Small-diameter acellular porcine corneal stroma for peripheral corneal ulceration treatment

AIM:To evaluate the clinical efficacy of small-diameter acellular porcine corneal stroma(SAPS)for the treatment of peripheral corneal ulceration(PCU).METHODS:This retrospective clinical study included 18 patients(18 eyes)with PCU between April 2018 and December 2020.All patients had PCU and underwent lamellar keratoplasty with SAPS.Observation indicators included preoperative and postoperative best-corrected visual acuity(BCVA)and transparency of SAPS.The infection control rate in the surgical eye-lesion area was also calculated.RESULTS:Eighteen patients underwent lamellar keratoplasty with SAPS to treat PCU.None of the patients experienced rejection after 6mo(18/18)and 12mo(16/16)of follow-up.The BCVA(0.47±0.30)at the 6mo followup after operation was significantly improved compared with the baseline(0.99±0.80),and the difference was statistically significant(Z=-3.415,P<0.05).The BCVA at the 12mo follow-up after operation was not statistically significant compared to the 6mo(Z=0,P=1).With time,the SAPS graft gradually became transparent.At the 6mo(18/18)and 12mo(16/16)follow-up,none of the patients had recurrent corneal infection.CONCLUSION:SAPS is clinically effective in the treatment of PCU,improving the patient’s BCVA and reducing the incidence of rejection after keratoplasty.

Effect of autologous serum after amniotic membrane transplantation for persistent corneal ulcers

AIM:To investigate the effect of adding autologous serum eye drops to the postoperative regime after amniotic membrane transplantation for severe persistent corneal ulcers.METHODS:Forty eyes of 40 patients with persistent corneal ulcers were randomly assigned to artificial tears(sodium hyaluronate 0.2%,ATs group,n=20)or autologous serum eye drops(ASEDs,n=20)following treatment with amniotic membrane transplantation.Digital slit lamp images were acquired from all patients before and 30d post treatment.The area with fibrovascular tissue was calculated using Image J.Central corneal sensitivity was assessed by Cochet-Bonnet aesthesiometry before and one month after treatment.Scar tissue transparency was assessed with a novel optical densitometry.RESULTS:Mean age of patients was 61.65±16.47y and 57.3±19.11y in the ATs group and ASEDs group,respectively.Twenty-two male and 18 female patients were included in the study.The improvement in visual acuity was significantly greater in the ASEDs group(0.14±0.04)than the ATs(0.08±0.04;P=0.00046).Cochet-Bonnet aesthesiometry improved significantly after treatment with a similar rate between groups.There were no statistically significant differences in the area of postoperative fibrovascular tissue between the two groups(P=0.082).The success rate in the two groups was similar.The difference in densitometry between the ATs and ASEDs group was statistically significant(P=0.042)with greater reduction from baseline in the ASEDS group.CONCLUSION:Autologous serum eye drops can lead to better visual acuity,more stable results and improved densitometry and should be considered in the postoperative care following amniotic membrane transplantation.

Etiology of inflammatory bowel disease:A unified hypothesis

Inflammatory bowel disease(IBD),including both ulcerative colitis(UC) and Crohn's disease(CD),emerged and dramatically increased for about a century.Despite extensive research,its cause remains regarded as unknown.About a decade ago,a series of findings made me suspect that saccharin may be a key causative factor for IBD,through its inhibition on gut bacteria and the resultant impaired inactivation of digestive proteases and over digestion of the mucus layer and gut barrier(the Bacteria-Protease-Mucus-Barrier hypothesis).It explained many puzzles in IBD such as its emergence and temporal changes in last century.Recently I further found evidence suggesting sucralose may be also linked to IBD through a similar mechanism as saccharin and have contributed to the recent worldwide increase of IBD.This new hypothesis suggests that UC and CD are just two symptoms of the same morbidity,rather than two different diseases.They are both caused by a weakening in gut barrier and only differ in that UC is mainly due to increased infiltration of gut bacteria and the resultant recruitment of neutrophils and formation of crypt abscess,while CD is mainly due to increased infiltration of antigens and particles from gut lumen and the resultant recruitment of macrophages and formation of granulomas.It explained the delayed appearance but accelerated increase of CD over UC and many other phenomena.This paper aims to provide a detailed description of a unified hypothesis regardingthe etiology of IBD,including the cause and mechanism of IBD,as well as the relationship between UC and CD.

Breastfeeding and genetic factors in the etiology of inflammatory bowel disease in children

Inflammatory bowel disease is a chronic,debilitating disorder of the gastrointestinal tract.The etiology of inflammatory bowel disease has not been elucidated,but is thought to be multifactorial with both environmental and genetic influences.A large body of research has been conducted to elucidate the etiology of inflammatory bowel disease.This article reviews this literature,emphasizing the studies of breastfeeding and the studies of genetic factors,particularly NOD2 polymorphisms.

Changes in interleukin-6 tear concentration and clinical outcome in moderate-to-severe bacterial corneal ulcers after corneal collagen cross-linking

We aimed to evaluate interleukin-6（IL-6） tear concentration and clinical outcome in patients with moderate-to-severe bacterial corneal ulcers post corneal collagen cross-linking（CXL） therapy. This pre-post designed study involving 21 moderate-to-severe corneal ulcer patients who underwent CXL therapy. Patients with infectious corneal ulcer were given CXL therapy as adjunctive treatment after 5 d of broadspectrum antibiotic treatment. Patients with moderate to severe infectious bacterial corneal ulcers were included in this study. Tear sampling was performed before CXL therapy, using sterile Schimer paper from conjunctival inferior fornix. CXL therapy was performed in accordance with the CXL Dresden protocol. Data recording and tear sampling were then performed at day 1 and day 7 after CXL therapy. Data recording included, presence of conjunctival hyperemia, visual analogue scale（VAS）, size of corneal defects, and decemetocele. There was a decrease in IL-6 tear concentration by day 7 after CXL therapy（P=0.001）. IL-6 concentration at 1 h after therapy（2274.67±2120.46 pg/m L） tended to be lower than before therapy（4330.09±3169.70 pg/m L）, but the difference was not statistically significant（P=0.821）. The size of corneal defects decreased significantly post CXL（P=0.007）. The log MAR visual acuity before and after CXL therapy was not found to be significantly different（P=0.277）. There was a significant decrease in VAS values（P=0.018） and blepharospasm（P=0.011） pre and post CXL. There was no significant decrease in conjunctival hyperemia pre and post CXL（P=0.293）. There was significant reduction in IL-6 tear concentration and clinical improvement in moderateto-severe bacterial corneal ulcers which underwent CXL therapy.

Corneal ulcer caused by nocardia brasiliensis in a patient with diabetes

Dear Sir,Iam Dr.Sheng-Li Mi,from the Biomanufacturing engineering laboratory,Graduate School at Shenzhen,Tsinghua University,Shenzhen,China.I write to present a case report of nocardia brasiliensis in a patient with diabetes.Nocardia is part of a group of aerobic actinomycetes,widely distributed in soil.Nocardia asteroids and nocardia brasiliensis are the most common human pathogens.Humans infected by nocardia asteroids through the respiratory tract mainly suffer from primary suppurative pulmonary conditions.Infection of nocardia brasiliensis often occurs in the advanced stages of a progressive disease or immune disorder,especially Cushing syndrome,diabetes,or in patients using corticosteroids,immunosuppressive agents and broad-spectrum antibiotics for long time[1].To our knowledge,the reports of nocardia keratitis was very rare

Corneal ulcer possibly caused by the opportunistic pathogen Schizophyllum commune

Dear Editor,I am Dr.Xian-Ning Liu,from the Institute of Ophthalmology of Xi’an First Hospital in Xi’an,Shaanxi Province,China.I write to present a case report of corneal ulcer caused by Schizophyllum commune(S.commune).Mycotic keratitis is one of the most severe causes of corneal blindness in developing countries,such as China and India[1-2].

A Preliminary Report of Predisposing Factors and Predominant Microbiological Diagnosis of Corneal Ulcers Seen at the Federal Teaching Hospital Abakaliki, Nigeria

Background: Microbial keratitis often results in poor visual outcome despite treatment. A revision of treatment protocol based on local evidence may be required in order to obtain better treatment outcome. Objectives: To determine the predisposing factors and predominant microbiological diagnosis of corneal ulcers seen at the Federal Teaching Hospital Abakaliki (FETHA), Ebonyi State, Nigeria. Materials and Methods: This is a preliminary report of an on-going longitudinal descriptive study of all consenting corneal ulcer patients managed at the FETHA eye clinic over a 4-month period. Information obtained were socio-demographic data, presenting complaints, duration of symptoms prior to presentation, history of preceding trauma, medications used before presentation, presenting and final visual acuity and microbiological diagnosis. Results: A diagnosis of corneal ulcer was made in 8 out of the 852 outpatients seen over the study period giving a hospital prevalence rate of 0.59%. Five patients (62.50%) were males, five (62.50%) were farmers and 4 patients (50%) were above 60 years of age. The microbial diagnoses were bacterial keratitis 37.5% (Staphylococcus aureus), fungal keratitis 25% (Fusarium spp. and aspergillus) and acanthamoeba (25%). None of the patients ever used contact lenses. There was a history of eye trauma in 50% of the patients. All the eyes presented blind after a period of failed attempts to treat by self or quacks. Mean duration before presentation was two weeks. Treatment improved the visual acuity in 37.5% of patients. Conclusion: Bacteria, fungi and acanthamoeba organisms were the microbiological isolates from the scrapings of corneal ulcer patients seen in the eye clinic of FETHA;with bacterial organisms being the most common. Farming activities, preceding eye trauma, delayed presentation, self-medication and use of traditional eye medications (TEM) were common findings among the patients. A future larger study is recommended to confirm the findings of this study. Eye health education campaigns should be directed at farmers to encourage early presentation to hospitals.

Management of corneal ulceration with a moisture chamber due to temporary lagophthalmos in a brain injury patient:A case report

BACKGROUND This study describes the use of a moisture chamber to treat corneal ulceration due to temporary lagophthalmos in a critically ill patient.CASE SUMMARY A 46-year-old woman was admitted to the intensive care unit after a car accident.She suffered multiple injuries that included brain injury and presented with moderately decreased consciousness and lagophthalmos in her right eye.Within 6 d,her consciousness improved considerably;at which time,exposure keratopathy occurred and worsened to corneal ulceration.Lubricating gel,antibiotic ointment,and bandage contact lens were all ineffective in preventing or treating the exposure keratopathy.Instead of tarsorrhaphy,a moisture chamber was applied which successfully controlled the corneal ulceration.The moisture chamber was discontinued when complete eyelid closure recovered a week later.CONCLUSION A moisture chamber may be an effective,noninvasive alternative to tarsorrhaphy for treating severe exposure keratopathy due to temporary lagophthalmos.

Amniotic membrane transplantation in a patient with impending perforated corneal ulcer caused by Streptococcus mitis: A case report and review of literature

BACKGROUND Streptococcus mitis(S.mitis)is an opportunistic pathogen that can lead to severe ocular infections.In previous reports,penetrating keratoplasty(PK)was usually adopted for the treatment of persistent corneal ulcers.This report describes an unusual case of nonhealing descemetocele caused by S.mitis treated by antibiotics plus amniotic membrane transplantation(AMT).CASE SUMMARY A 63-year-old woman presented with a right persistent corneal ulcer that she had suffered from for the past 9 mo.The culture of a corneal scraping yielded S.mitis.The right eye descemetocele decreased in diameter from 3 to 0.8 mm after the continuous administration of topical vancomycin and ceftriaxone for 2 wk.Due to the slow healing,AMT was performed.Her corneal erosion healed and gradually became clear.Her visual acuity recovered from initially counting fingers to 100/200 at the last follow-up,67 mo after AMT.CONCLUSION Antibiotics plus AMT may be an effective alternative treatment other than PK to promote epithelializationand to reduce inflammation in the corneas complicated by S. mitis keratitis.

Effect of Topical FK506 Used alone or Combined with Keratoplasty on Patients with Recurrent Mooren′s Corneal Ulcer

Purpose: To evaluate the efficacy of topical 0.1% FK506 used alone or combined with keratoplasty on patients with recurrent Mooren′s ulcer. Methods: This is a retrospective interventional consecutive case series. Nine patients (15 eyes) with recurrent Mooren′s ulcer were treated with topical 0.1% FK506 alone or combined with keratoplasty. Two eyes with ulcers involving less than half the corneal limbus were treated with topical 0.1% FK506. Of the other 13 eyes with ulcers involving more than half the limbus, twelve were treated with excision of the ulcer and adjacent conjunctiva combined with lamellar keratoplasty. One eye with a central impending corneal perforation was treated with penetrating keratoplasty.Topical 0.1% FK506 was given post-operatively to all thirteen eyes after re-epithelia-lisation of the cornea. FK506 levels in the surgically resected cornea and conjunctiva of the operated eyes were measured using enzyme immunoassay procedures. Twelve patients (17 eyes) with recurrent Mooren′s ulcer treated with lamellar keratoplasty combined with topical 0.1% dexamethasone were taken as the control. The main measure of the outcome was the recurrence of Mooren′s ulcer in the patients. Results: Nine patients (15 eyes) with recurrent Mooren′s ulcer were all successfully treated. Vision in 5 eyes improved by two lines or better after treatment. No recurrence was observed during the follow up period of 12 to 22 months. After topical application of 0.1% FK506, concentrations of 30～350 ng/g of FK506 were found in the cornea and conjunctiva. Seven eyes of Mooren′s ulcer in the control group recurred during the follow up period. Conclusion: Topical 0.1% FK506 used alone or combined with keratoplasty is a safe and effective therapy for patients with recurrent Mooren′s ulcer.

A Rare Association of Giant Cell Arteritis with Recurrent Corneal Ulcer

We report a rare case of association of temporal arteritis with recurrent central corneal ulcer. A 91-year-old male with a remote history of clinically diagnosed giant cell arteritis (GCA) and penetrating keratoplasty (PK) for corneal edema in 1990’s in the left eye presented with irritation and severe dry eye. He progressively developed central corneal ulcer regardless of treatment with aggressive lubrication and patching. The clinical course, blood tests and temporal artery biopsy results yielded the diagnosis of recurrent GCA. The clinical course improved after starting oral steroids. The case report illustrates the importance of ruling out GCA in patients with recurrent corneal ulcers and history of GCA. It also highlights the significance of shared understanding between primary care physicians and specialists to handle common and chronic diseases to make efficient diagnoses and plan treatment regimens. This is the first plausible case of reported GCA association with central corneal ulcer in the United States.

淡紫紫孢菌引起角膜溃疡1例

患者,男,24岁,2022年9月16日因“右眼畏光、痒、视物不清”1个月余,门诊就诊,右眼有人工晶体的植入,此次受外伤后结膜混合充血,角膜中央溃疡,上皮大疱样改变。角膜溃疡组织标本分离培养出丝状真菌,经质谱鉴定为淡紫紫孢菌,并经rDNA ITS序列测定证实。予伏立康唑抗真菌治疗有效,病情好转,予以出院。

溃疡性结肠炎的中医药治疗研究进展

溃疡性结肠炎(ulcerative colitis,UC)是一种病因尚不十分明确、以结直肠黏膜连续性、弥漫性炎症改变为特点的慢性非特异性肠道炎性疾病,其病变主要限于大肠黏膜和黏膜下层。西医尚无可治愈该病的特效药物,氨基水杨酸类、糖皮质激素或免疫抑制剂虽对本病均有一定疗效,但服药时间长,不良反应大;中医药治疗慢性溃疡性结肠炎具有自身特点和独特优势,疗效稳定,不易复发,避免了西药治疗带来的不良反应,且治疗费用低廉,符合国情,深受患者欢迎,具有广阔的应用前景。该文就中医治疗溃疡性结肠炎的研究进展进行分析探讨,综述如下。

生物工程角膜板层角膜移植在真菌性角膜溃疡患者中的应用

目的探讨生物工程角膜板层角膜移植在真菌性角膜溃疡患者中的有效性及安全性。方法选取44例真菌性角膜溃疡患者为研究对象,根据使用的角膜材料分为生物工程组[采用脱细胞猪角膜基质(APCM)进行板层角膜移植,20例]和人供体组(采用人供体角膜材料进行板层角膜移植,24例)。比较两组术后不同时间角膜植片透明度评分、最佳矫正视力(BCVA)和术后角膜上皮愈合时间、术后并发症及复发率。结果术后1、3、6、12个月,随着时间的延长两组角膜植片透明度评分均逐渐降低,术后1、3、6个月生物工程组角膜植片透明度评分高于人供体组(P<0.05),但术后12个月两组角膜植片透明度评分比较,差异无统计学意义(P>0.05)。术后3、6、12个月,随着时间的延长两组患眼BCVA均逐渐增加,但生物工程组患眼术后3、6、12个月的BCVA均低于人供体组(P<0.05);两组角膜上皮愈合时间及术后角膜上皮愈合延迟、角膜植片排斥、角膜植片溶解、新生血管长入角膜植片4项并发症发生率和术后复发率比较,差异无统计学意义(P>0.05)。结论以APCM为材料进行板层角膜移植治疗真菌性角膜溃疡临床效果好,安全性高,可作为生物工程角膜应用于角膜病致盲的治疗。

黄河三角洲地区135例小肠溃疡的临床分析

目的:总结黄河三角洲地区小肠溃疡患者的病因构成、内镜表现及临床特点,为临床诊治提供依据。方法:回顾性分析2020年5月1日—2023年3月1日于滨州医学院附属医院经小肠镜或胶囊内镜首次诊断为小肠溃疡的135例患者的临床资料。结果:黄河三角洲地区小肠溃疡多发于40~59岁,男女比例为1.55︰1。小肠溃疡的病因主要以克罗恩病最多见,临床表现多为腹痛、腹泻、便血和黑便,影像学检查特点为小肠管壁增厚、肠系膜淋巴结肿大及小肠管腔狭窄。小肠镜及胶囊内镜检出率分别为26.83%及8.67%,常见溃疡部位为回肠、回盲部和空肠,内镜下溃疡特点以不规则样、纵行、环形、节段性为主,病理改变主要是黏膜慢性炎和伴炎细胞浸润。结论:小肠溃疡的病因复杂,临床特点缺乏特异性,小肠镜及胶囊内镜有助于小肠溃疡的诊断,但内镜下的表现常有重叠,病理活检在疾病的诊断中仍具有一定的局限性,应进一步探究CT等辅助检查在小肠溃疡诊断及鉴别诊断中的作用。

基于“土虚木郁”探讨腹泻型肠易激综合征与溃疡性结肠炎共同发病机制及证治

腹泻型肠易激综合征(IBS-D)与溃疡性结肠炎(UC)是临床较为常见的消化系统疾病,二者虽在疾病性质上有所不同,但在临床症状表现、发病机制及治疗策略等方面有诸多类似之处。基于对中医古籍的研究及临证经验的总结,众多中医学者认为“土虚木郁”是此二者疾病共同的发病机制,治疗时从肝脾论治往往可取得满意的临床疗效。多项现代医学研究表明中医“土虚木郁”与脑肠互动异常、肠道菌群-胆汁酸轴失衡等IBS-D和UC共同的病理生理学改变密切相关。该文基于中医“异病同治”理念及现代医学研究进展,以“土虚木郁”为切入点,探讨IBS-D和UC共同的发病机制及临床证治。

中医药防治溃疡性结肠炎机制研究进展

溃疡性结肠炎(ulcerative colitis UC)是临床上发病原因尚不明确的炎症性肠病,治疗UC在目前国际上仍旧是一个医学难题。中医认为UC发病是感受外邪、饮食不节、情志等因素所致发病。现代医学则认为发病与基因遗传、病菌感染、免疫异常、肠道环境、防御机能、精神因素及环境影响等因素密切相关,其机制研究上与肠道菌群失调、免疫系统紊乱、氧化还原失衡、精神心理刺激等方面相关。目前西医治疗多采用抗菌药物治疗、激素治疗、免疫抑制剂等方式,有手术指征的行手术治疗。中医药治疗上根据患者整体情况进行辨证施治,给予中药口服、灌肠及传统中医特色治疗等,作用以调节控制免疫系统、修复肠道黏膜屏障、肠道菌群调节、纠正氧化-抗氧化失衡、改善血液流变学指标等。近些年中医药治疗UC的研究机制逐渐深入,但中医药关于全面整理防治作用机制的文章相对较少。文中基于UC发病的中西医研究,对中医药防治UC的机制进行综述,提供较为全面的临床与实验研究认识,为进一步深入探讨UC的发病、治疗及相应的机制研究提供参考。

一例猫角膜腐骨合并衣原体感染的诊疗

一例因眼部异常分泌物持续增多且保守治疗无效前来就诊的患猫,通过临床检查和实验室检查,确诊为角膜溃疡引起的角膜腐骨病并伴有衣原体感染。因该病例耽误治疗时间较长、面积较大,且溃疡部位位于角膜中央周围,故行角膜结膜瓣遮盖术。经严格术后用药及精心护理,患猫恢复良好。

基于《金匮要略》论治溃疡性结肠炎

目的 基于《金匮要略》论治溃疡性结肠炎(UC),为临床辨治此病开拓新思路。方法 通过学习《金匮要略》、参考相关注家注释以及结合UC的现代研究成果,剖析并提炼《金匮要略》中对此病病因病机、治法方药、调理养护的思想。结果 《金匮要略》认为UC的病机为先天不足,脾肾阳虚,本虚标实共致气滞血瘀湿停、脂络受损;标本兼治,治本“当以温药和之”,辅以行气化瘀、缓肝解郁、清热解毒、消痈排脓等祛除标实;强调日常调护需“近其所喜,远其所恶”。结论 《金匮要略》中论述的有关UC的论治,对于现代医学认识、治疗及调护UC具有现实意义。