Chitosan-based thermosensitive hydrogel with long-term release of murine nerve growth factor for neurotrophic keratopathy

Neurotrophic keratopathy is a persistent defect of the corneal epithelium,with or without stromal ulceration,due to corneal nerve deficiency caused by a variety of etiologies.The treatment options for neurotrophic keratopathy are limited.In this study,an ophthalmic solution was constructed from a chitosan-based thermosensitive hydrogel with long-term release of murine nerve growth factor(CTH-mNGF).Its effectiveness was evaluated in corneal denervation(CD)mice and patients with neurotrophic keratopathy.In the preclinical setting,CTH-mNGF was assessed in a murine corneal denervation model.CTH-mNGF was transparent,thermosensitive,and ensured sustained release of mNGF for over 20 hours on the ocular surface,maintaining the local mNGF concentration around 1300 pg/mL in vivo.Corneal denervation mice treated with CTH-mNGF for 10 days showed a significant increase in corneal nerve area and total corneal nerve length compared with non-treated and CTH treated mice.A subsequent clinical trial of CTH-mNGF was conducted in patients with stage 2 or 3 neurotrophic keratopathy.Patients received topical CTH-mNGF twice daily for 8 weeks.Fluorescein sodium images,Schirmer’s test,intraocular pressure,Cochet-Bonnet corneal perception test,and best corrected visual acuity were evaluated.In total,six patients(total of seven eyes)diagnosed with neurotrophic keratopathy were enrolled.After 8 weeks of CTH-mNGF treatment,all participants showed a decreased area of corneal epithelial defect,as stained by fluorescence.Overall,six out of seven eyes had fluorescence staining scores<5.Moreover,best corrected visual acuity,intraocular pressure,Schirmer’s test and Cochet-Bonnet corneal perception test results showed no significant improvement.An increase in corneal nerve density was observed by in vivo confocal microscopy after 8 weeks of CTH-mNGF treatment in three out of seven eyes.This study demonstrates that CTH-mNGF is transparent,thermosensitive,and has sustained-release properties.Its effectiveness in healing corneal epithelial defects in all eyes with neurotrophic keratopathy suggests CTH-mNGF has promising application prospects in the treatment of neurotrophic keratopathy,being convenient and cost effective.

Bilateral malignant glaucoma with bullous keratopathy:A case report

BACKGROUND Malignant glaucoma,caused by aqueous misdirection,is a challenging postsurgical complication presented with normal/high intraocular pressure and shallowing of the central and peripheral anterior chambers.Its incidence is about 0.6%-4.0%.It can be secondary to filtering surgeries,laser iridotomy,and cataract surgery.Short axial length and a history of angle closure glaucoma are its main risk factors.Here,we report a bilateral malignant glaucoma with bullous keratopathy in the patient’s left eye.CASE SUMMARY We present a case of bilateral malignant glaucoma.The cause of malignant glaucoma for each eye of this patient was different.Hence,the management strategy and selection of surgical methods were also different.However,the normal anterior chamber was ultimately maintained,and maximum visual function was preserved.Even though the left eye received multiple surgeries and corneal endothelial decompensation occurred,the formation of a retroendothelial fibrous membrane partially compensated for the function of the corneal endothelium.CONCLUSION The formation of a retroendothelial fibrous membrane partially compensated for the function of the corneal endothelium.

Usage of topical insulin for the treatment of diabetic keratopathy,including corneal epithelial defects

BACKGROUND Diabetic keratopathy(DK)occurs in 46%-64%of patients with diabetes and requires serious attention.In patients with diabetes,the healing of corneal epithelial defects or ulcers takes longer than in patients without diabetes.Insulin is an effective factor in wound healing.The ability of systemic insulin to rapidly heal burn wounds has been reported for nearly a century,but only a few studies have been performed on the effects of topical insulin(TI)on the eye.Treatment with TI is effective in treating DK.AIM To review clinical and experimental animal studies providing evidence for the efficacy of TI to heal corneal wounds.METHODS National and international databases,including PubMed and Scopus,were searched using relevant keywords,and additional manual searches were conducted to assess the effectiveness of TI application on corneal wound healing.Journal articles published from January 1,2000 to December 1,2022 were examined.The relevancy of the identified citations was checked against predetermined eligibility standards,and relevant articles were extracted and reviewed.RESULTS A total of eight articles were found relevant to be discussed in this review,including four animal studies and four clinical studies.According to the studies conducted,TI is effective for corneal re-epithelialization in patients with diabetes based on corneal wound size and healing rate.CONCLUSION Available animal and clinical studies have shown that TI promotes corneal wound healing by several mechanisms.The use of TI was not associated with adverse effects in any of the published cases.Further studies are needed to enhance our knowledge and understanding of TI in the healing of DK.

ICU患者暴露性角膜炎风险评估量表的编制及信效度检验

目的编制ICU患者暴露性角膜炎风险评估量表,并检验其信度和效度。方法基于循证系统查阅文献编制量表初始条目池;通过2轮德尔菲专家函询,形成初始版量表;采用方便抽样法选取298例ICU患者,采用暴露性角膜炎风险评估量表进行调查,对量表信效度进行检验,并绘制受试者工作特征曲线确定最佳临界值。结果ICU患者暴露性角膜炎风险评估量表包括3个维度、12个条目;2轮函询专家积极系数分别为100%和80.95%,权威系数为0.892、0.888,肯德尔和谐系数为0.364和0.492;量表整体的Cronbach′sα系数为0.834,折半信度为0.795,评定者间信度0.841,内容效度为0.917;最佳临界值为8.5分,受试者工作特征曲线下面积为0.925。结论ICU患者暴露性角膜炎风险评估量具有良好的信效度,可用于ICU患者暴露性角膜炎的风险评估。

角膜神经移植在神经营养性角膜病治疗中的应用

神经营养性角膜病变(NK)是一种退行性疾病,其中角膜神经受损导致角膜感觉减退,严重者可致失明。传统的NK治疗旨在支持角膜愈合和防止角膜损伤的进展。近年来,角膜神经移植在NK中取得了一些进展。与传统治疗相比,角膜神经移植不仅能解决角膜神经缺损的问题,从而避免后续发生的角膜病变;还能显著恢复角膜敏感性、角膜上皮和视力等。角膜神经移植手术主要分为直接角膜神经移植和间接角膜神经移植两大类。如今,该手术方法已逐渐用于临床,并在疱疹病毒和神经瘤引起的单侧NK以及双侧NK上取得了令人满意的临床疗效。然而,对于干眼、糖尿病和慢性青光眼等引起的NK的手术治疗知之甚少。未来可通过多中心前瞻性随机研究来进一步完善针对NK的病因治疗。本文将从角膜神经移植手术的具体术式、手术方式的选择以及手术的时机三个方面介绍这一新型外科技术。

犬大疱性角膜病的病例诊断和治疗

1只1岁龄犬双眼角膜严重水肿,经眼科检查发现,该患犬角膜上皮完整,角膜上皮下方及基质层存在水疱,诊断为大疱性角膜病(BK)同时并发葡萄膜炎。在保守治疗无效的情况下选择角膜热成型术结合桥型结膜瓣遮盖术对其进行治疗。术后2个月,患犬角膜恢复良好。本文描述了该病例的诊断和治疗过程,并对BK的治疗方法进行了讨论。

NADPH氧化酶4在1型糖尿病模型小鼠角膜病变中的致病作用及其机制

目的探讨还原型烟酰胺腺嘌呤二核苷酸氧化酶4(Nox4)在1型DM模型小鼠角膜病变中的致病作用及其可能机制。方法选择Nox4基因敲除(Nox4^(-/-))纯合子雄性小鼠40只,以鼠龄、性别匹配的野生型C57BL/6(Nox4^(+/+))小鼠120只作为对照。采用随机数字表法分别将2种小鼠随机分为DM组和非DM组,DM组小鼠采用链脲佐菌素腹腔内注射法构建1型DM模型。采用随机数字表法分别将Nox4^(+/+)小鼠DM组和非DM组分为普通饲料喂养小鼠和添加Nox4抑制剂GKT137831(GKT)饲料喂养小鼠。于DM造模后第16周采用酚红棉线法检测各组小鼠泪液分泌量;采用荧光素钠染色评分法评估角膜上皮完整性;采用激光扫描共聚焦显微镜观察角膜基质层神经纤维密度变化;采用CellROX荧光探针检测角膜上皮中活性氧簇(ROS)含量;采用免疫荧光染色法检测小鼠角膜上皮中E-Cadherin蛋白和核因子-κB(NF-κB)蛋白表达变化;采用角膜铺片TUBB3染色法检测角膜中央区神经纤维密度。结果Nox4^(+/+)小鼠DM组和非DM组泪液分泌量分别为(2.40±1.18)和(5.30±1.02)mm/min,差异有统计学意义(P<0.01);Nox4^(-/-)小鼠DM组泪液分泌量为(4.19±0.63)mm/min,明显多于Nox4^(+/+)小鼠DM组,差异有统计学意义(P<0.05);普通饲料喂养小鼠与GKT添加饲料喂养小鼠DM组泪液分泌量分别为(2.23±0.83)和(4.02±0.71)mm/min,差异有统计学意义(P<0.01)。与Nox4^(+/+)小鼠非DM组比较,Nox4^(+/+)小鼠DM组角膜荧光素染色评分显著升高,角膜神经纤维密度显著降低,角膜上皮中ROS荧光强度明显增强,E-Cadherin蛋白表达荧光强度减弱,NF-κB蛋白表达荧光强度增强。Nox4^(-/-)或GKT添加饲料喂养小鼠DM组与非DM组比较角膜上皮中ROS荧光增强,E-Cadherin蛋白表达荧光减弱。Nox4^(-/-)和GKT添加饲料喂养小鼠DM组角膜上皮细胞中NF-κB蛋白荧光强度均较弱,与非DM组强度一致。角膜铺片免疫荧光染色显示,Nox4^(+/+)小鼠DM组中TUBB3染色的神经纤维密度明显低于非DM组,Nox4^(-/-)或GKT添加饲料喂养小鼠DM组角膜基质层神经纤维与非DM组比较无明显减少。结论Nox4参与了糖尿病角膜病变的致病过程,其机制可能与氧化应激诱导ROS产物聚集,激活NF-κB介导的炎症反应有关。

ICU患者暴露性角膜病变发生率及危险因素的Meta分析

目的:系统分析ICU患者暴露性角膜病变的发生率及危险因素,为临床医护人员进行早期干预提供参考依据。方法:计算机检索国内外数据库中关于ICU患者暴露性角膜病变发生率和(或)危险因素的文献,严格按照纳入与排除标准筛选文献,应用Stata 17.0软件进行Meta分析。用Begg检验和漏斗图判定发表偏倚。结果:共纳入15篇文献,涉及2470例患者,ICU患者暴露性角膜病变合并发生率为30.0%,眼睑闭合不全、结膜水肿、凸眼、机械通气及格拉斯哥评分<9分是ICU患者暴露性角膜病变的危险因素(P<0.05)。结论:暴露性角膜病变在ICU患者中发生率较高,临床医护人员应根据相关危险因素进行早期有针对性的干预,降低其发生率。

自体血清点眼对神经营养性角膜病变持续角膜上皮缺损的疗效评估

目的评估自制自体血清滴眼液对神经营养性角膜病变(NK)持续角膜上皮缺损的治疗效果。方法采用系列病例观察研究方法,纳入2020年1月至2021年1月于首都医科大学附属北京同仁医院诊断为NK导致的持续性角膜上皮缺损患者20例20眼,按照病变严重程度将患眼分级,采用自制自体血清滴眼液为主的综合治疗,记录角膜上皮愈合时间。采用角膜荧光素染色法标记缺损的直径和面积,10倍裂隙灯显微镜下测量治疗前及治疗后1、2、3、4、8周角膜缺损直径和面积变化;采用标准对数视力表测定患眼治疗前及治疗后1、2、4、12和24周LogMAR视力改变;采用激光扫描共聚焦显微镜和Cochet-Bonnet角膜知觉计分别检查患眼治疗前及治疗后4、12、24周角膜神经纤维分布变化及角膜知觉丝线长度。采用多重线性回归分析评估基线角膜缺损特征对上皮愈合时间的影响。结果治疗前角膜缺损范围直径为5.00(4.00,5.75)mm,缺损面积为15.50(12.00,20.00)mm2。伴角膜基质水肿者占45%(9/20),伴内皮皱褶者占35%(7/20)。除1例糖尿病伴葡萄膜炎患者治疗前角膜溃疡面积较大(8 mm×6 mm),自体血清滴眼液治疗2周效果不明显,联合角膜清创+羊膜移植手术覆盖缺损之后继续用自体血清滴眼液治疗外,其余19例均以自体血清滴眼液治疗为主,20例患者全部治愈。自体血清滴眼液治疗前时程为2周~3个月,平均(39.55±25.34)d。角膜上皮修复时间为12~42 d,平均(19.68±9.25)d。自体血清滴眼液使用前后各时间点角膜缺损面积和直径总体比较差异均有统计学意义(χ2=43.130、28.265,均P<0.001),其中治疗后不同时间点角膜上皮缺损面积和直径均小于治疗前,差异均有统计学意义(均P<0.05)。自体血清点眼前后不同时间点LogMAR视力总体比较差异有统计学意义(χ2=84.229,P<0.001),其中自体血清点眼1、2、4、12和24周患眼LogMAR视力均优于治疗前,差异均有统计学意义(均P<0.05)。自体血清滴眼液使用前后各时间点角膜知觉丝线长度总体比较差异有统计学意义(χ2=55.295,P<0.001),其中自体血清点眼4、12和24周角膜知觉丝线长度均长于治疗前,差异均有统计学意义(均P<0.05)。治疗前角膜缺损严重程度分级对愈合时间的影响有统计学意义(β=10.55,P=0.032),角膜缺损直径和角膜缺损面积对愈合时间的影响均无统计学意义(β=-2.02,P=0.501;β=0.49,P=0.199)。结论以自体血清滴眼液为主的治疗对NK导致的顽固角膜缺损安全有效。停止血清治疗后个别患者角膜缺损复发,再次使用后仍有效。疑难病例可联合手术治疗。

积雪草苷在高糖诱导人角膜上皮细胞损伤修复中的作用及机制研究

目的探究积雪草苷(AS)对高糖诱导的人角膜上皮细胞(HCEC)损伤修复的作用及机制。方法体外培养HCEC;CCK-8法检测不同浓度的葡萄糖及AS对HCEC细胞增殖活性的影响,筛选出HCEC最佳高糖诱导浓度(150 mmol·L^(-1))及AS干预浓度(20μmol·L^(-1))进行后续实验;实验分组:空白对照组(NC组;仅加入培养基DMEM)、高糖组(HG组;添加150 mmol·L^(-1)葡萄糖)、AS组(添加20μmol·L^(-1)的AS)、高糖+AS组(HG+AS组;添加150 mmol·L^(-1)葡萄糖及20μmol·L^(-1)的AS)。CCK-8法检测各组细胞培养24 h、48 h及72 h增殖活性;细胞划痕实验检测各组细胞培养24 h迁移能力;TUNEL染色实验检测各组细胞凋亡率;RT-PCR检测各组细胞中Wnt1、β-catenin、CyclinD1 mRNA的表达;Western blot检测各组细胞中Wnt1、β-catenin、CyclinD1蛋白表达。结果与NC组比较,HG组细胞培养24 h、48 h及72 h时增殖活性均明显降低,差异均有统计学意义(均为P<0.001);与HG组比较,HG+AS组细胞培养24 h、48 h及72 h时增殖活性均升高,差异均有统计学意义(均为P<0.001)。与NC组比较,HG组细胞凋亡率明显升高,差异有统计学意义(P<0.001);与HG组比较,HG+AS组细胞凋亡率明显降低,差异有统计学意义(P<0.01)。与NC组比较,HG组细胞迁移能力明显被抑制,差异有统计学意义(P<0.0001);与HG组比较,HG+AS组细胞迁移能力明显增强,差异有统计学意义(P<0.0001)。与NC组比较,HG组细胞中Wnt1、β-catenin及CyclinD1 mRNA表达均明显降低,差异均有统计学意义(均为P<0.05);与HG组比较,HG+AS组细胞中Wnt1、β-catenin及CyclinD1 mRNA表达均明显升高,差异均有统计学意义(均为P<0.001)。与NC组比较,HG组细胞中Wnt1、β-catenin及CyclinD1蛋白表达均明显降低,差异均有统计学意义(均为P<0.01);与HG组比较,HG+AS组细胞中Wnt1、β-catenin及CyclinD1蛋白表达均明显升高,差异均有统计学意义(均为P<0.01)。结论AS可以缓解因高糖导致的HCEC损伤,促进细胞增殖和迁移,抑制细胞凋亡,这种作用可能是通过激活Wnt/β-catenin信号通路实现的。

2型糖尿病患者中不同影响因素下角膜生物力学特性的变化趋势分析

目的探讨2型糖尿病(T2DM)患者的相关危险因素,以及这些危险因素与角膜生物力学[角膜滞后量(CH)和角膜阻力因子(CRF)]之间的关系。方法回顾性临床研究。选取从2022年2月至2023年3月就诊于资阳市中心医院的T2DM患者650例,采用Logistic回归分析对患者性别、年龄、糖尿病病程、高血压病史、吸烟史、饮酒史、体质量指数(BMI)、舒张压(DBP)、空腹血糖(FBG)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、糖化血红蛋白(HbA1C)进行独立危险因素评估,同时进一步根据糖尿病病程、FBG、DR分期、HbA1c(%)等不同病变程度分组,通过眼反应分析仪(ORA)测量患者的CH和CRF值,分析两者的数值变化趋势。结果研究显示T2DM病程、吸烟史、BMI、FBG、DR、HbA1c、TC、TG、LDLC是T2DM的共同危险因素,HDLC是其保护因素(均P<0.05)。随着糖尿病病程延长、空腹血糖的升高、HbA1C的累计,CH和CRF值逐渐降低,特别是HbA1c(%)>12时CH和CRF数值降低幅度最大,分别为(1.85±0.33)mmHg和(1.28±0.69)mmHg。与NonDR组相比,轻度NPDR、中度NPDR、重度NPDR和PDR组中CH和CRF值逐渐降低,其中PDR组中CH、CRF值最低,组间方差分析显示CH、CRF值差异具有统计学意义(P<0.05)。结论在2型糖尿病患者中,早期测量患者角膜生物力学特性,评估CH和CRF数值变化,及时采取干预措施,对于降低糖尿病性角膜病变具有重要作用。

Therapeutic effects of sericin on diabetic keratopathy in Otsuka Long-Evans Tokushima Fatty rats

An Otsuka Long-Evans Tokushima Fatty(OLETF)rat provides a useful model for studies to develop corneal wound healing drugs for use in diabetic keratopathy resulting from type 2 diabetes mellitus.We investigated the effects of sericin on corneal wound healing in OLETF rats.Corneal wounds were prepared by removal of the corneal epithelium and documented using a TRC-50X.Sericin was instilled into the eyes of rats five times a day following corneal abrasion.The plasma levels of glucose,triglycerides,cholesterol and insulin in 38 wk old OLETF rats were significantly higher than in normal control rats(LETO rats),and the rate of corneal wound healing in OLETF rats was slower than in normal rat,probably due to the suppression of cell migration and proliferation caused by high plasma glucose levels.The corneal wounds of OLETF rats instilled with saline showed almost complete healing 72h after corneal epithelial abrasion.On the other hand,the instillation of sericin has a potent effect in promoting wound healing and wound size reduction in OLETF rats and the wounds showed almost complete healing at 48 h after abrasion.The sericin may be an effective and safe drug to promote corneal wound healing in diabetic keratopathy.

Combined Descemet stripping automated endothelial keratoplasty and intravitreal dexamethasone implant for concomitant pseudophakic bullous keratopathy and cystoid macular edema

Dear Editor,Endothelial cell density decreases with age and in various ocular conditions,including corneal endotheliitis,uveitis,pseudoexfoliation syndrome,and birth injury(1)The reduction of endothelial cell density is exacerbated over time after intraocular surgery(1)Descemet stripping automated endothelial keratoplasty(DSAEK)is considered the primary procedure for patients with only endothelial dysfunction.

Dellen-like keratopathy associated with glaucoma drainage devices

To report the first case of dellen-like keratopathy with superior corneal thinning associated with implantation of glaucoma drainage devices. A 70-year-old male with a history of primary open angle glaucoma and dry eye disease underwent placement of glaucoma drainage devices with antimetabolite application in both eyes. Prior to placement, minimal refractive error was noted on manifest refraction. Several years later, the patient was referred for decreased vision and corneal irregularity. Examination showed pathologic corneal curvature, superior corneal thinning, and epithelial demarcation lines immediately anterior to the glaucoma drainage devices in both eyes. The epithelium remained intact with no evidence of limbal stem cell deficiency. Manifest refraction revealed a large change in both eyes. Topography was used to confirm the presence of irregular corneal curvature anterior to the glaucoma drainage devices. Dellen-like keratopathy with superior thinning is a rare sequela after implantation of a glaucoma drainage device that must be considered in elderly patients who undergo glaucoma surgery. It is likely related to a combination of tear film alteration related to previously large anterior blebs, antimetabolite application, and aqueous humor flow patterns around the drainage devices. Treatment should focus on lubrication.

Toxic keratopathy associated with abuse of topical anesthetics and amniotic membrane transplantation for treatment

AIMTo evaluate the clinical findings of toxic keratopathy associated with abuse of topical anesthetics and the treatment efficacy of amniotic membrane transplantation (AMT).METHODSFifteen eyes of 10 patients with abuse of topical anesthetics were included in this study. The data collected included patients' demographic information, initial best corrected visual acuity (BCVA), clinical findings, time to AMT, duration of epithelization, additional treatments, posttreatment BCVA, and the results of psychiatric examination.RESULTSAll patients were male, with the mean age of 37.9&#x000b1;5.4y. The patients had received 0.5% proparacaine hydrochloride due to pain resulting from foreign bodies, such as welding flash burns and car battery explosions, for a mean of 18.2&#x000b1;12.4d. The mean initial BCVA of the patients was 0.069&#x000b1;0.100. All patients had persistent epithelial defects, stromal infiltration, ring ulcer, and corneal edema. Initially, medical treatment was attempted in all cases. Because of severe pain, persistent epithelial defects and progressing stromal thinning did not improve with medical treatment, thus, the patients underwent AMT. The mean posttreatment BCVA of the patients was 0.33&#x000b1;0.27. All of them, except for two patients, showed improved visual acuity. One patient underwent evisceration for corneal melting and endophthalmitis in another center, and one patient underwent evisceration for severe pain of unknown origin. All 5 patients who consented to a psychiatric examination had depression, had personality disorder, and used tobacco.CONCLUSIONAMT appears to be an effective method for pain relief, rapid epithelial and stromal healing; however, visual prognosis is still poor despite medical and surgical interventions.

Analysis of corneal morphologic and pathologic changes in early-stage congenital aniridic keratopathy

AIM：To determine typical corneal changes of congenital aniridic keratopathy（CAK）using corneal topography and confocal systems,and to identify characteristics that might assist in early diagnosis.METHODS：Patients with CAK and healthy control subjects underwent detailed ophthalmic examinations including axial length,corneal thickness,tear film condition,corneal topography,and laser-scanning in vivo confocal microscopy（IVCM）. RESULTS：In early stage aniridic keratopathy,Schirmer I test（SIT）,break-up time（BUT）,mean keratometry（mean K）and simulated keratometry（sim K）were reduced relative to controls（P〈0.05）,while simulation of corneal astigmatism（sim A）and corneal thickness were increased（P〈0.05）. In addition,significantly more eyes exhibited flat cornea compared with the control group. Inflammatory dendritic cells were present in the aniridic epithelium,with significantly increased density relative to controls（P〈0.05）. Palisade ridge-like features and abnormal cell morphology were observed in six out of sixteen CAK cases. In central cornea area,the aniridic corneas had the increased subbasal nerve density. CONCLUSION：These changes in corneal morphology in borderline situations can be useful to confirm the diagnosis of CAK.

Ethylenediaminetetraacetic Acid Chelation for Band Keratopathy before Ab Interno Glaucoma Surgery

An 87-year-old woman with primary open-angle glaucoma presented to our hospital. Although the combined cataract and minimally invasive glaucoma surgeries (MIGS) were an appropriate surgical option, the presence of band keratopathy made it difficult to perform ab interno glaucoma surgery in her right eye (OD);therefore, the corneal opacity was removed using ethylenediaminetetraacetic acid (EDTA) chelation procedure. One month after chelation, microhook ab interno trabeculotomy and cataract surgery were performed successfully. Clear intraoperative visualization of the angle structures is critical for the success of these MIGS procedures. In glaucomatous eyes that require MIGS, EDTA chelation is a good neoadjuvant therapy for coexisting band keratopathy.

Infective crystalline keratopathy due to Citrobacter koseri

Rationale:Infectious keratopathy is an ocular emergency with the potential to cause irreversible blindness.Patient's concerns:A 63-year-old diabetic man presented with a 3-day history of painful red right eye.He had a history of multiple ocular surgeries in the affected eye without recent ocular trauma.Diagnosis:Infective crystalline keratopathy secondary to Citrobacter koseri.Interventions:Topical corticosteroids were discontinued,and dual topical antibiotic therapy of moxifloxacin 5%and gentamycin 0.3%were applied.Outcomes:Twelve hours after the start of treatment,the crystalline nature of the infiltrate disappeared,with enlargement of the epithelial defect.The antibiotic regime was continued and the lesion healed within a week of presentation with residual scarring.Lessons:Infective crystalline keratopathy classically presents with intrastromal branching fern-like opacities and minimal anterior segment inflammation in an immunosuppressed eye.The mainstay of management is corticosteroid discontinuation and the administration of empirical antibiotics until the results of the culture and sensitivity are available.In Citrobacter-related cases,treatment may result in a suppurative appearance before healing of the lesion.

线粒体自噬在糖尿病眼病中作用的研究进展

线粒体自噬是线粒体在生理和病理条件下发生的高度保守的自我降解过程。近年来研究表明,线粒体自噬在糖尿病眼病的发生发展中起着至关重要的作用。本文就线粒体自噬调控途径以及线粒体自噬在糖尿病眼病中作用的研究进展进行综述,以期为临床诊治提供新的思路。

枸杞多糖对高糖诱导衰老小鼠角膜上皮细胞增殖的影响

目的:观察不同剂量枸杞多糖(LBP)对高糖诱导的衰老小鼠角膜上皮(MCE)细胞增殖的影响。方法:采用含有不同浓度葡萄糖(5.5 mmol/L、12.5 mmol/L、25 mmol/L、50 mmol/L、100 mmol/L、200 mmol/L)的杜氏改良Eagle培养基(DMEM)孵育MCE细胞48 h,用MTT检测不同葡萄糖浓度对MCE细胞增殖的影响。建立高糖损伤模型,用不同浓度(50μg/ml、100μg/ml、200μg/ml和400μg/ml)的LBP处理葡萄糖损伤的MCE细胞48 h,观察MCE细胞增殖情况。结果:在用25 mmol/L的葡萄糖浓度处理MCE细胞,细胞增殖最强(P<0.01),葡萄糖浓度为200 mmol/L时,MCE细胞增殖力最低(P<0.01)。在所建立的高糖损伤模型(葡萄糖200 mmol/L)中LBP 200μg/ml促进MCE细胞增殖作用最强(P<0.05)。结论:一定浓度的葡萄糖可抑制MCE细胞增殖,LBP可保护高糖损伤的MCE细胞,促进其增殖。