Effect of the combination of basic fibroblast growth factor and cysteine on corneal epithelial healing after photorefractive keratectomy in patients affected by myopia

The combined effect of epidermal growth factor and keratinocyte growth factor delivered by hyaluronic acid hydrogel on corneal wound healing

This study strategically incorporates epidermal growth factor (EGF) and keratinocyte growth factor (KGF) within a hyaluronic acid (HA) hydrogel to enhance corneal wound healing. The controlled release of EGF and KGF from the HA hydrogel is engineered to promote the regeneration of both the epithelial and stromal layers. Specifically, EGF plays a pivotal role in the regeneration of the epithelial layer, while KGF exhibits efficacy in the regeneration of the stromal layer. The combination of these growth factors facilitates efficient regeneration of each layer and demonstrates the capability to modulate each other's regenerative effects. The interplay between EGF and KGF provides an understanding of their cooperative influence on the dynamics of corneal wound healing. The results of this study contribute to the development of advanced strategies for corneal wound management and offer insights into the complex process of corneal regeneration.

ICL Postimplantation Decentration and Tilt in Myopic Patients with Primary Iridociliary Cysts

Purpose

To observe the decentration and tilt of implantable collamer lens (ICL) as well as possible visual effects postimplantation in primary iridociliary cysts.

Methods

The present investigation was a retrospective cohort study. All 48 patients (91 eyes) who underwent ICL surgery at the Center of Refraction Surgery of Tianjin Medical University Eye Hospital between July 2018 and May 2020 were split into two groups based on the absence or presence of primary iridociliary cysts established by ultrasonic biological microscopy (UBM) examination. Intraocular pressure (IOP), corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), anterior chamber angle (ACA), anterior chamber volume (ACV), and anterior chamber depth (ACD) were recorded preoperatively and postoperatively at 1, 6, and 12 months. Additionally, we performed an analysis of the ICL vault, decentration, and tilt using a rotating Scheimpflug Oculus Pentacam camera system at 1, 6, and 12 months after surgery.

Results

No serious complications were observed. Significant postoperative improvement (P < 0.05) of UDVA was established in the two studied groups; however, we did not observe statistically significant intergroup differences (P > 0.05) throughout the entire research period. In each group, the preoperative ACA, ACV, and ACD were statistically significantly reduced (P < 0.05), but no such decrease was established between their postoperative values (P > 0.05). We observed no statistical differences between both groups with regard to their values of IOP, ACA, ACV, ACD, ICL vault, ICL decentration, and tilt at 1, 6, and 12 months after surgery. Similarly, no statistically significant within-group correlation (P > 0.05) of the decentration of ICL and the tilt and the CDVA values was established.

Conclusion

No postimplantation effect of ICL with a central hole on vision was established in myopia patients with primary iridociliary cysts, within certain limits of ICL decentration and tilt values.

Antioxidant Defense and Pseudoexfoliation Syndrome: An Updated Review

Oxidative stress (OS) affects the anterior ocular tissues, rendering them susceptible to several eye diseases. On the other hand, protection of the eye from harmful factors is achieved by unique defense mechanisms, including enzymatic and non-enzymatic antioxidants. The imbalance between oxidants and antioxidants could be the cause of pseudoexfoliation syndrome (PEXS), a condition of defective extracellular matrix (ECM) remodeling. A systematic English-language literature review was conducted from May 2022 to June 2022. The main antioxidant enzymes protecting the eye from reactive oxygen species (ROS) are superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx), which catalyze the reduction of specific types of ROS. Similarly, non-enzymatic antioxidants such as vitamins A, E and C, carotenoids and glutathione (GSH) are involved in removing ROS from the cells. PEXS is a genetic disease, however, environmental and dietary factors also influence its development. Additionally, many OS products disrupting the ECM remodeling process and modifying the antioxidative defense status could lead to PEXS. This review discusses the antioxidative defense of the eye in association with PEXS, and the intricate link between OS and PEXS. Understanding the pathways of PEXS evolution, and developing new methods to reduce OS, are crucial to control and treat this disease. However, further studies are required to elucidate the molecular pathogenesis of PEXS.

Eye Habits Affect the Prevalence of Asthenopia in Patients with Myopia

Purpose

This study aims to explore the risk factors of asthenopia in the myopic population.

Methods

In this cross-sectional study, myopia patients were inquired about their eye habits and were requested to complete an asthenopia questionnaire and ocular examinations. Age, gender, occupation, anisometropia, eye care education, weekly outdoor activity time, duration of continuous near work, daily screen time, dry eye, near phoria, and binocular accommodative facility were calculated using the Student's test-test, Mann Whitney U test, and Pearson's chi-square test. Spherical equivalents and astigmatism were calculated using a generalized estimating equation. Binary logistic regression was performed on factors with a p-value <0.05.

Results

Of the 65 myopic patients, 57% showed asthenopia, 52% experienced blurry vision, 37% felt their eyes hurt or sore, and 28% felt tired when performing close work. Asthenopia patients were older than patients without asthenopia (Z = −2.887, p=0.004). Daily screen time, continuous near-work time, eye care education, and dry eye were positively correlated with asthenopia (χ² = 8.64, p=0.003; χ2 = 13.873, p < 0.001, χ2 = 9.643, p=0.002; χ2 = 7.035, p=0.008). After eliminating collinearity, eye care education and continuous near-work time were identified as independent risk factors of asthenopia, with odds ratios of 0.115 and 4.227, respectively.

Conclusion

This study shows that receiving eye care education from schools and hospitals and limiting near-work duration to less than 45 minutes per session could reduce the occurrence of asthenopia in myopic patients. This approach may be a more economical and convenient way for myopic people to relieve asthenopia.

Increased Matrix Metalloproteinase-2 and Matrix Metalloproteinase-3 Concentrations in Corneal Epithelium of Patients with Recurrent Corneal Erosions

Purpose

To assess the role of selected matrix metalloproteinases in defective corneal re-epithelization in patients with recurrent corneal erosions.

Subjects

The study group (group 1) included patients with recurrent corneal erosions qualified for phototherapeutic keratectomy. The group 1 was divided into two subgroups regarding the etiology of recurrent corneal erosions: group 1A, Cogan's basement membrane dystrophy, and group 1B, trauma. The control group (group 2) included patients with healthy eyes qualified for Epi-Bowman Keratectomy.

Methods

The analyzed material was the corneal epithelium collected during phototherapeutic keratectomy or Epi-Bowman Keratectomy in the study or control group, respectively. Matrix metalloproteinases concentration was determined by an immunohistochemical method using Human Magnetic Luminex® Assay.

Results

The study revealed a statistically significantly higher concentration of matrix metalloproteinase-2 in group 1 compared to the control and a statistically significantly higher concentration of matrix metalloproteinase-3 in group 1 compared to the control.

Conclusions

The results obtained in the study can prove that matrix metalloproteinase-2 and matrix metalloproteinase-3 having the ability to dissolve anchoring fibers and the corneal epithelial basement membrane could be responsible for epithelial instability and their accumulation in the corneal epithelium may induce recurrence of erosion.

Effect of multivitamin drug on intractable dry eye symptoms

Dry eye is a disorder of tear film and ocular surface characterized by ocular discomforts. It is associated with multiple causes and sometimes intractable. We investigated the effect of oral multivitamin supplementation (MVG) on dry eyes. Tear break-up time (TBUT), fluorescein ocular surface staining score, and tear secretion Schirmer test were measured in dry eye patients refractory to conventional topical treatment. The ocular surface disease index (OSDI), visual analog pain score (VAS), and modified standardized patient evaluation of eye dryness questionnaire were analyzed. In total, 42 eyes of 42 patients were included. TBUT increased at 1 and 3 months compared to baseline (p < 0.05). OSDI decreased at 1 and 3 months compared to baseline (p < 0.05). VAS score, impact on life, and frequency of total symptoms decreased at 3 months compared to baseline (p < 0.05). Oral administration of MVG, a vitamin complex formulation, was effective in stabilizing tear stability and alleviating symptoms in patients with intractable dry eye. Thus, it may be a viable treatment option for intractable dry eye.

Corneal morphological changes after small incision lenticule extraction for myopic anisometropia

Purpose

This research aims to study the corneal morphological changes in adult patients with myopic anisometropia after small incision lenticule extraction (SMILE) and the safety, efficacy, and predictability of clinical outcomes.

Methods

This was a prospective cohort study. Patients with myopic anisometropia [refractive difference &gt;2.0 diopters (D)] were included in this study who underwent SMILE at our hospital from September 2019 to March 2021. For the two eyes of each patient, the one with higher myopia was defined as group A, and the fellow eye was group B. The follow-up time points were set as 1 week, 1 month, 3 months, and 6 months after the surgery. The data collected were uncorrected and best-corrected distance visual acuity (UDVA and CDVA), spherical equivalent (SE), efficacy and safety indexes, posterior corneal elevation (PCE), anterior and posterior corneal radius of curvature in the 3 mm area at the center of the thinnest point of the cornea (ARC and PRC), and higher-order aberrations (HOAs).

Results

The study included 36 patients (72 eyes), and the mean age was 25.2 ± 6.4 years. The preoperative SEs were −6.45 ± 1.25 D in group A and −3.76 ± 1.29 D in group B. Six months after surgery, the SEs in groups A and B were −0.09 ± 0.50 D and 0.07 ± 0.47 (P = 0.059), respectively. The efficacy indexes were 1.06 ± 0.16 in group A and 1.07 ± 0.14 in group B (P = 0.750). The safety indexes were 1.08 ± 0.14 in group A and 1.12 ± 0.15 in group B (P = 0.173). The PCE was significantly reduced at 6 months after surgery in pagebreak both groups (P &lt; 0.05). The ARC was significantly higher than before the surgery (P &lt; 0.05) in the two groups. The two groups showed significant increases in total HOAs, coma 90°, and spherical aberrations (P &lt; 0.05).

Conclusion

SMILE is predictable, effective, and safe in correcting myopic anisometropia. The postoperative changes in HOAs are characteristic.

Inflammatory Bowel Disease Guidelines for Corneal Refractive Surgery Evaluation

Inflammatory bowel disease (IBD) is a chronic systemic inflammatory condition that can potentially adversely affect surgical outcomes in patients receiving elective ophthalmic procedures. In this case series, 21 eyes of 11 patients with ulcerative colitis or Crohn’s disease underwent laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), or small incision lenticule extraction (SMILE). Their surgical outcomes were followed up for an average of 8.9 ± 4.6 months. All the patients in this study did well, with 100% of eyes corrected for distance vision achieving uncorrected distance visual acuity 20/20 by postoperative month three. Common symptoms noted during the postoperative period included dry eyes, irritation, foreign body sensation, and blurry vision, all of which improved in prevalence and severity over the follow-up period, and none of the patients experienced a flare-up of their disease. Despite the successful outcomes in these patients, the authors recognize the inherent risks of operating on patients with IBD. Currently, there are no consensus guidelines for clinicians to follow to ensure that they are adequately screening these patients for eligibility, so the authors are suggesting a relevant, focused review of systems, a brief IBD history-related questionnaire, and a preliminary surgical decision-making flowchart for use in surgical evaluation.

Neurotrophic Keratopathy in Systemic Diseases: A Case Series on Patients Treated With rh-NGF

Purpose

To evaluate the prevalence, clinical ocular presentation and corneal healing in moderate and severe neurotrophic keratopathy (NK) caused by systemic diseases and treated with rh-NGF.

Setting

Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, University of Messina, Italy.

Design

Retrospective observational study of case series.

Materials and Methods

In this retrospective observational study 11 patients (five female and six males) aged from 24 to 88 years (55.4 ± 21.3 years) with moderate and severe NK caused by systemic diseases were enrolled. The VAS questionnaire was dispensed. The ocular examination comprised slit lamp evaluation, ocular surface assessment with Keratograph 5M (Oculus, Germany), corneal sensitivity with Cochet-Bonnet esthesiometer (Lunneaux, France) and corneal thickness measurement with AC-OCT (DRI, Triton, Topcon, Japan). The underlying systemic causes of NK were determined.

Results

The main cause of NK was post-neuroma surgery (36%), followed by diabetes (18%). The remaining causes were rheumatoid arthritis (9%), post-traumatic (9%), post-surgery (9%), atopia (9%), Graves' disease (9%). Seven eyes presented severe grade of NK with corneal ulcer and in four a moderate grade was registered. The rh-NGF (Cenegermin) was administered with a standard protocol one drop six times daily for 8 weeks. The complete healing of all corneal defects was registered at the end of the treatment.

Conclusions

The post-neuroma surgery was the most common cause of NK and severe grade was clinically more represented. The rh-NGF proved effective to promote corneal recovery with all defects healed after the treatment.

Sutureless Amniotic Membrane Transplantation in Inflammatory Corneal Perforations

Introduction: The aim of this study was to evaluate the efficacy of sutureless amniotic membrane transplantation (SAMT) in patients with corneal perforation secondary to ocular surface inflammatory diseases. Methods: Twelve eyes of eleven patients with corneal perforation associated with Sjögren’s syndrome and ocular cicatricial pemphigoid were included. Surgical procedure consisted in the application of two layers of amniotic membrane covering the corneal perforation and a therapeutic contact lens placed above the two layers, followed by sutureless tarsorrhaphy with Steri-strip applied for 15 days to immobilize the eyelids. All patients underwent slit-lamp examination, fluorescein corneal staining, and anterior segment optical coherence tomography (AS-OCT), preoperatively and post-surgery, weekly for one month, and then every two weeks for three months. Results: All 12 eyes had complete resolution of corneal perforation. Pachymetry measurements improved in all eyes, and complete healing of the corneal ulcer was obtained following treatment and maintained up to 3 months follow-up in all patients. Conclusions: SAMT was proven to be a safe and effective option for the management of inflammatory corneal perforation. The procedure is non-traumatic and easy to perform since the surgical technique is sutureless and does not require topical therapy because it takes advantage of the intrinsic properties of the membrane itself.

Comparison of transepithelial and conventional photorefractive keratectomy in myopic and myopic astigmatism patients: a randomized contralateral trial

Background

To assess transepithelial photorefractive keratectomy (tPRK) in terms of corneal epithelial healing rate, postoperative pain, postoperative discomfort, and visual and refraction outcomes compared to mechanical epithelial debridement PRK (mPRK) and alcohol-assisted PRK (aaPRK).

Methods

In this double-masked, randomized clinical trial, thirty-nine patients underwent tPRK in one eye and mPRK in the fellow eye (arm A), and 33 patients underwent tPRK in one eye and aaPRK in the contralateral eye (arm B). All surgical procedures were done using the Schwind Amaris excimer laser. The area of corneal epithelial defect in all eyes was captured and analyzed using ImageJ software.

Results

Mean epithelial healing time was respectively 3.74 ± 0.82 and 3.59 ± 0.79 days in tPRK versus mPRK (P = 0.21) in arm A, and 3.67 ± 0.92 and 3.67 ± 0.74 days in tPRK versus aaPRK (P = 1.00) in arm B. Accounting for the initial corneal epithelial defect area, the epithelial healing rate was faster in conventional PRK groups compared to tPRK (both P<0.001) in both arms. However, there was no significant difference in safety, efficacy, spherical equivalent refractive accuracy, or corneal haze development between tPRK and conventional PRK groups (all P > 0.05).

Conclusions

All three methods are effective in terms of visual and refractive outcomes. However, although time to complete re-epithelialization was similar with the three methods, the epithelial healing rate was faster in conventional PRK considering the initial corneal epithelial defect area, and the patients experienced less pain and discomfort in the first postoperative day.

Trial registration

IRCT, IRCT20200317046804N1. Retrospectively registered 5 May 2020.

Two-Step Transepithelial Photorefractive Keratectomy with WaveLight EX500 Platform for Adolescents and Adults with Low to Moderate Myopia: A 12-Month Comparative Evaluation

Purpose

To compare the visual and refractive results obtained after two-step TransPRK using an EX500 excimer laser for low to moderate myopic correction in adolescents and adults.

Patients and Methods

Retrospectively, 91 eyes of 52 patients were categorized into four groups based on age and level of myopia. The demographics, data of efficacy, safety, predictability, stability, and post-operative complications were evaluated at 1, 3, 6, and 12 months post-operatively.

Results

At 1-month, adolescents with low myopia achieved the highest mean efficacy index (P =0.034). The efficacy indices continuously increased during the 1-year follow-up in all groups, except in adolescents with moderate myopia. The highest safety and efficacy indices were recorded in adolescents with low myopia at 1-year. Post-operative spherical equivalent within ±0.50 D at 1 year was 48.75% of all treated eyes; however, the final mean refractive spherical equivalent (MRSE) was under-corrected in all groups. By month 3, the percentage of eyes that had grade 0.5 haze was most prevalent in adolescents with moderate myopia (P <0.001).

Conclusion

two-step TransPRK using an EX500 proved to be an effective, predictable, stable and safe procedure for the correction of low to moderate myopia with or without astigmatism at 1 year. Adolescents with low myopia achieved the best-post-operative UDVA, efficacy and safety indices. Adolescents tolerated night visual problems and dry eye symptoms better than adults.

Anandamide Concentration-Dependently Modulates Toll-Like Receptor 3 Agonism or UVB-Induced Inflammatory Response of Human Corneal Epithelial Cells

Photodamage-induced and viral keratitis could benefit from treatment with novel nonsteroid anti-inflammatory agents. Therefore, we determined whether human corneal epithelial cells (HCECs) express members of the endocannabinoid system (ECS), and examined how the endocannabinoid anandamide (AEA, N-arachidonoyl ethanolamine) influences the Toll-like receptor 3 (TLR3) agonism- or UVB irradiation-induced inflammatory response of these cells. Other than confirming the presence of cannabinoid receptors, we show that endocannabinoid synthesizing and catabolizing enzymes are also expressed in HCECs in vitro, as well as in the epithelial layer of the human cornea in situ, proving that they are one possible source of endocannabinoids. p(I:C) and UVB irradiation was effective in promoting the transcription and secretion of inflammatory cytokines. Surprisingly, when applied alone in 100 nM and 10 μM, AEA also resulted in increased pro-inflammatory cytokine production. Importantly, AEA further increased levels of these cytokines in the UVB model, whereas its lower concentration partially prevented the transcriptional effect of p(I:C), while not decreasing the p(I:C)-induced cytokine release. HCECs express the enzymatic machinery required to produce endocannabinoids both in vitro and in situ. Moreover, our data show that, despite earlier reports about the anti-inflammatory potential of AEA in murine cornea, its effects on the immune phenotype of human corneal epithelium may be more complex and context dependent.

Association of Myopia in Elementary School Students in Jiaojiang District, Taizhou City, China

Background

The aim of our study was to evaluate the prevalence of myopia in elementary school students and to assess the risk factors for myopia.

Methods

This school-based cross-sectional study was performed on students from two elementary schools in Jiaojiang, Taizhou City, China. A total of 556 students, whose age ranged from 9 to 12 years, were included. The uncorrected visual acuity and noncycloplegic refractive error tests were performed to determine the myopia. Each student was asked to fulfill the questionnaire about the possible factors associated with myopia. Multivariate logistic analyses of risk factors were conducted.

Results

The overall prevalence of myopia among those students was 63.7%, ranged from 53.4% in grade 4 to 72.5% in grade 6. Multivariate logistic analysis showed that adjusting the height of desks and chairs according to the changing height and the presence of myopia in parents were significantly associated with myopia in these students, respectively.

Conclusions

Our results showed that myopia among elementary school students was associated with environmental and hereditary factors.

Age-Related Change of Axial Length, Spherical Equivalent, and Prevalence of Myopia and High Myopia in School-Age Children in Shanghai: 2014–2018

Purpose. To investigate the age-related change of axial length (AL), spherical equivalent (SE), and prevalence of myopia and high myopia in children at 7–18-year-olds in Shanghai in 2014 and 2018, respectively. Methods. This was an observational study in Shanghai. The same 3 schools were selected in 2014 and 2018, respectively. AL, SE, prevalence of myopia and high myopia, height, and weight were measured. A questionnaire regarding the lifestyles was completed. Results. Mean age was smaller in 2018 than in 2014 ( $P<0.001$ ), and mean AL was shorter in 2018 than in 2014 ( $P=0.003$ ), whereas mean SE was greater in 2018 than in 2014 ( $P<0.001$ ). The prevalence of myopia and high myopia was lower in 2018 than in 2014 ( $P<0.001$ and $P=0.013$ , respectively). Mean AL increased with age from 7-year-olds to 18-year-olds in 2014 and 2018 (both $P<0.001$ ), respectively. Mean SE decreased with age in 2014 and 2018 (both $P<0.001$ ), respectively. The prevalence of myopia and high myopia increased with age in 2014 and 2018 (all $P<0.001$ ), respectively. Less mean time outdoors and more mean time of study of all children were observed in 2018 than in 2014 ( $P=0.018$ and $P<0.001$ , respectively). Conclusion. This study shows normative growth values for AL and SE in Shanghai children at the age of 7–18-year-olds, as well as the age-specific prevalence of myopia and high myopia.

Peripheral Refraction in Myopic Children with and without Atropine Usage

Purpose

To compare the patterns of relative peripheral refractions of myopic children who were currently on atropine treatment for myopia control and myopic children who did not use atropine.

Methods

Chinese children (n = 209) aged 7 to 12 years participated in the study, 106 used atropine and 103 did not. Participants were also classified into three groups: emmetropes (SE: +0.50 to −0.50 D), low myopes (SE: −0.50 to −3.00 D), and moderate myopes (SE: −3.00 to −6.00 D). The central and peripheral refractions along the horizontal meridians (for both nasal and temporal fields) were measured in 10-degree steps to 30 degrees.

Results

There were no statistically significant differences in spherical equivalent and astigmatism of the three refractive groups in either the nasal or temporal retina. The atropine group showed a significant relative myopia in the temporal 30° field in spherical equivalent compared to the emmetropic group (t₄₉ = 3.36, P=0.02). In eyes with low myopia, the atropine group had significant relative myopia in the nasal 30° and temporal 30° fields (t₁₁₈ = 2.59, P=0.01; t₁₁₈ = 2.06, P=0.04), and it is also observed at 20° and 30° of the nasal field for the moderate myopic group (t₃₆ = 2.37, P=0.02; t_2.84 = 2.84, P=0.01).

Conclusion

Significant differences in relative peripheral refraction were found between the atropine group and its controls. The findings suggested that the eyes that received atropine may have a less prolate shape and thus explain why using atropine is effective in controlling myopia progression.

Oral l-Cysteine Supplementation Enhances the Long Term-Effect of Topical Basic Fibroblast Growth Factor (bFGF) in Reducing the Corneal Haze after Photorefractive Keratectomy in Myopic Patients

We aimed at evaluating the long-term effects of l-cysteine oral supplementation to basic fibroblast growth factor (bFGF) eye-drops on corneal re-epithelization and transparency in myopic patients subjected to photorefractive keratectomy (PRK). Forty patients subjected to bilateral PRK for myopia were enrolled and randomly divided into two groups receiving an additional therapy together with the standard postoperative treatment consisting in local tobramycin 0.3%, dexamethasone 0.1%, diclofenac 0.1%, and 0.2% hyaluronate. Group 1 included 20 patients (11 males and 9 females; 34.09 ± 8 years of age) receiving only bFGF eye-drops (10 μg/10 μL) four times a day for 7 days starting from the day of surgery; Group 2 included 20 patients (12 males and 8 females; 37.35 ± 11.5 years of age) who were postoperatively administered with topical basic fibroblast growth factor (bFGF; 10 μg/10 μL) four times a day for 7 days plus oral l-cysteine supplementation (500 mg/capsule) once a day for 15 days, starting 7 days before PRK. Patients were followed-up for 12 months. Clinical ophthalmologic parameters were recorded for all the 80 examined eyes. The corneal transparency was evaluated in vivo by slit lamp and confocal microscopy. The data showed that: (a) the corneal haze occurred in a smaller percentage of the patients who were postoperatively administered with topical bFGF plus oral l-cysteine supplementation (Group 2) compared to patients who received only bFGF (Group 1); (b) at 6 months of follow-up, the stromal mean image brightness of the patients belonging to Group 2 was significantly lower than that of the Group 1 (p < 0.03), and, interestingly, the difference was even more evident at 12 month from the treatment (p < 0.001). Moreover, the final mean of the spherical equivalent refraction was −0.06 ± 0.2 D in Group 1 and −0.08 ± 0.3 D in Group 2, whereas the final uncorrected distance visual acuity (UDVA) was equal or superior to 20/25 in 100% of eyes in both Group 1 and 2. Post refractive patients can benefit from the administration of l-cysteine before the surgery and in association with bFGF in the early postoperative period, showing a faster corneal re-epithelization able to prevent corneal haze in the long-term recovery.

Effect of recombinant bovine basic fibroblast growth factor gel on repair of rosacea skin lesions: A randomized, single-blind and vehicle-controlled study

The aim of the present study was to assess the effect of topical use of recombinant bovine basic fibroblast growth factor (rbFGF) gel on the repair of facial skin lesions in patients with rosacea. In the present single-blind study, a total of 1,287 patients with Demodex mite-induced rosacea who received treatment with ornidazole tablets were randomized to rbFGF gel treatment group (n=651) or control group (n=636) without revealing the group identity. Patients in the treatment group were treated with topical application of rbFGF gel over the skin lesions (0.2 g/cm²) for up to 8 weeks, whereas patients in the control group received gel vehicle treatment unless ulceration occurred. Skin lesions of all patients were scored prior to and following treatment with rbFGF gel and subjected to histological analysis. All patients were followed up for 6 months. Significant improvement in the total effective rates for erythema, papules, desquamation and dryness were observed in the rbFGF treatment group. At the end of the 2, 4 and 6 months of follow-up, the total effective rates for patients in the treatment group were significantly higher than those in the control group (81.67 vs. 28.84%; 85.11 vs. 40.81%, and 96.56 vs. 55.82%, respectively). Following treatment for 6 months, none of the patients in the rbFGF group exhibited ulceration or scar formation. In the control group, 61% of patients experienced exacerbation of skin lesions, of which, 12% exhibited ulceration and were treated with rbFGF gel to prevent scar formation. Histological analysis revealed gradual reduction in epidermal hyperplasia and resolution of dermal edema in skin lesions treated with rbFGF gel. In conclusion, rbFGF gel may improve the repair of facial rosacea skin lesions in patients treated with anti-Demodex.

Effects of the Usage of l-Cysteine (l-Cys) on Human Health

This review summarizes recent knowledge about the use of the amino acid l-Cysteine (l-Cys) through diet, nutritional supplements or drugs with the aim to improve human health or treat certain diseases. Three databases (PubMed, Scopus, and Web of Science) and different keywords have been used to create a database of documents published between 1950 and 2017 in scientific journals in English or Spanish. A total of 60,885 primary publications were ultimately selected to compile accurate information about the use of l-Cys in medicine and nutritional therapies and to identify the reported benefits of l-Cys on human health. The number of publications about the use of l-Cys for these purposes has increased significantly during the last two decades. This increase seems to be closely related to the rise of nutraceutical industries and personalized medicine. The main evidence reporting benefits of l-Cys usage is summarized. However, the lack of accurate information and studies based on clinical trials hampers consensus among authors. Thus, the debate about the role and effectiveness of supplements/drugs containing l-Cys is still open.

Corneal Regeneration After Photorefractive Keratectomy: A Review

Photorefractive keratectomy (PRK) remodels corneal stroma to compensate refractive errors. The removal of epithelium and the ablation of stroma provoke the disruption of corneal nerves and a release of several peptides from tears, epithelium, stroma and nerves. A myriad of cytokines, growth factors, and matrix metalloproteases participate in the process of corneal wound healing. Their balance will determine if reepithelization and stromal remodeling are appropriate. The final aim is to achieve corneal transparency for restoring corneal function, and a proper visual quality. Therefore, wound-healing response is critical for a successful refractive surgery. Our goal is to provide an overview into how corneal wounding develops following PRK. We will also review the influence of intraoperative application of mitomycin C, bandage contact lenses, anti-inflammatory and other drugs in preventing corneal haze and post-PRK pain.