Umbilical cord blood serum therapy for the management of persistent corneal epithelial defects

AIM:Toevaluatetheroleofumbilical cord blood serum(CBS) therapy in cases with persistent corneal epithelial defects(PED).METHODS:Sixteen eyes of 14 patients with PED who were resistant to conventional treatment were treated with 20% umbilical cord serum eye drops. Patients were followed-up weekly until epithelization was complete.The collected data included the grade of corneal lesion(Grade I: epithelial defect +superficial vascularization,Grade II: epithelial defect +stromal edema, Grade III:corneal ulcer +stromal melting), the size of epithelial defect(pretreatment, 7th, 14 thand 21stdays of treatment),and follow-up time was evaluated retrospectively.RESULTS:The mean size of epithelial defect on two perpendicular axes was 5.2×4.6-mm2(range: 2.5-8 mm×2.2-9 mm2). Mean duration of treatment was 8.3 ±5wk.CBS therapy was effective in 12 eyes(75%) and ineffective in 4 eyes(25%). The epithelial defects in 4ineffective eyes were healed with amniotic membrane transplantation and tarsorrhaphy. The rate of complete healing was 12.5% by 7d, 25% by 14 d, and 75% by 21 d.The healing time was prolonged in Grade III eyes in comparison to eyes in Grade I or Grade II.CONCLUSION:The results of the current study indicated the safety effectiveness of CBS drops in the management of PED. The grade of disease seems have a role on the healing time.

Corneal epithelial defects following vitreoretinal surgery:incidence and outcomes from the DISCOVER study

AIM:To investigate the incidence,risk factors,clinical course,and outcomes of corneal epithelial defects(CED)following vitreoretinal surgery in a prospective study setting.METHODS:This was a post-hoc analysis of all participants in DISCOVER intraoperative optical coherence tomography study.Subjects with CED 1 d after surgery without intraoperative corneal debridement was defined as the postoperative CED group.Subjects who underwent intraoperative debridement were defined as intraoperative debridement group.Eyes were matched 2:1 with controls(eyes without postoperative CED)for comparative assessment.The primary outcomes were the incidence of CED on postoperative day one and the incidence of required intraoperative debridement.Secondary outcomes included time to defect closure,delayed healing(>2 wk),visual acuity(VA)and presence of scarring at one year and cornea consult.RESULTS:This study included 856 eyes that underwent vitreoretinal surgery.Intraoperative corneal debridement was performed to 61(7.1%)subjects and postoperative CED developed spontaneously in 94(11.0%)subjects.Significant factors associated with postoperative CED included prolonged surgical duration(P=0.003),diabetes mellitus(P=0.04),postoperative ocular hypotension(P<0.001).Prolonged surgical duration was associated with intraoperative debridement.Delayed defect closure time(>2 wk)was associated with corneal scar formation at the end of the 1 y in all epithelial defect subjects(P<0.001).The overall rate of corneal scarring for all eyes undergoing vitrectomy was 1.8%.CONCLUSION:Prolonged duration of surgery is the strongest factor associated with both intraoperative debridement and spontaneous postoperative CED.Delayed defect closure is associated with a greater risk of corneal scarring at one year.The overall rate of corneal scarring following vitrectomy is low at<2%.

Corneal matrix repair therapy with the regenerating agentin neurotrophic persistent epithelial defects

Citation： Utine CA, Engin Durmaz C, Koqak N. Corneal matrix repair therapy with the regenerating agent in neurotrophic persistent epithelial defects, lntJOphthalmo12017;10（12）：1935-1939

The inflammation influence on corneal surface after frontalis suspension surgery

AIM： To study the influence of frontalis muscle flap suspension on ocular surface by analyzing the clinical features and inflammatory cytokines.METHODS： A prospective, observational case series. Thirty-one eyes of 25 patients with severe congenital blepharoptosis who underwent frontalis muscle flap suspension surgery with at least 6 mo of follow-up were included in the study. The main outcome measures were margin reflex distance 1（MRD_1）, degree of lagophthalmos, ocular surface disease index（OSDI）, fluorescein staining（Fl）, tear break-up time（BUT）, Schirmer I test, and inflammatory cytokine assay.RESULTS： The degrees of lagophthalmos significantly increased after surgery. The OSDI scores significantly increased 1wk postoperatively and then decreased 4wk after operation. The Fl scores reflected corneal epithelial defects in sixteen patients at early stage postoperatively. The BUT and Schirmer I test values remained stable and did not show change compared to those before surgery. The inflammatory cytokines in conjunctival epithelial cells（including IL-1β, IL-6, IL-8, TNF-α, and IL-17A） significantly increased 1wk after the surgery（P〈0.001）, then returned to the normal level at 24wk postoperatively. The levels of inflammatory cytokine IL-1β, IL-6, IL-8, TNF-α, and IL-17A elevated significantly and were positively correlated with OSDI and Fl scores.CONCLUSION： Frontalis muscle flap suspension surgery results in lagophthalmos in early period of post-operation and relieved after months. The elevation of inflammatory cytokines level may participate in the occurrence of corneal epithelial defects at the early postoperative stage.