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.

Resistant corneal ulcers in a tertiary care ophthalmic center in Egypt: 10 years epidemiological study

AIM:To investigate the magnitude of problem caused by resistant corneal ulcers and its epidemiological characteristics.METHODS:Patients with corneal lesions were selected and carefully examined and cases with resistant corneal ulcers were further investigated and data were recorded using a specific data sheet designed in hospital.Then,collected data from patients were statistically analyzed.RESULTS:Totally 1939 cases were included in the study,including 816 fungal cases(42.1%)and 1123(57.9%)non-fungal cases.Age of the participants ranged from 18 to 73y.Fungal cases were more common in middle age(35-55y).Men were more affected(53.5%)of cases included in the study.Keratomycosis affected more unskilled personnel(75.1%),large families with small houses(higher crowding index 73.9%),rural(64.5%)residence.Patients with sanitary water sources(34.8%)and waste disposal(24.4%)were less affected.CONCLUSION:Keratomycosis is more frequent in unskilled personnel,rural locations,outdoor water sources and insanitary waste disposal systems.Corneal trauma and contact lens are common risk factors.

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.

Central corneal epithelium self-healing after ring-shaped glycerin-cryopreserved lamellar keratoplasty in Terrien marginal degeneration

Dear Sir, I am Dr Yan-Long Bi, from the Department of Ophthalmology, Tongji University Affiliated to Tongji University School of Medicine, Shanghai, China. I write to present a case report of total limbal stem cells deficiency after treatment with ring-shaped lamellar keratoplasty secondary to Terrien marginal degeneration. During 3 years

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

Repair of Spontaneous Corneal Perforation in Pellucid Marginal Degeneration Using Amniotic Membrane

A 47-year-old woman with a history of pellucid marginal degeneration was referred for management of hydrops and peripheral perforation of the right cornea. The initial management with cyanoacrylate tissue adhesive and bandage contact lens did not preclude aqueous leakage the next day. Amniotic membrane grafting using both a surgical graft and a bandage patch was thus performed in the operating room the following day. There was no aqueous leakage on the first post-operative day. The corneal integrity was restored with resolution of the corneal edema;and the visual acuity improved from 20/400 before surgery to 20/40 three months later. This case illustrates the clinical efficacy of amniotic membrane grafting as an effective alternative in the management of spontaneous corneal perforation resulted from pellucid marginal degeneration.

Surgical Technique Affects the Incidence of Marginal Ulceration after Roux-en-Y in Gastric Bypass

Background: Marginal ulceration (MU) is a recognized complication of Roux-en-Y gastric bypass (RYGB) surgery. While several possible risk factors have been reported, the mechanism of MU remains incompletely understood. The aim of this study was to compare the effect of surgical technique on the incidence of MU. Methods and Material: This was a retrospective study of 749 patients undergoing RYGB over a ten-year period with at least one year of follow-up. The diagnosis of MU was made based on clinical symptoms and confirmed by postoperative endoscopy (POE). We assessed four different gastric bypass (GBP) techniques: T1—Open, non-divided stomach, circular stapler, non-vagotomy (n = 332);T2—Open, divided stomach, circular stapler, vagotomy (n = 91);T3—Laparoscopic, divided, circular stapler, vagotomy (n = 152);T4—Laparoscopic, divided, linear stapler, vagotomy (n = 174). Results: The four groups were similar with respect to age and mean BMI. The frequency of POE was 16%, 25%, 28% and 27% in groups T1-T4 respectively (NS). The incidence of MU was significantly lower in T1 (2.1%) compared to T2 (5.5%), T3 (15.1%) and T4 (12.6%), p 0.05. MU occurred significantly more frequently with an antecolic Roux limb versus retrocolic (14.5% vs 5.6%, p 0.05). Conclusion: The incidence of MU after RYGB surgery is influenced by surgical technique. The lowest incidence of MU was with a non-divided stomach, no vagotomy, transverse staple line, and circular stapled anastomosis. A retrocolic Roux limb was protective. There was no difference in the incidence of MU using laparoscopic versus open bypass if a similar technique was employed or using linear versus circular stapler for the gastrojejunostomy.

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.

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.

Oriented cellulose hydrogel:Directed tissue regeneration for reducing corneal leukoplakia and managing fungal corneal ulcers

Fungal corneal ulcer is one of the leading causes of corneal blindness in developing countries.Corneal scars such as leukoplakia are formed due to inflammation,oxidative stress and non-directed repair,which seriously affect the patients'subsequent visual and life quality.In this study,drawing inspiration from the oriented structure of collagen fibers within the corneal stroma,we first proposed the directional arrangement of CuTA-CMHT hydrogel system at micro and macro scales based on the 3D printing extrusion method combined with secondary patterning.It played an antifungal role and induced oriented repair in therapy of fungal corneal ulcer.The results showed that it effectively inhibited Candida albicans,Aspergillus Niger,Fusarium sapropelum,which mainly affects TNF,NF-kappa B,and HIF-1 signaling pathways,achieving effective antifungal functions.More importantly,the fibroblasts interacted with extracellular matrix(ECM)of corneal stroma through formation of focal adhesions,promoted the proliferation and directional migration of cells in vitro,induced the directional alignment of collagen fibers and corneal stromal orthogonally oriented repair in vivo.This process is mainly associated with MYLK,MYL9,and ITGA3 molecules.Furthermore,the downregulation the growth factors TGF-βand PDGF-βinhibits myofibroblast development and reduces scar-type ECM production,thereby reducing corneal leukoplakia.It also activates the PI3K-AKT signaling pathway,promoting corneal healing.In conclusion,the oriented CuTA-CMHT hydrogel system mimics the orthogonal arrangement of collagen fibers,inhibits inflammation,eliminates reactive oxygen species,and reduces corneal leukoplakia,which is of great significance in the treatment of fungal corneal ulcer and is expected to write a new chapter in corneal tissue engineering.

A Novel Tectonic Keratoplasty with Femtosecond Laser ntrastromal Lenticule for Corneal Ulcer and Perforation

Background： Small incision refractive lenticule extraction （SMILE） is an effective laser procedure that treats myopia. This research was to describe a novel approach to treat corneal ulcer or perforation using the corneal lenticules obtained from SMILE and to evaluate the safety and effectiveness of tectonic keratoplasty with femtosecond laser intrastromal lenticule （TEKIL）. Methods： A total of twenty patients （22 eyes） were monitored for at least 6 months and were assessed using slit lamp microscopy, optical coherence tomography, and best-corrected visual acuity （BCVA）. Postoperative complications throughout the study period were recorded. Results： Corneal ulcer in 14 patients （16 eyes） and corneal perforation in six patients （6 eyes） were treated with TEKIL. The patients were ten females and ten males, with a mean age of 58.5 ± 16.3 years （range： 16 81 years）. In this study, the most causes of corneal ulcer or perforation were immunologic causes （54.5%）. After TEKIL procedure, global integrity was achieved in all cases. No immune rejection or perforation was detected. The mean BCVA improved from 0.17± 0.20 preoperatively to 0.27 ± 0.25 postoperatively at the final follow-up （t = 2.095, P 0.052）. The postoperative BCVA improved in 12 eyes （54.5%） and maintained in nine eyes （40.9%）. Vision function successfully maintained in all eyes （100%）. In three cases, corneal ulcers were treated by reoperation of TEKIL at 3 months alter the initial surgery for the reason that the residual corneal thickness was 〈250 μm. Conclusions： TEKI L seems to be an effective treatment for corneal ulcer and perforation in the condition of emergency and donor shortage.

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。

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。

InIncidence and clinical features of endoscopic ulcers developing after gastrectomy

AIM： To determine the precise incidence and clinica features of endoscopic ulcers following gastrectomy. METHODS： A consecutive series of patients who un- derwent endoscopic examination following gastrectomy between 2005 and 2010 was retrospectively analyzed. A total of 78 patients with endoscopic ulcers and 759 without ulcers following gastrectomy were enrolled. We analyzed differences in patient age, sex, size of the le- sions, method of operation, indications for gastric resec- tion, and infection rates of Helicobacterpylor/（H. pylor/~ between the nonulcer and ulcer groups. RESULTS： The incidence of endoscopic ulcers after gastrectomy was 9.3% and that of marginal ulcers was 8.6%. Ulcers were more common in patients with Billroth l] anastomosis and pre-existing conditions forpeptic ulcer disease （PUD）. Infection rates of H. pylori- did not differ significantly between the two groups. The patients who underwent operations to treat PUD had lower initial levels of hemoglobin and higher rates of hospital admission. CONCLUSION： H. pylori was not an important factor in ulcerogenesis following gastrectomy. For patients who underwent surgery for PUD, clinical course of mar- ginal ulcers was more severe.

Molecular mechanism of the inhibition effect of Celecoxib on corneal collagen degradation in three dimensions

AIM: To clarify the molecular mechanism of Celecoxib on corneal collagen degradation and corneal ulcer. METHODS: Rabbit corneal fibroblasts were harvested and suspended in serum-free MEM. Type I collagen, DMEM, collagen reconstitution buffer and corneal fibroblast suspension were mixed on ice. The resultant mixture solidify in an incubator, after which test reagents and plasminogen was overlaid and the cultures were returned to the incubator. The supernatants from collagen gel incubations were collected and the amount of hydroxyproline in the hydrolysate was measured. Immunoblot analysis of MMP1, 3 and TIMP1, 2 was performed. MMP2, 9 was detected by the method of Gelatin zymography. Cytotoxicity Assay was measured. RESULTS: Celecoxib inhibited corneal collagen degradation in a dose and time manner; Celecoxib inhibited the IL-1 beta induced increases in proMMP1, 2, 3, 9 and active MMP1, 2, 3, 9 in a concentration-depended manner. Celecoxib can also inhibit the IL-1 beta induced increases in the TIMP1, 2. CONCLUSION: Celecoxib can inhibit corneal collagen degradation induced by IL-1 beta, this effect is the consequence of the reduction of MMP1, 2, 3, 9 and TIMP1, 2. The results of the present study provide new insight into Celecoxib in cornela ulcer treatment.