in both groups healed by 4 weeks after treatment began. Median time to reepithelialization (2 weeks) was not significantly different between serum-treated and placebo-treated eyes. Irrespective of treatment group, median time to reepithelialization was not significantly different for Boxers versus non-Boxer breeds. Direct correlations were detected between time to reepithelialization and vascularization score at study entry, vascularization score at time of reepithelialization, and ulcer area at study entry in both groups. Time to reepithelialization was not correlated with age, sex, or duration of signs in either group. CONCLUSIONS AND CLINICAL RELEVANCE Topical application of undiluted heterologous serum was well tolerated by dogs with SCCEDs but, as an adjunct to standard treatment, did not reduce time to corneal reepithelialization.

Construction of Anterior Hemi-Corneal Equivalents Using Nontransfected Human Corneal Cells and Transplantation in Dog Models

Tissue-engineered human anterior hemi-cornea (TE-aHC) is a promising equivalent for treating anterior lamellar keratopathy to surmount the severe shortage of donated corneas. This study was intended to construct a functional TE-aHC with nontransfected human corneal stromal (ntHCS) and epithelial (ntHCEP) cells using acellular porcine corneal stromata (aPCS) as a carrier scaffold, and evaluate its biological functions in a dog model. To construct a TE-aHC, ntHCS cells were injected into an aPCS scaffold and cultured for 3 days; then, ntHCEP cells were inoculated onto the Bowman's membrane of the scaffold and cultured for 5 days under air-liquid interface condition. After its morphology and histological structure were characterized, the constructed TE-aHC was transplanted into dog eyes via lamellar keratoplasty. The corneal transparency, thickness, intraocular pressure, epithelial integrity, and corneal regeneration were monitored in vivo, and the histological structure and histochemical property were examined ex vivo 360 days after surgery, respectively. The results showed that the constructed TE-aHC was highly transparent and composed of a corneal epithelium of 7-8 layer ntHCEP cells and a corneal stroma of regularly aligned collagen fibers and well-preserved glycosaminoglycans with sparsely distributed ntHCS cells, mimicking a normal anterior hemi-cornea (aHC). Moreover, both ntHCEP and ntHCS cells maintained positive expression of their marker and functional proteins. After transplantation into dog eyes, the constructed TE-aHC acted naturally in terms of morphology, structure and inherent property, and functioned well in maintaining corneal clarity, thickness, normal histological structure, and composition in dog models by reconstructing a normal aHC, which could be used as a promising aHC equivalent in corneal regenerative medicine and aHC disorder therapy.

Corneal ulcerative disease in dogs under primary veterinary care in England: epidemiology and clinical management

BACKGROUND

Corneal ulcerative disease (CUD) has the potential to adversely affect animal welfare by interfering with vision and causing pain. The study aimed to investigate for the first time the prevalence, breed-based risk factors and clinical management of CUD in the general population of dogs under primary veterinary care in England.

RESULTS

Of 104,233 dogs attending 110 clinics participating within the VetCompass Programme from January 1st to December 31st 2013, there were 834 confirmed CUD cases (prevalence: 0.80%, 95% confidence interval (CI) 0.75-0.86). Breeds with the highest prevalence included Pug (5.42% of the breed affected), Boxer (4.98%), Shih Tzu (3.45%), Cavalier King Charles Spaniel (2.49%) and Bulldog (2.41%). Purebred dogs had 2.23 times the odds (95% CI 1.84-2.87, P < 0.001) of CUD compared with crossbreds. Brachycephalic types had 11.18 (95% CI 8.72-14.32, P < 0.001) and spaniel types had 3.13 (95% CI 2.38-4.12, P < 0.001) times the odds for CUD compared with crossbreds. Pain was recorded in 385 (46.2%) cases and analgesia was used in 455 (54.6%) of dogs. Overall, 62 (7.4%) cases were referred for advanced management and CUD contributed to the euthanasia decision for 10 dogs.

CONCLUSIONS

Breeds such as the Pug and Boxer, and conformational types such as brachycephalic and spaniels, demonstrated predisposition to CUD in the general canine population. These results suggest that breeding focus on periocular conformation in predisposed breeds should be considered in order to reduce corneal disease.

The Effect of High Intensity Focused Ultrasound Keratoplasty on Rabbit Anterior Segment

Purpose. To evaluate the safety of high-intensity focused ultrasound keratoplasty as a treatment for presbyopia by examining its effect on the rabbit anterior segment. Methods. The right corneas of 36 New Zealand rabbits were treated with HIFU keratoplasty. The animals were sacrificed at 1, 7, 15, 30, 60, and 90 days after operation. Collagen type I, MMP-2, and MMP-9 were evaluated using immunohistochemistry. For the detection of apoptosis, the TUNEL method was applied. The SOD and MDA levels were analyzed with assay kits. Results. Collagen type I, MMP-2, and MMP-9 levels were altered after the operation but returned to normal within 90 days. The apoptotic index (AI) of the corneal cells decreased from 1 to 30 days gradually. No apoptosis was observed in the epithelial cells of the lens, and the SOD and MDA levels were normal at any time point. Conclusion. After HIFU keratoplasty, the histomorphology of the cornea changed, the corneal collagen type I levels decreased, the corneal MMP-2 and MMP-9 levels increased, and the corneal cells underwent apoptosis for a period of time. Ninety days after the operation, the levels returned to normal, and the lenses were not affected. Thus, HIFU presents good biological safety for eyes.

Protective Role of Hinokitiol Against H2O2-Induced Injury in Human Corneal Epithelium

PURPOSE

We recently found that hinokitiol has anti-inflammatory activity in human corneal epithelial (HCE) cells. Herein, we investigated the protective role of hinokitiol against H₂O₂-induced injury in HCE cells and the mechanisms that underlie its action.

METHODS

HCE cells were incubated with different concentrations of hinokitiol or dimethylsulfoxide (DMSO), which served as a vehicle control, before H₂O₂ stimulus. The cell viability was evaluated using a cell counting kit-8 (CCK-8) assay. TUNEL, phosphorylated histone γH2A.X, cleaved caspase-3 expression analyses, and location of cytochrome c were conducted to detect cell injury and apoptosis. Reactive oxygen species (ROS), catalase (CAT), superoxide dismutase (SOD), methane dicarboxylic aldehyde (MDA), and total antioxidative capacity (T-AOC) were used to determine oxidative stress. Bcl-2 and Bax protein expressions were measured by western blotting.

RESULTS

Hinokitiol significantly improved the cell viability, decreased the apoptosis rate, inhibited DNA damage, and reduced cleaved caspase-3 expression and the leakage of cytochrome c from mimitochondrion to cytoplasm of HCE cells against the oxidative stress induced by H₂O₂. Generation of ROS and MDA and decreased activity of CAT, SOD, and T-AOC were also ameliorated by hinokitiol administration. Moreover, Bcl-2 expression was down-regulated while Bax was up-regulated by H₂O₂ stimulus, which were reversed by hinokitiol application.

CONCLUSION

Hinokitiol protects HCE cells against H₂O₂-induced injury likely by its antioxidant activity and modulating the Bcl-2 signaling pathway.

Expressão de metaloproteinases de matriz e PCNA em úlceras de córnea profundas, induzidas em coelhos, tratadas com plasma rico em plaquetas

O objetivo deste estudo foi avaliar a influência do plasma rico (PRP) e pobre (PPP) em plaquetas na proliferação celular e expressão de metaloproteinases de matriz (MMPs), durante a reparação de úlceras corneais profundas. Foram utilizadas 45 coelhas, distribuídas em 3 grupos (G) experimentais (n=15), designados como grupos PRP (GR), PPP (GP) e Controle (GC), de acordo com o tratamento. Todos os animais foram submetidos à indução cirúrgica unilateral de úlcera corneal. No GR e GP, o sangue autólogo foi centrifugado, utilizando-se protocolo padronizado, e foram confeccionados os colírios de PRP e PPP, e instilados cinco vezes ao dia. No GC, foi utilizado colírio lubrificante. Cada grupo foi subdividido (n=5), segundo o momento final de avaliação, sendo 4 (M4), 7 (M7) e 30 dias (M30). As córneas dos animais foram processadas para avaliação morfológica e imuno-histoquímica para PCNA, MMP1, MMP2, MMP9, MT1-MMP e TIMP1. No M4, os níveis de MMP2 foram maiores no GP e GR, sendo que, no M7, esse comportamento foi observado apenas no GP. No M30, no GR, verificou-se maior número de células epiteliais e marcação para MMP1 que o GP. No GR, a proliferação celular foi maior no M4 que nos demais momentos, e a marcação para MMP2 foi maior no M4 que no M30. O PRP estimula a proliferação celular na fase inicial (M4) do tratamento quando comparado aos demais momentos, diferentemente dos demais tratamentos. O uso de colírios de plasma rico e pobre em plaquetas influencia a expressão de metaloproteinases de matriz envolvidas no processo de reparação corneal.

Molecular mechanisms of suberoylanilide hydroxamic acid in the inhibition of TGF-β1-mediated canine corneal fibrosis

OBJECTIVE

To investigate molecular mechanisms mediating anti-fibrotic effect of SAHA in the canine cornea using an in vitro model. We hypothesized that SAHA attenuates corneal fibrosis by modulating Smad-dependent and, to a lesser extent, Smad-independent signaling pathways activated by TGF-β1, as well as matrix metalloproteinase (MMP) activity.

METHODS

Cultured canine corneal fibroblasts (CCF) were incubated in the presence/absence of TGF-β1 (5 ng/mL) and SAHA (2.5 μm) for 24 h. Western blot analysis was used to quantify non-phosphorylated and phosphorylated isoforms of Smad2/3, p38 MAP kinase (MAPK), ERK1/2, and JNK1. Real-time PCR and zymography were utilized to quantify MMP1, MMP2, MMP8, and MMP9 mRNA expressions and MMP2 and MMP9 protein activities, respectively.

RESULTS

TGF-β1 treatment caused a significant increase in phospho-Smad2/3 and phospho-p38 MAPK. SAHA treatment reduced TGF-β1-induced phosphorylation of Smad2/3 but not of p38 MAPK. TGF-β1 did not modulate the phosphorylation of ERK1/2 or JNK1. SAHA caused a significant reduction in phospho-ERK1/2 expression regardless of concurrent TGF-β1 treatment. Neither SAHA alone nor in combination with TGF-β1 altered phospho-JNK1 expression. TGF-β1 significantly increased MMP1 and MMP9 mRNA expressions but did not alter MMP2 mRNA. SAHA treatment attenuated TGF-β1-induced MMP9 mRNA expression while significantly enhancing TGF-β1-induced MMP1 mRNA expression. Zymography detected reduced expression of MMP2 and MMP9 proteins in untreated control CCF. TGF-β1 treatment did not alter their expression, but SAHA treatment +/-TGF-β1 significantly increased MMP2 and MMP9 protein expressions.

CONCLUSIONS

The corneal anti-fibrotic effects of SAHA involve multiple mechanisms including modulation of canonical and non-canonical components of TGF-β1 intracellular signaling and MMP activity.

Ocular Surface as Barrier of Innate Immunity

Sight is one of the most important senses that human beings possess. The ocular system is a complex structure equipped with mechanisms that prevent or limit damage caused by physical, chemical, infectious and environmental factors. These mechanisms include a series of anatomical, cellular and humoral factors that have been a matter of study. The cornea is not only the most powerful and important lens of the optical system, but also, it has been involved in many other physiological and pathological processes apart from its refractive nature; the morphological and histological properties of the cornea have been thoroughly studied for the last fifty years; drawing attention in its molecular characteristics of immune response. This paper will review the anatomical and physiological aspects of the cornea, conjunctiva and lacrimal apparatus, as well as the innate immunity at the ocular surface.

Systemic Prolidase Activity and Oxidative Stress in Keratoconus

AIM

Our aim was to evaluate the serum prolidase activity, total antioxidant capacity (TAC) and total oxidant status (TOS) in patients with keratoconus.

MATERIAL AND METHOD

A total 69 keratoconus patients and 72 control subjects with similar age and gender were evaluated within the scope of this study. The keratoconus group was divided into four stages with the modified Krumeich classification. Serum prolidase activity, TAC and TOS were measured and compared between the patient and control groups.

RESULTS

The median serum prolidase enzyme activity value was 528.3 (684.1-416.7) U/L in the keratoconus group and 606.2 (812.9-482.3) U/L in the control group. The difference between the groups was statistically significant (p = 0.027). The median TAC value was 1.24 (1.37-1.05) mmol/L in the keratoconus group and 1.29 (1.38-1.18) mmol/L in the control group. The median TOS value was 2 (4-1) μmol/L in the keratoconus group and 3 (4-2) μmol/L in the control group. There was no statistically significant difference between the two groups in terms of TAC or TOS (p = 0.113 and p = 0.366, respectively). There was a positive correlation between TAC and TOS in keratoconus group but not in the control group (r = 0.670, p = 0.001 and r = 0.141, p = 0.241, respectively). No significant relationship was seen between the keratoconus group stages and serum prolidase activity, TAS or TOS (p = 0.894, p = 0.155 and p = 0.381, respectively).

CONCLUSION

In conclusion, a significant relationship was found between decreased serum prolidase activity and keratoconus but there was no significant relationship between keratoconus and serum TAC or TOS.