Investigation of Needle Characteristics Using an Animal Model for Improved Outcomes in Anterior Chamber Paracentesis

Background/Aims: The current standard of care to perform an anterior chamber paracentesis involves the use of a multipurpose market needle and syringe. The use of standard needles for this purpose may result in injury to the patient due to increased force with insertion and increased globe displacement during the procedure. This research investigates the current market needle characteristics and the impact of each needle characteristic on force. Methods: Several comparative trials were conducted to evaluate the needles. Needle characteristics of interest were gauge, primary bevel angle, number of bevels in the lancet, and needle hub geometry. Measurements of corneal insertion forces were made using a synthetic thermoplastic polyurethane medium, and bovine and porcine models. Needle safety was investigated with corneal abrasion experiments. Results: Reduced insertion force was observed with lower lancet primary angle. There was no difference based on the number of bevels in the lancet. Rounded hub geometry had minimal distribution to the corneal epithelium. Conclusions: Needle characteristics impact the force needed for needle insertion into the tissue. Since higher force can lead to increased risk and less efficiency during the procedure, reducing this force may improve the outcomes of the procedure. Needle entry can be reduced by designing an improved needle that includes a lower gauge and reduced primary angle of the lancet.

Corneal Permeability and Uptake of Twenty-Five Drugs: Species Comparison and Quantitative Structure-Permeability Relationships

The purpose of this study was to determine corneal permeability and uptake in rabbit, porcine, and bovine corneas for twenty-five drugs using an N-in-1 (cassette) approach and relate these parameters to drug physicochemical properties and tissue thickness through quantitative structure permeability relationships (QSPRs). A twenty-five-drug cassette containing β-blockers, NSAIDs, and corticosteroids in solution at a micro-dose was exposed to the epithelial side of rabbit, porcine, or bovine corneas mounted in a diffusion chamber, and the corneal drug permeability and tissue uptake were monitored using an LC-MS/MS method. Data obtained were used to construct and evaluate over 46,000 quantitative structure-permeability (QSPR) models using multiple linear regression, and the best-fit models were cross-validated by Y-randomization. Drug permeability was generally higher in rabbit cornea and comparable between bovine and porcine corneas. Permeability differences between species could be explained in part by differences in corneal thickness. Corneal uptake between species correlated with a slope close to 1, indicating generally similar drug uptake per unit weight of tissue. A high correlation was observed between bovine, porcine, and rabbit corneas for permeability and between bovine and porcine corneas for uptake (R² ≥ 0.94). MLR models indicated that drug characteristics such as lipophilicity (LogD), heteroatom ratio (HR), nitrogen ratio (NR), hydrogen bond acceptors (HBA), rotatable bonds (RB), index of refraction (IR), and tissue thickness (TT) are of great influence on drug permeability and uptake. When data for all species along with thickness as a parameter was used in MLR, the best fit equation for permeability was Log (% transport/cm²·s) = 0.441 LogD - 8.29 IR + 8.357 NR - 0.279 HBA - 3.833 TT + 10.432 (R² = 0.826), and the best-fit equation for uptake was Log (%/g) = 0.387 LogD + 4.442 HR + 0.105 RB - 0.303 HBA - 2.235 TT + 1.422 (R² = 0.750). Thus, it is feasible to explain corneal drug delivery in three species using a single equation.

Ruthenium-induced corneal collagen crosslinking under visible light

Corneal collagen crosslinking (CXL) is a commonly used minimally invasive surgical technique to prevent the progression of corneal ectasias, such as keratoconus. Unfortunately, riboflavin/UV-A light-based CXL procedures have not been successfully applied to all patients, and result in frequent complications, such as corneal haze and endothelial damage. We propose a new method for corneal crosslinking by using a Ruthenium (Ru) based water-soluble photoinitiator and visible light (430 nm). Tris(bipyridine)ruthenium(II) ([Ru(bpy)₃]²⁺) and sodium persulfate (SPS) mixture covalently crosslinks free tyrosine, histidine, and lysine groups under visible light (400-450 nm), which prevents UV-A light-induced cytotoxicity in an efficient and time saving collagen crosslinking procedure. In this study, we investigated the effects of the Ru/visible blue light procedure on the viability and toxicity of human corneal epithelium, limbal, and stromal cells. Then bovine corneas crosslinked with ruthenium mixture and visible light were characterized, and their biomechanical properties were compared with the customized riboflavin/UV-A crosslinking approach in the clinics. Crosslinked corneas with a ruthenium-based CXL approach showed significantly higher young's modulus compared to riboflavin/UV-A light-based method applied to corneas. In addition, crosslinked corneas with both methods were characterized to evaluate the hydrodynamic behavior, optical transparency, and enzymatic resistance. In all biomechanical, biochemical, and optical tests used here, corneas that were crosslinked with ruthenium-based approach demonstrated better results than that of corneas crosslinked with riboflavin/ UV-A. This study is promising to be translated into a non-surgical therapy for all ectatic corneal pathologies as a result of mild conditions introduced here with visible light exposure and a nontoxic ruthenium-based photoinitiator to the cornea. STATEMENT OF SIGNIFICANCE: Keratoconus, one of the most frequent corneal diseases, could be treated with riboflavin and ultraviolet light-based photo-crosslinking application to the cornea of the patients. Unfortunately, this method has irreversible side effects and cannot be applied to all keratoconus patients. In this study, we exploited the photoactivation behavior of an organoruthenium compound to achieve corneal crosslinking. Ruthenium-based organic complex under visible light demonstrated significantly better biocompatibility and superior biomechanical results than riboflavin and ultraviolet light application. This study promises to translate into a new fast, efficient non-surgical therapy option for all ectatic corneal pathologies.

Scanning electron microscopy and morphometric analysis of superficial corneal epithelial cells in dromedary camel (Camelus dromedarius)

It is likely that superficial corneal epithelial cells (SCECs) of the dromedary camels have a significant role in their survival at arid and semiarid regions. To the best of our knowledge, SCECs of camels' eyes have not been characterized previously using scanning electron microscopy (SEM), combined with morphometric analysis. Therefore, in the current study, we aim to describe the shape, topographical distribution, and density of SCECs associated with morphometric analysis using SEM. Twelve healthy adult camels' corneas were obtained immediately after slaughter. Each cornea has been divided into nine parts: central (C), middle dorsal (MD), middle ventral (MV), middle nasal (MN), middle temporal (MT), peripheral dorsal (PD), peripheral ventral (PV), peripheral nasal (PN), and peripheral temporal (PT). SCECs were distinguished and characterized into light, medium, and dark mosaics. The polygonal cells have been externally covered with microplicae that were more numerous above the light cells. The topographic distribution of light, medium, and dark cells revealed a well-defined concentration of light cells in excess of other cells in all parts as follows: PV (92.5%), PN (78.5%), MN (78%), MT (74.7%), PD (73.8%), PT (70.7%), MV (68.7%), MD (66.3%), and C (19.3%). The PV part recorded the highest density of light cells, while the C portion showed the lowest density for the same cells. We concluded that the light cells extensively predominate in all parts of the camels' cornea except the C part, indicating an adaptive modification to the harsh environment. Additionally, the PV and PN parts represent the permanent and endogenous source as well as a proliferative reserve for SCECs in dromedary camel.

Scaling and maintenance of corneal thickness during aging

Corneal thickness is tightly regulated by its boundary endothelial and epithelial layers. The regulated set-point of corneal thickness likely shows inter-individual variations, changes by age, and response to stress. Using anterior segment-optical coherence tomography, we measure murine central corneal thickness and report on body size scaling of murine central corneal thickness during aging. For aged-matched mice, we find that corneal thickness depends on sex and strain. To shed mechanistic insights into these anatomical changes, we measure epithelial layer integrity and endothelial cell density during the life span of the mice using corneal fluorescein staining and in vivo confocal microscopy, respectively and compare their trends with that of the corneal thickness. Cornea thickness increases initially (1 month: 114.7 ± 3.0 μm, 6 months: 126.3 ± 1.6 μm), reaches a maximum (9 months: 129.3 ± 4.4 μm) and then reduces (12 months: 127 ± 2.9 μm, 13 months: 119.5 ± 7.6 μm, 14 months: 110.6 ± 10.6 μm), while the body size (weight) increases with age. We find that endothelial cell density reduces from 2 months old to 8 months old as the mice age and epithelial layer accumulates damages within this time frame. Finally, we compare murine corneal thickness with those of several other mammals including humans and show that corneal thickness has an allometric scaling with body size. Our results have relevance for organ size regulation, translational pharmacology, and veterinary medicine.

Biometria do bulbo ocular de bovinos da raça Nelore

Objetivou-se realizar a biometria de componentes do bulbo do olho de bovinos adultos da raça Nelore. Para tal, analisaram-se 121 bulbos oculares de animais abatidos com idade entre dois a três anos em um estabelecimento no município de Itaperuna-RJ, Brasil. Vinte medições macroscópicas foram feitas nos bulbos oculares e suas estruturas. Os bulbos apresentaram eixo óptico medindo 33,27 ± 1,55 mm, diâmetro equatorial de 38,07 ± 1,70 mm e volume estimado de 24,07 ± 3,51 mL. Houve correlação moderadamente positiva (r = 0,723, p < 0,0001) entre o eixo óptico e o diâmetro do bulbo ocular na raça. A córnea de bovinos da raça Nelore demonstrou eixos vertical e horizontal comparativamente menores do que a das raças europeias citadas na literatura, porém a proporção entre a altura e a largura da córnea se manteve semelhante. A lente também apresentou dimensões menores em comparação a outras raças. Este estudo fornece dados úteis para futuras investigações clínicas das anormalidades oculares na raça Nelore bem como para pesquisas em anatomia comparada.

A physiological perspective on the swelling properties of the mammalian corneal stroma

PURPOSE

The present studies were designed to assess whether measurement of corneal stroma swelling in the laboratory, especially in non-physiological solutions, was associated with a measurable effect on the keratocytes.

METHODS

Complete corneal stroma preparations were made from quality- and age-selected recent post-mortem cattle eyes. These were either assessed immediately or incubated in three different solutions, namely a balanced salts solution with glucose (BSSG), isotonic phosphate buffered saline (PBS) or pure water. Incubations were carried out at 37 degrees C for 9h, and repeated measures of wet mass made so that the rates and extent of swelling could be determined. After incubation, an aqueous extract was made of the stroma for measurements of the levels the enzymes lactate dehydrogenase (LDH), aldehyde dehydrogenase (ALDH) and N-acetyl-beta-glucosaminidase.

RESULTS

The initial rates of swelling were lowest in BSSG, marginally faster in PBS and much faster in water. The secondary rates of swelling showed the same sequence being 10.0%/h in BSSG, 14.8%/h in PBS and 34.2%/h in water. Compared to non-incubated preparations, reductions in all three enzyme activities occurred. For LDH, these were 15% with BSSG, 40% in PBS and 80% with water. Similar results were seen with ALDH activity when comparing the three incubation solutions, while incubation in BSSG also resulted in a substantial (40%) reduction in N-acetyl-glucosaminidase activity.

CONCLUSIONS

When immersed in an isotonic BSSG with added glucose at 37 degrees C, the swelling of a complete bovine corneal stroma is much less than smaller pieces of stroma, and also slightly less than if isotonic PBS was used. With the use of BSSG, little or no change in cytoplasmic enzyme activities occurred, but measurable decreases were noted with PBS and very substantial decreases when water was used, indicating a toxic effect on the keratocytes. The observation that substantial decreases in a lysosomal enzyme activity could occur even with the use of BSSG indicate substantial stress is imposed on the stroma during these types of experiments. Notwithstanding, the data collectively indicate that the keratocyte cells within the collagen matrix of the stroma can be substantially damaged and this needs to be taken into account in future experiments on the true physiology of the corneal stroma.

Changes in hydration, protein and proteoglycan composition of the collagen-keratocyte matrix of the bovine corneal stroma ex vivo in a bicarbonate-mixed salts solution, compared to other solutions

Many solutions have been used to investigate the swelling properties of the mammalian corneal stroma but few of the solutions resemble the expected extracellular matrix fluid of the corneal stroma, and little information is available on whether incubation ex vivo causes significant changes in the gross composition of the stroma. From quality-selected recent post-mortem eyes of adult cattle, stroma preparations were cut from the central part of the cornea. The time-dependent changes in wet mass were assessed over 9 h at 37 degrees C, and the preparations then dried. Various solutions of known pH (6.88-8.32) and osmolality (<50-327 mosmol/kg) were used, and were assayed for protein and proteoglycan after the incubation. The rates and extent of stromal swelling were lowest in a glucose-supplemented mixed salts solution containing 35 mM bicarbonate (0.5% CO2) solution, marginally greater in a mixed salts solution containing 35 mM bicarbonate (5% CO2) or similar non-bicarbonate mixed salts solutions (including BSS), and progressively greater in phosphate-buffered saline (PBS), various phosphate buffers (10-67 mM) and saline solutions (0.025-1%), and greatest in water. The initial rates of swelling ranged from 44 to 451 mg/h and the secondary rates from 9 to 106 mg/h. In all solutions, protein and proteoglycans were detected, but these ranged from around 1 to 10% of the samples with the bicarbonate-buffered solutions, to around 30% with the use of some phosphate buffers or saline.

Swelling of the collagen-keratocyte matrix of the bovine corneal stroma ex vivo in various solutions and its relationship to tissue thickness

AIM

The mammalian corneal stroma, like some other connective tissues, can absorb fluid, swell and become oedematous. Since studies on the corneal stroma have been carried out with different types of preparations and solutions, inter-study comparisons are very difficult. A study was thus undertaken on a standardised preparation to assess the relative magnitude of this swelling and its relationship to thickness of the preparations.

METHODS

From selected recent post-mortem eyes of adult cattle, stroma preparations were cut from the central part of the cornea. These preparations were immersed in various solutions of known pH and osmolality, and the time-dependent changes in wet mass were assessed over 9 h at 37 degrees C. The relative rates and magnitude of the swelling of the tissue were then compared.

RESULTS

A reference value for stromal swelling was obtained by incubation in a 35 mM bicarbonate-buffered mixed salts solution equilibrated with 5% CO2-air (pH 7.60) where a 3.39-fold increase in wet mass and a 4.58-fold increase in thickness was realised in 9 h, at an initial rate of 76 +/- 3%/h. The swelling was essentially the same in an organic buffer-mixed salt solution (pH 7.5) but progressively greater in phosphate-buffered saline (pH 7.5), a range of phosphate buffers (10-67 mM, pH 7.5), NaCl solutions (0.025-1%) and with gross swelling observed in water (where a 15.9-fold increase in wet mass occurred along with a 25-fold increase in thickness, at an initial rate of 643 +/- 62%/h). Overall, the wet mass changes were strongly related to thickness (P < 0.001).

CONCLUSIONS

The results confirm that the selection of solution(s) for studies on corneal stromal swelling is critical. The swelling (oedema) is lower in a physiologically-relevant solution (similar to the aqueous humour of the eye). This indicates that the swelling tendency of the corneal stroma has been overestimated in the past, and that a similar discrepancy may also exist for studies on other connective tissues ex vivo when non-physiological experimental solutions are used.

Re-assessment of the potential impact of physiologically relevant pH changes on the hydration properties of the isolated mammalian corneal stroma

The pH sensitivity of the swelling of the mammalian corneal stroma was reinvestigated to assess whether or not there were detectable differences in the hydration properties of this collagen-keratocyte matrix within a physiologically relevant range (as opposed to extremes of acid or alkaline pH) and at a physiologically relevant temperature. From recent post-mortem eyes of adult cows, square (8 x 8 mm) samples of corneal stroma were prepared and incubated in an isotonic, buffered (HEPES etc.), mixed salts solution with added glucose at 37 degrees C. The time-dependent changes in wet mass were assessed over 24 h. The rate and magnitude of stromal swelling were different within the range of pH 6.5-8.5. The wet mass of stromal samples increased almost 2-fold within 1 h, and then at lesser rates to realise 3.25-3.75-fold and 4-5-fold increases in wet mass by 9 h and 24 h respectively. The maximum increases were observed at pH 7.25-7.5, with most of the effect being the result of differences in the initial rate of swelling. The discontinuous swelling and the pH effect on the rates of swelling were also evident when the data were fitted to a previous kinetic model (Elliott et al., J. Physiol. (Lond.) 298 (1980) 453-470). It is concluded that pH changes in the physiological range can have a small but reproducible impact on the swelling kinetics of the isolated mammalian corneal stroma ex vivo.

In vitro hydration kinetics of recent post-mortem tissue versus pre-dried corneal stromal tissue

Both recent post-mortem and pre-dried corneal tissue has been used for laboratory studies of stromal swelling, but it has yet to be defined whether the same hydration (H value, mg H2O/mg dry mass) is obtained after extended re-hydration. Fresh or pre-dried pieces (8x8 mm squares) of ovine stromas were immersed in 1% NaCl for 24 hr at 37 degrees C, with the wet mass assessed regularly. Pre-drying was achieved in air for 7 days (with sulphuric acid, CaSO4 or silica gel as desiccants), or in an oven for 24 hr at 60, 70 or 80 degrees C. Fresh stroma preparations (</=2 hr post-mortem) had initial H values of 3.1, which increased to 27.8 after 24 hr in saline. After pre-drying over sulphuric acid, CaSO4 or silica gel, the H values after 24 hr in saline were 19.1, 13.1 and 7.3 respectively (all statistically different from fresh tissue (P<0.01). Following oven drying at 60, 70, and 80 degrees C, final H values of 8.5, 6.6, and 5.0 were obtained after 24 hr in saline. Recent post-mortem material showed sustained swelling over at least 24 hr. For pre-dried tissue, initial rates of hydration change over 1 hr were higher, but subsequent rates were substantially less after 2 hr. These studies indicate that fresh tissue should be used in studies concerning the swelling properties of the corneal stroma.

Determination of the unit size of the corneal endothelial cell mosaic from Fourier component image analysis

Scanning electron micrographs were taken of the central region of the corneal endothelium of cows (Holstein). The cells were outlined and an image overlay generated of approximately 100 cells. Via a Windows-based scanning system, the overlay was subjected to a two-dimensional Fourier transform on a Unix-based system. A custom algorithm was developed (IRIS) to sequentially analyse the Fourier transform pattern. The transform and resultant harmonics spectrum were compared to those obtained from artificial cell mosaics generated from uniform sized symmetrical hexagons. The position, width, and height of the 1st harmonic component of the frequency distribution appears to be derived from average cell-cell border distances across the image. The radial position of the 1st harmonic is inversely related to the unit cell size in the mosaic, i.e. the dominant cell size. The application of such techniques to cell mosaic analyses is discussed.