Two-step strategy—conjunctival flap covering surgery combined with secondary deep anterior lamellar keratoplasty for the treatment of high-risk fungal keratitis

AIM:To investigate whether the two-step strategy[conjunctival flap covering surgery(CFCS)combined with secondary deep anterior lamellar keratoplasty(DALK)]is effective for patients with high-risk fungal keratitis(FK).METHODS:In this noncomparative,retrospective case series,10 subjects(6 males,4 females)with a mean age of 56.5±7.1(range 47-72)y with high-risk FK undergone the two-step strategy were included.Reported outcome measures were healing of the corneal ulcer,recurrence of FK,reject reaction,improvement in best corrected visual acuity(BCVA)and relevant complications.RESULTS:The average diameter of corneal infiltrates was 7.50±0.39 mm,ranging from 6.94 to 8.13 mm.The mean depth of corneal infiltrates was 422.4±77.1μm,ranging from 350 to 535μm.The mean corneal thickness was 597.4±117.3μm,ranging from 458 to 851μm.Hypopyon and endothelial plaques were presented in all patients.The period between the two steps was 3.65±0.9(ranging from 3 to 5)mo.The graft diameter was 7.75±0.39 mm.At the last follow-up(average 9.25±3.39,ranging from 5.5 to 17mo),no fungal recurrence or graft rejection appeared,and all patients showed improvement of BCVA.One patient suffered from liver function impairment due to oral voriconazole for 4wk and recovered spontaneously after 1wk of drug withdrawal.CONCLUSION:The two-step strategy is safe and effective in the treatment of high-risk FK by transforming intentional therapeutic penetrating keratoplasty during acute infection to later optical DALK.It is a practical strategy,especially in areas lacking fresh donor corneas and eye bank services.

Differential expression of antimicrobial peptides in human fungal keratitis

AIM:To analyze a series of antimicrobial peptides(AMPs)in corneal tissue from individuals with fungal keratitis(FK)during the active phase of the fungus infection and after healing.METHODS:Patients undergone lamellar keratoplasty for the treatment of severe FK or corneal scar had their corneal buttons sampled.Quantitative real-time polymerase chain reaction(PCR)was used to ascertain the gene expression of human beta-defensin(HBD)-1,-2,-3,-9,S100A7,8,9,and LL-37.RESULTS:All AMPs’messenger ribonucleic acid(mRNA)expression was considerably elevated in all samples(n=12).In contrast to controls,where HBD-2,-3,and S100A7 mRNAs were expressed at very low levels,it was discovered that HBD-1,-9,S100A8,S100A9,and LL-37 were constitutively expressed in all healed samples(n=4).HBD-1,-2-3,S100A7,and LL-37 mRNAs were significantly increased in all active FK samples(n=8).The levels of HBD-9,S100A8,and S100A9 mRNAs were moderately upregulated in all active FK samples.Subgroup comparison showed that HBD-2 was significantly increased in Fusarium keratitis samples(n=5),and LL-37 mRNAs were significantly enhanced in Aspergillus keratitis samples(n=3).Whereas there was not significantly increased of HBD-1,-3,-9,S100A7,8,9 mRNA in Aspergillus keratitis samples compared with Fusarium keratitis samples.CONCLUSION:AMPs expression is increased in active FK,but not all AMPs are equally expressed.HBD-2 and LL-37 expression levels are the highest,showing some specificity of AMP expression related to FK.Human AMPs,particularly HBD-2 may play a significant role in Fusarium keratitis and LL-37 might be the key player in Aspergillus keratitis.

角膜前基质针刺术治疗角膜上皮细胞功能障碍的临床疗效

目的:探讨角膜前基质针刺术(ASP)治疗角膜上皮细胞功能障碍(CED)的临床疗效。方法:选取2015-09/12于华中科技大学同济医学院附属协和医院眼科行ASP治疗的CED患者16例16眼,分别于术前、术后1、3mo观察裸眼视力、眼表疾病指数评分(OSDI)、角膜荧光染色、角膜上皮厚度、全角膜厚度、角膜上皮下树突状细胞密度、角膜内皮细胞密度、角膜上皮下神经丛密度。结果:术后1mo,本组患者裸眼视力、上皮下神经丛密度均较术前明显改善,OSDI评分、角膜上皮厚度、全角膜厚度、角膜上皮下树突状细胞密度均较术前明显降低(P<0.05),而角膜内皮细胞密度较术前无明显变化(P>0.05)。术后3mo,裸眼视力、OSDI评分、角膜上皮厚度、全角膜厚度、角膜内皮细胞密度与术后1mo无明显差异(P>0.05),但角膜上皮下树突状细胞密度明显下降,上皮下神经丛密度明显增加(P<0.05)。结论:ASP可以有效治疗CED及其诱发的炎症,并可修复其导致的角膜上皮下神经丛缺损。

Small-incision lenticule extraction versus femtosecond lenticule extraction for myopic:a systematic review and Meta-analysis

● AIM: To examine differences in efficacy, accuracy, safety, aberrations and corneal biomechanical between small incision lenticule extraction(SMILE) and femtosecond lenticule extraction(FLEx) for myopia.● METHODS: Comprehensive studies were conducted on the Pub Med, MEDLINE, EMBASE, and Cochrane Controlled Trials Register before 31 July, 2015. Meta-analyses were performed on the primary outcomes [loss of ≥2 lines of corrected distance visual acuity(CDVA), uncorrected distance visual acuity(UDVA) ≥20/20, spherical equivalent(SE) within ±0.50 diopters(D), final refractive SE], secondary outcomes were high-order aberrations(HOAs) and corneal biomechanical [central corneal thickness(CCT), corneal hysteresis(CH) and corneal resistance factor(CRF)].● RESULTS: Seven trials describing a total of 322 eyes with myopia were included in this Meta-analysis. No significant differences were found in the efficacy [UDVA weighted mean difference(WMD)-0.01; 95%CI:-0.04 to 0.01; P=0.37, UDVA ≥20/20, OR 1.49; 95%CI: 0.78 to 2.86; P=0.23], accuracy(SE WMD-0.03; 95%CI:-0.12 to 0.07; P=0.58, SE within ±0.5 D OR 1.25; 95%CI: 0.34 to 4.65; P=0.74), HOAs(WMD-0.04; 95%CI:-0.09 to 0.01; P=0.14) and CCT WMD 1.83; 95%CI:-7.07 to 10.72; P=0.69, CH WMD-0.01; 95%CI:-0.42 to 0.40; P=0.97, CRF WMD 0.17; 95%CI:-0.33 to 0.67; P=0.50) in the last fellow-up. But for safety, FLEx may achieve fewer CDVA lost two or more two lines(OR 11.11; 95%CI: 1.27 to 96.86; P=0.03) than SMILE, however CDVA(WMD 0.00; 95%CI:-0.03 to 0.02; P=0.77) is similar. ● CONCLUSION: SMILE and FLEx are comparable in terms of both efficacy, accuracy, aberrations and corneal biomechanical measures in the follow-up,but FLEx seems to be better in safety measures. The results should be interpreted cautiously since relevant evidence is still limited, although it is accumulating. Further large-scale, welldesigned randomized controlled trials are urgently needed.

Retinal nerve fiber layer thickness changes in obstructive sleep apnea syndrome:a systematic review and Metaanalysis

·AIM: To evaluate the retinal nerve fiber layer(RNFL)thickness changes in patients with obstructive sleep apnoea syndrome(OSAS), and detect possible prevalence of glaucoma in this population.·METHODS: Comprehensive studies were conducted on the Cochrane Library, Pub Med and Embase through March, 2015. Only studies that fit the selection criteria about RNFL and OSAS would be included. For the measures, we calculated the 95% confidence interval(CI)and weighted mean differences(WMD). The systematic review and Meta-analysis was performed by Rev Man 5.2software.·RESULTS: Nine case-control studies were analyzed containing a total of 1086 cases and 580 controls.Average RNFL thickness in OSAS was reduced significantly compared with healthy controls in random effects model(WMD =-2.56, 95% CI:-4.82 to-0.31, P =0.003, I2=57%). A significant RNFL thickness reduction were found between the two groups in inferior quadrant(WMD =-3.11, 95% CI:-5.53 to-0.69, P =0.01), superior quadrant(WMD =-2.37, 95% CI:-4.7 to 0.04, P =0.05). In nasal quadrant(WMD =-2.54, 95% CI:-6.53 to 1.45, P =0.21) and temporal quadrant(WMD=-1.26, 95% CI:-2.19 to 0.47, P =0.15) there was no difference of RNFL thickness between the two groups.·CONCLUSION: The results show that RNFL thickness is lower in patients with moderate or severe OSAS than in normal subjects or patients with mild OSAS according to the nine homogeneity studies.

Cryopreserved limbal lamellar keratoplasty for peripheral corneal and limbal reconstruction

This study aimed to evaluate the outcomes and described the recovery process of cryopreserved limbal lamellar keratoplasty(CLLK) for peripheral corneal and limbal diseases. Thirteen eyes of 12 patients with a mean age of 41±23.9 y were included. The average follow-up was 12.1±5.6 mo. Stable ocular surface was achieved in all eyes at last follow-up. Epithelialization originated from both recipient and graft in 9 eyes. We conclude that CLLK compensates for the shortage of donor corneas and cryopreserved limbal grafts provide epithelialization sources in ocular surface reconstruction.

Amniotic membrane transplantation with topical interferon alfa-2b after excision of ocular surface squamous neoplasia

To evaluate the outcome of amniotic membrane transplantation(AMT) after tumor excision followed by topical interferon alfa-2 b(IFNα2 b) drops for primary ocular surface squamous neoplasia(OSSN). Twelve eyes of 12 patients with a mean age of 66±10 y were included. The average followup was 23±10 mo. All 12 patients had limbal involvement. Smooth ocular surface and transparent cornea were achieved in all cases. No sign of inflammation, neovascularization, symblepharon or recurrence was noted at the last follow-up. We conclude that AMT with topical IFNα2 b drops restores a healthy ocular surface in OSSN without recurrence.

SARS-CoV-2 in the ocular surface of COVID-19 patients

The 2019 novel coronavirus disease(COVID-19)caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has spread globally,while the routes of transmission of this virus are still controversial.We enrolled 33 patients,without any ocular manifestation,with their ocular surface swabs collected for virus detection.RNA was detected strong positive in samples of both eyes from two patients.Therefore,SARS-CoV-2 may exist in the normal ocular surface of COVID-19 patients,suggesting that this virus might be spread through conjunctival contact.

SARS-CoV-2 in the ocular surface of COVID19 patients

The 2019 novel coronavirus disease(COVID-19)caused by severe acute respiratory syndrome coronavirus 2(SARSCoV-2)has spread globally,while the routes of transmission of this virus are still controversial.We enrolled 33 patients,without any ocular manifestation,with their ocular surface swabs collected for virus detection.RNA was detected strong positive in samples of both eyes from two patients.Therefore,SARS-CoV-2 may exist in the normal ocular surface of COVID-19 patients,suggesting that this virus might be spread through conjunctival contact.