Treatment of superficial corneal opacities with corneal stromal lenticule obtained through SMILE surgery

AIM:To evaluate the clinical efficacy and feasibility of superficial corneal opacities treated by excimer laser phototherapeutic keratectomy(PTK)combined with small incision lenticule extraction(SMILE)-derived corneal stromal lenticule transplantation.METHODS:A retrospective interventional case series of nine patients aged 12-59y with superficial corneal opacity caused by different pathologies who underwent standardized PTK combined with SMILE-derived corneal stromal lenticule transplantation was examined.Lenticule patches were fixed with fibrin glue.All patients underwent pre-and post-operative clinical assessments at different times for up to 12mo.Slit lamp microscopy,corneal density,uncorrected distance visual acuity(UDVA),corrected distance visual acuity(CDVA),and anterior segment optical coherence tomography(AS-OCT)were examined.RESULTS:The patients’mean age was 36.00±5.80(12-59)y.Seven eyes(77.8%)gained UDVA and CDVA at the last measurement compared to their preoperative levels.The densities of the total cornea,the total anterior corneal layer,and the anterior corneal layers of 0-2 and 2-6 mm decreased significantly by 12.4%,27.5%,46.7%,and 32.8%,respectively.After human allogeneic transplantation,the implanted lenticules of all eyes were clearly visible by AS-OCT and remained transparent without displacement or graft rejection.The thickness of the central cornea and corneal lenticule transplants were stable throughout the entire postoperative period.One case experienced the postoperative complication of delayed corneal epithelial healing.CONCLUSION:PTK combined with SMILE-derived corneal lenticule transplantation improves long-term visual acuity.Therefore,it is a new,safe,and effective method for treating superficial corneal opacity.

雷珠单抗或加减驻景方对形觉剥夺性近视豚鼠眼轴和脉络膜厚度的短期影响

目的:观察形觉剥夺性豚鼠近视模型中给予中药驻景方或雷珠单抗注射液干预后屈光度、眼轴长度和脉络膜厚度的短期变化。方法:取出生2wk的豚鼠60只,右眼戴头套诱导形觉剥夺性近视(FDM)动物模型。2wk后随机分为雷珠单抗组、驻景方组和生理盐水组(各组n=20)。雷珠单抗组第1d玻璃体腔注射雷珠单抗注射液0.02mg 1次,驻景方组给予加减驻景方灌胃3.285g/(kg·d)(1.5mL/d)共7d,生理盐水组给予等量生理盐水灌胃。分别测量记录三组豚鼠给药前和给药后1、3d,1wk的屈光度、眼轴长度和脉络膜厚度。结果:雷珠单抗组给药前后的各值均无差异(P>0.05)。驻景方组和生理盐水组给药后1、3d的屈光度明显降低、眼轴长度缩短、脉络膜厚度增厚(P<0.05),且3d时两组的各值变化最明显,但均在1wk时恢复到给药前的水平。三组间给药1、3d时生理盐水组和驻景方组的屈光度均低于雷珠单抗组,且眼轴长度较短,脉络膜厚度较厚(P<0.05),给药3d时生理盐水组的各值变化最明显(P<0.05)。给药1wk时三组间各指标均无差异(P>0.05)。结论:形觉剥夺性近视恢复期有一个短暂的脉络膜增厚时期,雷珠单抗注射液全程明显抑制了形觉剥夺性近视恢复期脉络膜的增厚,驻景方在3d时开始出现轻微的增厚抑制,均只持续了短暂的1wk时间。

屈光参差儿童单眼配戴角膜塑形镜后调节功能的变化

目的:观察屈光参差儿童单眼配戴角膜塑形镜后双眼调节功能的变化,探讨调节在角膜塑形镜控制近视进展中的机制。方法:前瞻性自身对照研究,对2016-09/2018-09在我院门诊就诊的屈光参差儿童单眼配戴角膜塑形镜的青少年22例44眼,将配戴角膜塑形镜的眼作为戴镜组,未作处理的另一眼作为未戴镜组。戴镜眼组22眼,等效球镜度-2.75±1.16D;未戴镜眼组22眼,等效球镜度-0.10±0.32D。观察戴镜前和戴镜12mo后双眼屈光度差值、单眼调节幅度、调节灵敏度和调节反应的变化情况。结果:戴镜组戴镜前的调节幅度和调节灵敏度低于未戴镜组(P<0.01),调节滞后高于未戴镜组(P<0.05)。戴镜组配戴12mo后的单眼调节幅度15.63±1.66D高于戴镜前11.25±3.15D(t=3.63,P<0.01),与未戴镜组无差异(t=0.75,P=0.46)。戴镜组配戴12mo后的单眼调节灵敏度14.63±1.58cyc/min高于戴镜前9.25±3.38cyc/min(t=2.83,P=0.01),与未戴镜组无差异(t=0.38,P=0.71)。戴镜组配戴12mo后的调节滞后0.62±0.29D较戴镜前1.35±0.26D减少(t=2.57,P=0.02),与未戴镜组无差异(t=0.61,P=0.55)。戴镜12mo后,未戴镜组的平均屈光度为-0.75±0.35D,戴镜组屈光度增长了-0.15±0.22D(t=2.90,P<0.01),未戴镜组屈光度增长了-0.65±0.39D(t=4.24,P<0.01),两组间屈光度的变化差值有差异(t=5.30,P<0.01)。未戴镜组12mo前后调节功能的变化无差异(P>0.05)。结论:屈光参差儿童单眼配戴角膜塑形镜后戴镜眼的调节功能较戴镜前明显改善,且与对侧眼一致,戴镜眼的屈光状态更稳定,未戴镜眼逐渐呈现轻度近视屈光状态,但调节功能未出现明显变化。

Corneal flap morphological analysis using anterior segment optical coherence tomography in laser in situ keratomileusis with femtosecond lasers versus mechanical microkeratome

AIM: To assess and compare the flap morphology using anterior segment optical coherence tomography (AS-OCT) in laser in situ keratomileusis (LASIK) with Femto LDV femtosecond lasers versus Hansatome mechanical Microkeratome. METHODS: AS-OCT (Visante) was used to compare 1 month postoperatively the morphology of the flaps created with Femto LDV femtosecond lasers or Hansatome Microkeratome. The intendedfiap thickness was 110 mu m and 160 mu m respectively. The thickness of twenty-five points across each flap, which were 0mm, 1.5mm, 2.5mm, and 3.5mm to the corneal vertex on the horizontal, vertical, 45 degrees and 135 degrees meridian respectively, was evaluated. RESULTS: One month postoperative, the central flap thickness in the Femto LDV group was 107.43 +/- 4.70 mu m, while 125.90 +/- 17.50 mu m in the Hansatome group. The difference between the actual and the expectedfiap thickness was 5.61 +/- 3.84 mu m and 31.52 +/- 12.27 mu m, respectively. The Hansatome group had presented a statistically significant result (P<0.001). Flap morphology showed a more regular planar shape in the Femto LDV group and a meniscus shape in the Hansatome group. CONCLUSION: AS-OCT is a direct and fast procedure to assess the flap morphology. The morphology by AS-OCT showed that the flaps created with Femto LDV femtosecond laser were more accurate and regular than the flaps created with Hansatome microkeratome.

Comparison of early changes in ocular surface markers and tear inflammatory mediators after femtosecond lenticule extraction and FS-LASIK

AIM:To compare the short-term impacts of femtosecond lenticule extraction(FLEx)and femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)on ocular surface measures and tear inflammatory mediators.METHODS:This prospective comparative nonrandomized clinical study comprised 75 eyes(75 patients).Totally 20 male and 15 female patients(age 21.62±3.25 y)with 35 eyes underwent FLEx,and 26 male and 14 female patients(age 20.18±3.59 y)with 40 eyes underwent FS-LASIK.Central corneal sensitivity,noninvasive tear breakup time,corneal fluorescein staining,Schirmer I test,tear meniscus height,and ocular surface disease index were evaluated in all patients.Tear concentrations of nerve growth factor(NGF),interleukin-1α(IL-1α),transforming growth factor-β1(TGF-β1),tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ),and matrix metalloproteinase-9(MMP-9)were assessed by multiplex antibody microarray.All measurements were performed preoperatively,and 1 d,1 wk,and 1 mo postoperatively.RESULTS:Patients who underwent FLEx exhibited a more moderate reduction in central corneal sensation and less corneal fluorescein staining than those in the FS-LASIK group 1 wk after the procedure(P<0.01).NGF was significantly higher 1 d and 1 wk after surgery in the FS-LASIK group than in the FLEx group(P<0.01).By contrast,compared to those in the FLEx group,higher postoperative values and slower recovery of tear TGF-β1,IL-1α,and TNF-αconcentrations were observed in the FS-LASIK group(P<0.01).Tear concentrations of NGF,TGF-β1,TNF-α,and IL-1αwere correlated with ocular surface changes after FLEx or FS-LASIK surgery.CONCLUSION:There is less early ocular surface disruption and a reduced inflammatory response after FLEx than after FS-LASIK.NGF,TGF-β1,TNF-α,and IL-1αmay contribute to the process of ocular surface recovery.

Comparison of corneal biological parameters between transepithelial and epithelium-off corneal cross-linking in keratoconus

AIM:To evaluate the differences in corneal biological parameters between transepithelial and epithelium-off corneal cross-linking in keratoconus.METHODS:In our prospective clinical trial,40 patients(60 eyes)with progressive keratoconus were randomized to undergo corneal cross-linking with transepithelial(TE group,n=30)or epithelium-off(EO group,n=30)keratoconus.Examinations comprised topography,corneal biomechanical analysis and specular microscopy at 6 mo postoperatively.RESULTS:The keratometer values were not significantly different between the TE and EO corneal cross-linked groups in different periods(each P>0.05).The corneal thickness of the EO group was greater than that of the TE group at 1 wk after the operation(each P<0.05).Regarding corneal biomechanical responses,the EO group showed a longer second applanation length than TE group(P=0.003).Regarding the corneal endothelial function,standard deviation of the endothelial cell size,and coefficient of variation in the cell area,the values of EO group were larger than those of TE group at 1 wk(P=0.011,0.026),and the percentage of hexagonal cells in EO group was lower than that in TE group at 1 and 6 mo(P=0.018,0.019).CONCLUSION:Epithelium-off corneal cross-linking may strengthen corneal biomechanics better than TE procedure can.However,the TE procedure with a lower ultraviolet-A irradiation intensity would be safer for corneal endothelial function.

Effects of curcumin nanoparticles on proliferation and VEGF expression of human retinal pigment epithelial cells

AIM:To investigate the effects of curcumin(Cur)nanoparticles loaded with chitosan derivatives grafted by deoxycholic acid(Chit-DC)on human retinal pigment epithelial(h RPE)cell proliferation and vascular endothelial growth factor(VEGF)m RNA expression.METHODS:Cur nanoparticles were synthesized with Chit-DC as the carrier and Cur as the supported drug.Cell counting kit-8(CCK-8)method was used to detect the effects of different concentrations of Cur/Chit-DC,Chit-DC,and Cur on the proliferation of h RPE cells for different times.The changes of Cur/Chit-DC and Cur on h RPE cell cycle were determined by flow cytometry.Semi-quantitative reverse transcription-polymerase chain reaction(RT-PCR)was used to detect the m RNA expression levels of VEGF in h RPE cells treated with Cur,Chit-DC and Cur/Chit-DC at 10μg/m L for 24 h.RESULTS:Different concentrations of Chit-DC nanoparticle treated h RPE cells had no significant difference in terms of optical density(OD)values compared with the control group at 24 h and 48 h.Moreover,there was no change in the cell morphology under a light microscope.After 24 h treatment with Cur/Chit-DC and Cur,the percentage of G0-G1 phase cells increased and the percentage of S phase cells decreased in all concentration groups.Cur/Chit-DC and Cur in all concentration groups inhibited the proliferation of h RPE cells in a time and dose dependent manner,and reduced the expression level of VEGF m RNA.CONCLUSION:The Cur/Chit-DC nanoparticles can release Cur continuously and have sustained release function.Both Cur/Chit-DC nanoparticles and Cur could inhibit h RPE cells cultured in vitro,and could reduce the expression level of VEGF m RNA in h RPE cells.