51
|
Thomasy SM, Leonard BC, Greiner MA, Skeie JM, Raghunathan VK. Squishy matters - Corneal mechanobiology in health and disease. Prog Retin Eye Res 2024; 99:101234. [PMID: 38176611 DOI: 10.1016/j.preteyeres.2023.101234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024]
Abstract
The cornea, as a dynamic and responsive tissue, constantly interacts with mechanical forces in order to maintain its structural integrity, barrier function, transparency and refractive power. Cells within the cornea sense and respond to various mechanical forces that fundamentally regulate their morphology and fate in development, homeostasis and pathophysiology. Corneal cells also dynamically regulate their extracellular matrix (ECM) with ensuing cell-ECM crosstalk as the matrix serves as a dynamic signaling reservoir providing biophysical and biochemical cues to corneal cells. Here we provide an overview of mechanotransduction signaling pathways then delve into the recent advances in corneal mechanobiology, focusing on the interplay between mechanical forces and responses of the corneal epithelial, stromal, and endothelial cells. We also identify species-specific differences in corneal biomechanics and mechanotransduction to facilitate identification of optimal animal models to study corneal wound healing, disease, and novel therapeutic interventions. Finally, we identify key knowledge gaps and therapeutic opportunities in corneal mechanobiology that are pressing for the research community to address especially pertinent within the domains of limbal stem cell deficiency, keratoconus and Fuchs' endothelial corneal dystrophy. By furthering our understanding corneal mechanobiology, we can contextualize discoveries regarding corneal diseases as well as innovative treatments for them.
Collapse
Affiliation(s)
- Sara M Thomasy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California - Davis, Davis, CA, United States; Department of Ophthalmology & Vision Science, School of Medicine, University of California - Davis, Davis, CA, United States; California National Primate Research Center, Davis, CA, United States.
| | - Brian C Leonard
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California - Davis, Davis, CA, United States; Department of Ophthalmology & Vision Science, School of Medicine, University of California - Davis, Davis, CA, United States
| | - Mark A Greiner
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, United States; Iowa Lions Eye Bank, Coralville, IA, United States
| | - Jessica M Skeie
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, United States; Iowa Lions Eye Bank, Coralville, IA, United States
| | | |
Collapse
|
52
|
Garis M, Meyer MD, Lwigale P. Expression of Nephronectin in the Descemet's membrane of mouse corneas during development and adult homeostasis. Exp Eye Res 2024; 240:109797. [PMID: 38246333 DOI: 10.1016/j.exer.2024.109797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/23/2024]
Abstract
Nephronectin (Npnt) is an extracellular matrix (ECM) protein with pleiotropic functions during organogenesis, disease, and homeostasis. Although the ECM plays a crucial role during development and homeostasis of the adult cornea, little is known about the expression of Npnt in the mammalian cornea. Here, we investigated the expression of Npnt during early embryonic and postnatal development, and in adult mouse corneas. We combined ultrastructural and immunohistochemical analyses to study the early formation of the Descemet's membrane and how the expression of Npnt relates to key basement membrane proteins. Our section in situ hybridization and immunohistochemical analyses revealed that Npnt mRNA is expressed by the nascent corneal endothelial cells at embryonic day (E) 14.5, whereas the protein is localized in the adjacent extracellular matrix. These expression patterns were maintained in the corneal endothelium and Descemet's membrane throughout development and in adult corneas. Ultrastructural analysis revealed discontinuous electron dense regions of protein aggregates at E18.5 that was separated from the endothelial layer by an electron lucent space. At birth (postnatal day, P0), the Descemet's membrane was a single layer, which continuously thickened throughout P4, P8, P10, and P14. Npnt was localized to the Descemet's membrane by E18.5 and overlapped with Collagens IV and VIII, Laminin, and Perlecan. However, the proteins subsequently shifted and formed distinct layers in the adult cornea, whereby Npnt localized between two Collagen VIII bands and anterior to Collagen IV but overlapped with Laminin and Perlecan. Combined, our results reveal the expression of Npnt in the mouse cornea and define its spatiotemporal localization relative to key basement membrane proteins during the formation of the Descemet's membrane and in the adult cornea. Understanding the spatiotemporal expression of Npnt is important for future studies to elucidate its function in the mammalian cornea.
Collapse
Affiliation(s)
- Matthew Garis
- Department of Biosciences, Rice University, Houston, TX, 77019, USA
| | - Matthew D Meyer
- Shared Equipment Authority, Rice University, Houston, TX, 77019, USA
| | - Peter Lwigale
- Department of Biosciences, Rice University, Houston, TX, 77019, USA.
| |
Collapse
|
53
|
Friedrich J, Sandner A, Nasseri A, Maier M, Zapp D. Accelerated corneal cross-linking (18mW/cm2 for 5 min) with HPMC-riboflavin in progressive keratoconus - 5 years follow-up. Graefes Arch Clin Exp Ophthalmol 2024; 262:871-877. [PMID: 37672103 PMCID: PMC10907430 DOI: 10.1007/s00417-023-06225-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/15/2023] [Accepted: 08/26/2023] [Indexed: 09/07/2023] Open
Abstract
PURPOSE To evaluate long-term results of accelerated corneal cross-linking (ACXL) in patients with progressive keratoconus, seventy-four eyes of 53 patients with progressive keratoconus (documented Kmax progression > 1D/a) who underwent ACXL (18mW/cm2 for 5 min) were included in a retrospective observational clinical study. The investigation focused on tomographic and keratometric parameters, refractive data, and visual outcomes at 5 years follow-ups. METHODS Corrected distance visual acuity (CDVA), slit lamp, and Pentacam® examinations were conducted, including assessments of thinnest corneal point (TP), minimum radius (Rmin), corneal astigmatism, and maximum anterior keratometry (Kmax). These examinations were performed two weeks before the surgery and, on average, 56 months after the surgery. In a subgroup of 24 eyes, Pentacam® examination data from an intermediate visit at 12 months until the final visit was evaluated to confirm continuous stability. The ACXL protocol included corneal abrasion, hydroxypropylmethylcellulose (HPMC)-riboflavin eye drops administered every 5 min for a total duration of 30 min, and irradiation with 18mW/cm2 for 5 min using riboflavin eye drops applied every minute during the irradiation process. Intraoperatively, minimal corneal pachymetry of > 400 µm was ensured in every patient. RESULTS After 56 months, all values exhibited statistically significant changes (paired t-test; CDVA p = 0.002; Kmax p < 0.001; Rmin p < 0.001; astigmatism p = 0.03; TP p < 0.001). In the subgroup analysis of 24 eyes, which included tomographical and keratometric parameters, no statistically significant changes were observed during the last 12 months of observation (paired t-test; Kmax p = 0.72; Rmin p = 0.67; astigmatism p = 0.72). Treatment failure was strictly defined as an increase in Kmax (> 1D) during the 5-year follow-up and was observed in only 3 eyes (4%). CONCLUSIONS ACXL is an effective and safe treatment for patients with progressive keratoconus. Our results demonstrate improvements in functional and tomographical outcomes even after high-energy ACXL (18mW/cm2 for 5 min) over a long-term period of 56 months. Our analysis indicates stable conditions in previously progressive keratoconus, particularly during the final year of the observation period. The treatment failure rate was 4%.
Collapse
Affiliation(s)
- Julia Friedrich
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, TUM, Munich, Germany.
| | - Alexandra Sandner
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, TUM, Munich, Germany
| | - Ali Nasseri
- Technische Universität München, Munich, Germany
| | - Mathias Maier
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, TUM, Munich, Germany
| | - Daniel Zapp
- Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar, TUM, Munich, Germany
| |
Collapse
|
54
|
Berger T, Seitz B, Flockerzi E, Suffo S, Flockerzi FA, Berger M, Szentmáry N, Daas L. Surgical management of complicated Descemet's membrane detachment in corneas without prior endothelial keratoplasty. Graefes Arch Clin Exp Ophthalmol 2024; 262:879-889. [PMID: 37682334 PMCID: PMC10907463 DOI: 10.1007/s00417-023-06231-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/09/2023] Open
Abstract
PURPOSE To provide insights into morphologic and functional features of eyes with complicated Descemet's membrane detachment (DMD) and report clinical outcomes after surgical intervention. METHODS Retrospective study of 18 eyes with complicated DMD between 2010 and 2022. Complicated DMD was defined if any of the following criteria applied: prior penetrating keratoplasty (PKP), corneal thinning, total DMD or persistent DMD after Air/Gas-Descemetopexy. Causes, surgical management, and clinical outcomes were analyzed. Scheimpflug tomography, anterior segment optical coherence tomography (AS-OCT) and histologic examination were performed to characterize corneas with DMD. RESULTS Fourteen eyes with prior PKP developed spontaneous DMD after 24.2 ± 12.9 years (range = 18 months - 47 years, median = 25.7 years). Complicated DMD without prior PKP was associated in three eyes after cataract surgery and in one eye after infectious keratitis. In cases with previous PKP, AS-OCT demonstrated rupture of Descemet's membrane (DM) in five eyes and spontaneous reattachment was found in four eyes within 8 weeks of initial diagnosis, with no rupture of DM in any of the cases. There was no rupture of DM in corneas without previous PKP. After prior keratoplasty, definitive surgical treatment was repeat PKP in 13 eyes and Air/Gas-Descemetopexy in one eye. In corneas without prior keratoplasty, three eyes underwent PKP and one eye Air/Gas-Descemetopexy. Histological examination of two corneal explants revealed a severely thinned graft-host junction and a disrupted DM close to the graft-host junction. Visual acuity improved from 1.80 ± 0.58 logMAR to 0.75 ± 0.69 logMAR after prior PKP and from 1.45 ± 0.65 logMAR to 0.85 ± 1.13 logMAR without prior PKP. The postoperative course was uneventful in 16 of 18 eyes. CONCLUSION PKP is an effective treatment option for complicated DMD, especially in ectatic corneas, whereas Air/Gas-Descemetopexy or Descemet Membrane Endothelial Keratoplasty do not address the primary issue of the curvature anomaly.
Collapse
Affiliation(s)
- Tim Berger
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany.
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Shady Suffo
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Fidelis A Flockerzi
- Institute of Pathology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Maximilian Berger
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Homburg/Saar, Germany
| | - Nóra Szentmáry
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Homburg/Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| |
Collapse
|
55
|
Kepez Yildiz B, Freitas R, Filippini P, Habroosh F, Said DG, Dua HS, Sahay P. Relationship of posterior peripheral corneal layers and the trabecular meshwork: an immunohistological and anatomical study. Br J Ophthalmol 2024:bjo-2023-324844. [PMID: 38418206 DOI: 10.1136/bjo-2023-324844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/23/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND/AIM With the popularity of endothelial keratoplasty (EK) procedures, Descemet membrane (DM) EK and pre-Descemet EK, considerable work has been done on understanding the posterior corneal anatomy. Most of the information available relates to the central cornea. We evaluated the peripheral cornea to explore the immunohistological and anatomical relationship between the pre-Descemet layer (PDL), DM and trabecular meshwork (TM). METHODS Six donor human sclerocorneal discs were studied. PDL, DM and TM were examined by light microscopy, transmission electron microscopy (TEM) and immunohistology. The DM was peeled from the centre to the limit of its peripheral attachment, to reach the transition zone (TZ) between TM and peripheral cornea. Ten-micron sections were stained with antibodies against collagens 1, 2, 3, 4, 5, 6, 12, elastin, myocilin, wnt-1, aquaporin, tenascin C, laminin and integrin alpha 3. RESULTS Collagens 2, 3, 4, laminin and myocilin were predominantly seen in the TZ between TM and peripheral cornea. Wnt-1, integrin alpha 3 and tenascin C were highly concentrated in TM. Collagen 1 was present predominantly in the corneal stroma. On TEM; DM was thinner with a denser banded structure spread throughout its thickness in the periphery compared with the central cornea where it presents as the distinct anterior banded layer. CONCLUSION The TZ between DM, PDL and TM shows a unique histological structure at the periphery. The collagen and elastin fibres of the TM are continuous with the PDL. The structures are firmly attached to each other. These findings provide structural information that is relevant to the preparation of DMEK donor tissue.
Collapse
Affiliation(s)
- Burçin Kepez Yildiz
- Ophthalmology, Ministry of Health Istanbul Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
- Academics Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rui Freitas
- Academics Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Perla Filippini
- Academics Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Fatima Habroosh
- Academics Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Dalia G Said
- Academics Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Harminder Singh Dua
- Academics Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Prity Sahay
- Academics Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
56
|
Morgan SR, O'Brart DPS, Huang J, Meek KM, Hayes S. An in vitro investigation into the impact of corneal rinsing on riboflavin/UVA corneal cross-linking. Eye Vis (Lond) 2024; 11:8. [PMID: 38414033 PMCID: PMC10900838 DOI: 10.1186/s40662-024-00375-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 02/07/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Corneal cross-linking (CXL) using riboflavin and ultraviolet-A light (UVA) is a treatment used to prevent progression of keratoconus. This ex vivo study assesses the impact on CXL effectiveness, as measured by tissue enzymatic resistance and confocal microscopy, of including a pre-UVA corneal surface rinse with balanced salt solution (BSS) as part of the epithelium-off treatment protocol. METHODS Sixty-eight porcine eyes, after epithelial debridement, were assigned to six groups in three experimental runs. Group 1 remained untreated. Groups 2-6 received a 16-min application of 0.1% riboflavin/Hydroxypropyl methylcellulose (HPMC) drops, after which Group 3 was exposed to 9 mW/cm2 UVA for 10 min, and Groups 4-6 underwent corneal surface rinsing with 0.25 mL, 1 mL or 10 mL BSS followed by 9 mW/cm2 UVA exposure for 10 min. Central corneal thickness (CCT) was recorded at each stage. Central 8.0 mm corneal buttons from all eyes were subjected to 0.3% collagenase digestion at 37 °C and the time required for complete digestion determined. A further 15 eyes underwent fluorescence confocal microscopy to assess the impact of rinsing on stromal riboflavin concentration. RESULTS Application of riboflavin/HPMC solution led to an increase in CCT of 73 ± 14 µm (P < 0.01) after 16 min. All CXL-treated corneas displayed a 2-4 fold greater resistance to collagenase digestion than non-irradiated corneas. There was no difference in resistance between corneas that received no BSS rinse and those that received a 0.25 mL or 1 mL pre-UVA rinse, but each showed a greater level of resistance than those that received a 10 mL pre-UVA rinse (P < 0.05). Confocal microscopy demonstrated reduced stromal riboflavin fluorescence after rinsing. CONCLUSIONS All protocols, with and without rinsing, were effective at enhancing the resistance to collagenase digestion, although resistance was significantly decreased, and stromal riboflavin fluorescence reduced with a 10 mL rinse. This suggests that a 10 mL surface rinse can reduce the efficacy of CXL through the dilution of the stromal riboflavin concentration.
Collapse
Affiliation(s)
- Siân R Morgan
- School of Optometry and Vision Sciences, Cardiff University, Maindy Road, Cardiff, UK.
| | - David P S O'Brart
- School of Optometry and Vision Sciences, Cardiff University, Maindy Road, Cardiff, UK
- Department of Ophthalmology, Guys and St. Thomas' NHS Foundation Trust, London, UK
- King's College, London, UK
| | - Jinhai Huang
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200030, China
| | - Keith M Meek
- School of Optometry and Vision Sciences, Cardiff University, Maindy Road, Cardiff, UK
| | - Sally Hayes
- School of Optometry and Vision Sciences, Cardiff University, Maindy Road, Cardiff, UK
| |
Collapse
|
57
|
Zhang D, Zhang H, Li L. [Characterization of rabbit corneal biomechanical properties after corneal refractive surgery based on rapid loading-unloading uniaxial tensile test]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 2024; 41:136-143. [PMID: 38403614 PMCID: PMC10894745 DOI: 10.7507/1001-5515.202306041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
In order to understand how the biomechanical properties of rabbit cornea change over time after corneal ablation, 21 healthy adult rabbits were used in this study, with the left eye as experimental side and the right eye as the control side. Firstly, a lamellar knife was used to remove a portion of the anterior corneal surface tissue (30%~50% of the original corneal thickness) from the left eye of each rabbit, as an animal model simulating corneal refractive surgery. Secondly, postoperative experimental rabbits were kept for one, three, or six months until being euthanized. Strip specimens were produced using their corneas in vitro to perform a uniaxial tensile test with an average loading-unloading rate of approximately 0.16 mm/s. Finally, the visco-hyperelastic material constitutive model was used to fit the data. The results showed that there was a significant difference in the viscoelastic parameters of the corneas between the experimental and the control eyes at the first and third postoperative months. There was a difference in tangential modulus between the experimental and the control eyes at strain levels of 0.02 and 0.05 at the third postoperative month. There was no significant difference in biomechanical parameters between the experimental and the control eyes at the sixth postoperative month. These results indicate that compared with the control eyes, the biomechanical properties of the experimental eyes vary over postoperative time. At the third postoperative month, the ratio of corneal tangential modulus between the experimental and the control eyes significantly increased, and then decreased. This work lays a preliminary foundation for understanding the biomechanical properties of the cornea after corneal refractive surgery based on rapid testing data obtained clinically.
Collapse
Affiliation(s)
- Di Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing 100069, P. R. China
- School of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong 271016, P. R. China
| | - Haixia Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing 100069, P. R. China
| | - Lin Li
- School of Biomedical Engineering, Capital Medical University, Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing 100069, P. R. China
| |
Collapse
|
58
|
Giurgola L, Rodella U, Gatto C, Rossi O, Honisch C, Ragazzi E, Ruzza P, Ferrari S, D'Amato Tóthová J. Assessment of performance and safety of Corneal Chamber hypothermic storage medium and PSS-L corneal rinsing solution in human and porcine corneas. BMJ Open Ophthalmol 2024; 9:e001453. [PMID: 38388003 PMCID: PMC10884202 DOI: 10.1136/bmjophth-2023-001453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
PURPOSE To prove the safety and performance of the hypothermic corneal storage medium "Corneal Chamber" and the rinsing solution "PSS-L" in support of the new Conformité Européenne (CE) certification process in accordance with the Medical Device Regulation. METHODS Fifteen (n=15) human donor corneas and 11 (n=11) porcine corneas were evaluated for the following parameters: endothelial cell density (ECD) and mortality, percentage of hexagonal cells (HEX%), coefficient of cellular area variation (CV%) and corneal transparency at Day 0 and after 14±1 days of storage in Corneal Chamber medium at 2-8°C. Then, the same parameters were assessed after rinsing of corneas in PSS-L for 1 min at room temperature. Evaluation of gentamicin sulfate carryover after corneal storage and PSS-L rinsing was performed by ultra-high performance liquid chromatography analysis on human corneas homogenates. RESULTS Human and porcine corneas stored in Corneal Chamber medium showed a good overall quality of the tissue according to the quality parameters evaluated. In particular, mean ECD, HEX% and CV% did not show statistically significant changes at the end of storage and endothelial mortality increased to 3.1±3.3 and 7.8±3.5% in human and porcine corneas, respectively. Tissue rinsing with PSS-L did not affect the quality parameters evaluated before and gentamicin sulfate residues were absent in human corneas. CONCLUSIONS Corneal preservation in Corneal Chamber medium at 2-8°C for 14 days and the corneal rinse with PSS-L are safe and effective procedures allowing the preservation of the corneal quality parameters as well as the complete elimination of gentamicin sulfate from the tissues before transplantation.Cite Now.
Collapse
Affiliation(s)
| | - Umberto Rodella
- R&D Department, Alchimia srl, Ponte San Nicolò, Italy
- Research Centre, Fondazione Banca degli Occhi del Veneto, Venice, Italy
| | - Claudio Gatto
- R&D Department, Alchimia srl, Ponte San Nicolò, Italy
| | - Orietta Rossi
- R&D Department, Alchimia srl, Ponte San Nicolò, Italy
| | - Claudia Honisch
- Institute of Biomolecular Chemistry of CNR, CNR, Padova, Italy
| | - Eugenio Ragazzi
- Department of Pharmaceutical and Pharmacological Sciences, Università degli Studi di Padova, Padova, Italy
| | - Paolo Ruzza
- Institute of Biomolecular Chemistry of CNR, CNR, Padova, Italy
| | - Stefano Ferrari
- Research Centre, Fondazione Banca degli Occhi del Veneto, Venice, Italy
| | | |
Collapse
|
59
|
Rigi M, Son HS, Moon L, Matthaei M, Srikumaran D, Jun AS, Eberhart CG, Soiberman US. Collagen type XII is undetectable in keratoconus Bowman's layer. Br J Ophthalmol 2024; 108:343-348. [PMID: 36746614 PMCID: PMC10466210 DOI: 10.1136/bjo-2022-322180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/21/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE Corneal biomechanical failure is the hallmark of keratoconus (KC); however, the cause of this failure remains elusive. Collagen type XII (COL12A1), which localises to Bowman's layer (BL), is thought to function in stress-bearing areas, such as BL. Given the putative protective role of COL12A1 in biomechanical stability, this study aims to characterise COL12A1 expression in all corneal layers involved in KC. METHODS TaqMan quantitative PCR was performed on 31 corneal epithelium samples of progressive KC and myopic control eyes. Tissue microarrays were constructed using full-thickness corneas from 61 KC cases during keratoplasty and 18 non-KC autopsy eyes and stained with an antibody specific to COL12A1. Additionally, COL12A1 was knocked out in vitro in immortalised HEK293 cells. RESULTS COL12A1 expression was reduced at transcript levels in KC epithelium compared with controls (ratio: 0.58, p<0.03). Immunohistochemical studies demonstrated that COL12A1 protein expression in BL was undetectable, with reduced expression in KC epithelium, basement membrane and stroma. CONCLUSIONS The apparent absence of COL12A1 in KC BL, together with the functional importance that COL12A1 is thought to have in stress bearing areas, suggests that COL12A1 may play a role in the pathogenesis of KC. Further studies are necessary to investigate the mechanisms that lead to COL12A1 dysregulation in KC.
Collapse
Affiliation(s)
- Mohammed Rigi
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Hyeck-Soo Son
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany
| | - Loren Moon
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Mario Matthaei
- Department of Ophthalmology, University Hospital Cologne, Cologne, Germany
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Charles G Eberhart
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Uri S Soiberman
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| |
Collapse
|
60
|
Li N, Fan Z, Peng X. Analysis of the effect of calcium ions on promoting the penetrability of riboflavin into the corneal stroma by iontophoresis. Int Ophthalmol 2024; 44:89. [PMID: 38366000 DOI: 10.1007/s10792-024-03031-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/11/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE To investigate the effect of calcium ions on promoting the penetrability of riboflavin into the corneal stroma by iontophoresis and to analyse the possible mechanism. METHODS Forty rabbits were divided into five groups randomly: 0.1% riboflavin-balanced salt solution (BSS) by iontophoresis group, 0.1% riboflavin-saline solution by iontophoresis group, 0.1% riboflavin-zinc gluconate solution by iontophoresis group, 0.1% riboflavin-calcium gluconate solution by iontophoresis group and classical riboflavin instillation after corneal de-epithelialization as the control group. The riboflavin concentrations in corneal stroma were determined and compared by high-performance liquid chromatography (HPLC) after removing epithelium and endothelium. RESULTS Iontophoretic delivery of a 0.1% riboflavin-calcium gluconate solution was the closest to the effect of classical de-epithelialization. The other solvents were unsufficient at enhancing the permeability of the riboflavin. CONCLUSION Calcium ions can promote the penetrability of riboflavin into the corneal stroma by iontophoresis.
Collapse
Affiliation(s)
- Na Li
- Department of Ophthalmology, The Third Medical Center of Chinese, PLA General Hospital, Yongding Road 69, Beijing, 100039, China.
| | - Zhengjun Fan
- Department of Ophthalmology, The Sixth Medical Center of Chinese, PLA General Hospital, Beijing, 100048, China
| | - Xiujun Peng
- Department of Ophthalmology, The Sixth Medical Center of Chinese, PLA General Hospital, Beijing, 100048, China
| |
Collapse
|
61
|
Boix-Lemonche G, Hildebrand T, Haugen HJ, Petrovski G, Nogueira LP. Contrast-enhanced Micro-CT 3D visualization of cell distribution in hydrated human cornea. Heliyon 2024; 10:e25828. [PMID: 38356495 PMCID: PMC10865036 DOI: 10.1016/j.heliyon.2024.e25828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/27/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024] Open
Abstract
Background The cornea, a vital component of the human eye, plays a crucial role in maintaining visual clarity. Understanding its ultrastructural organization and cell distribution is fundamental for elucidating corneal physiology and pathology. This study comprehensively examines the microarchitecture of the hydrated human cornea using contrast-enhanced micro-computed tomography (micro-CT). Method Fresh human corneal specimens were carefully prepared and hydrated to mimic their in vivo state. Contrast enhancement with Lugol's iodine-enabled high-resolution Micro-CT imaging. The cells' three-dimensional (3D) distribution within the cornea was reconstructed and analyzed. Results The micro-CT imaging revealed exquisite details of the corneal ultrastructure, including the spatial arrangement of cells throughout its depth. This novel approach allowed for the visualization of cells' density and distribution in different corneal layers. Notably, our findings highlighted variations in cell distribution between non-hydrated and hydrated corneas. Conclusions This study demonstrates the potential of contrast-enhanced micro-CT as a valuable tool for non-destructive, 3D visualization and quantitative analysis of cell distribution in hydrated human corneas. These insights contribute to a better understanding of corneal physiology and may have implications for research in corneal diseases and tissue engineering.
Collapse
Affiliation(s)
- Gerard Boix-Lemonche
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | | | | | - Goran Petrovski
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- Department of Ophthalmology, and Norwegian Center for Stem Cell Research, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology, University of Split School of Medicine and University Hospital Centre, Split, Croatia
- UKLO Network, University St. Kliment Ohridski – Bitola, Bitola, Macedonia
| | - Liebert Parreiras Nogueira
- Oral Research Laboratory, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| |
Collapse
|
62
|
Al Bdour M, Abu-Ameerh M, Gharaibeh A, AlQudah R, Hubaishy L, AlAdwan M, AlRyalat SA. Intrastromal corneal ring segments for keratoconus patients: up to 12 years follow up. Int Ophthalmol 2024; 44:50. [PMID: 38336951 DOI: 10.1007/s10792-024-02912-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 12/24/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE Intrastromal corneal ring segment (ICRS) implantation is a surgical technique developed with the purpose of avoiding the progression of corneal protrusion and is considered a viable option for managing patients with keratoconus as it stabilizes or improves vision thus delaying or excluding the need of more advanced surgical intervention such as penetrating keratoplasty. However, long term follow up is still limited to determine its actual success in achieving this goal. The current project aims to provide an extended follow up reporting a mean followup of around 5 years, extending up to 12.5 years. METHODS We recruited patients who performed their ICRS between 2008 and 2013. We contacted patients for a follow up exam with a possible corneal tomography. For each patient, we obtained baseline pre operative data and latest follow up data which included visual acuity, subjective refraction, clinical slit-lamp exam, and corneal tomography. We compared the change in best corrected visual acuity and maximum keratometry readings from clinical visits before ring implantation to the latest follow up. RESULTS A total of 68 eyes for 53 patients were included. The mean duration of follow up was 53.87 (± 38.8) months, with a maximum duration of 153 months. We found a significant improvement in corrected and uncorrected visual acuity, keratometries and refraction during the follow up period. On correlation analysis, strong negative significant correlation was found between duration since surgery and change in uncorrected visual acuity (p = 0.03, ρ = 0.338) and mean keratometry values (p = 0.033, ρ = 0.296). At the latest follow up for majority of patients with more than 100 weeks of follow up (12 eyes), uncorrected visual acuity were equal to or worse than baseline. CONCLUSION This study represents the largest follow up for ICRS implanted in keratoconus patients. Improvement of visual acuity following ICRS implantation can be expected in the first few years, after which, a decline occurring thereafter.
Collapse
Affiliation(s)
- Muawyah Al Bdour
- Department of Ophthalmology, The University of Jordan, Amman, 11942, Jordan
| | | | - Almutez Gharaibeh
- Department of Ophthalmology, The University of Jordan, Amman, 11942, Jordan
| | - Ruba AlQudah
- Department of Ophthalmology, The University of Jordan, Amman, 11942, Jordan.
| | - Lana Hubaishy
- Department of Ophthalmology, The University of Jordan, Amman, 11942, Jordan
| | - Mai AlAdwan
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | | |
Collapse
|
63
|
Çınar AC, Küpeli Çınar A, Güçlü H. Evaluation of the effect of intravitreal injections on corneal epithelial, scleral and limbal region changes in diabetic retinopathy by AS-OCT. Int Ophthalmol 2024; 44:31. [PMID: 38329554 DOI: 10.1007/s10792-024-02947-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 12/04/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE The aim of the study is to evaluate the effects of diabetic retinopathy and intravitreal injections on the corneal, limbal and scleral areas. METHODS Patients with diabetes mellitus at different diagnosis and treatment levels were compared among themselves and with the control group in terms of corneal, limbal and scleral aspects with the help of anterior segment optical coherence tomography. In addition, clinical tests such as tear break-up time, Schirmer test-I and ocular surface disease index questionnaire were applied to the patients and the difference between the groups was investigated. RESULTS When the groups were examined in terms of BUT, SCH-I and OSDI, there was a statistically significant difference between control group and diabetic group(p < 0.05). In the limbal region, all measurements are higher than in patients with diabetic eye involvement. Thinning was detected in the scleral area with intravitreal injection (p < 0.05). CONCLUSION It should be known that DM may cause undesirable changes in the limbal region, and the importance of non-invasive detection with AS-OCT should not be forgotten. Since intravitreal injections for DME cause thinning of the sclera, it can cause various complications, and it may be recommended to change the quadrant in repetitive injection applications.
Collapse
Affiliation(s)
- Abdulkadir Can Çınar
- Department of Ophtalmology, Trakya University School of Medicine, 22000, Edirne, Turkey.
| | - Ayça Küpeli Çınar
- Department of Ophtalmology, Trakya University School of Medicine, 22000, Edirne, Turkey
| | - Hande Güçlü
- Department of Ophtalmology, Trakya University School of Medicine, 22000, Edirne, Turkey
| |
Collapse
|
64
|
Puistola P, Miettinen S, Skottman H, Mörö A. Novel strategy for multi-material 3D bioprinting of human stem cell based corneal stroma with heterogenous design. Mater Today Bio 2024; 24:100924. [PMID: 38226015 PMCID: PMC10788621 DOI: 10.1016/j.mtbio.2023.100924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/17/2024] Open
Abstract
Three-dimensional (3D) bioprinting offers an automated, customizable solution to manufacture highly detailed 3D tissue constructs and holds great promise for regenerative medicine to solve the severe global shortage of donor tissues and organs. However, uni-material 3D bioprinting is not sufficient for manufacturing heterogenous 3D constructs with native-like microstructures and thus, innovative multi-material solutions are required. Here, we developed a novel multi-material 3D bioprinting strategy for bioprinting human corneal stroma. The human cornea is the transparent outer layer of your eye, and vision loss due to corneal blindness has serious effects on the quality of life of individuals. One of the main reasons for corneal blindness is the damage in the detailed organization of the corneal stroma where collagen fibrils are arranged in layers perpendicular to each other and the corneal stromal cells grow along the fibrils. Donor corneas for treating corneal blindness are scarce, and the current tissue engineering (TE) technologies cannot produce artificial corneas with the complex microstructure of native corneal stroma. To address this, we developed a novel multi-material 3D bioprinting strategy to mimic detailed organization of corneal stroma. These multi-material 3D structures with heterogenous design were bioprinted by using human adipose tissue -derived stem cells (hASCs) and hyaluronic acid (HA) -based bioinks with varying stiffnesses. In our novel design of 3D models, acellular stiffer HA-bioink and cell-laden softer HA-bioink were printed in alternating filaments, and the filaments were printed perpendicularly in alternating layers. The multi-material bioprinting strategy was applied for the first time in corneal stroma 3D bioprinting to mimic the native microstructure. As a result, the soft bioink promoted cellular growth and tissue formation of hASCs in the multi-material 3D bioprinted composites, whereas the stiff bioink provided mechanical support as well as guidance of cellular organization upon culture. Interestingly, cellular growth and tissue formation altered the mechanical properties of the bioprinted composite constructs significantly. Importantly, the bioprinted composite structures showed good integration to the host tissue in ex vivo cornea organ culture model. As a conclusion, the developed multi-material bioprinting strategy provides great potential as a biofabrication solution for manufacturing organized, heterogenous microstructures of native tissues. To the best of our knowledge, this multi-material bioprinting strategy has never been applied in corneal bioprinting. Therefore, our work advances the technological achievements in additive manufacturing and brings the field of corneal TE to a new level.
Collapse
Affiliation(s)
- Paula Puistola
- Eye Regeneration Group, Faculty of Medicine and Health Technology, Tampere University, Tampere 33520, Finland
| | - Susanna Miettinen
- Adult Stem Cell Group, Faculty of Medicine and Health Technology, Tampere University, Tampere 33520, Finland
- Research, Development and Innovation Centre, Tampere University Hospital, 33520 Tampere, Finland
| | - Heli Skottman
- Eye Regeneration Group, Faculty of Medicine and Health Technology, Tampere University, Tampere 33520, Finland
| | - Anni Mörö
- Eye Regeneration Group, Faculty of Medicine and Health Technology, Tampere University, Tampere 33520, Finland
| |
Collapse
|
65
|
Akhtar S, Smedowski A, Khan AA, Debasi H, Mofty H, Samivel R, Almubrad T. Glycosaminoglycans and collagen fibril distribution at various depths of the corneal stroma of normal and CXL treated rats. Exp Eye Res 2024; 239:109780. [PMID: 38176513 DOI: 10.1016/j.exer.2024.109780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/21/2023] [Accepted: 01/01/2024] [Indexed: 01/06/2024]
Abstract
Corneal collagen cross-linking (CXL) is widely used to treat keratoconus and ecstatic corneal disorders. The present studies were carried out to investigate the distribution of glycosaminoglycans (GAGs) and collagen fibril (CF) at different depths of the normal and CXL treated corneal stroma of four week old rats 7 days after standard CXL application. Ten Wistar rats' corneas were used for the study. The epithelium of the cornea from the left eye of each rat was removed and treated with standard CXL application using riboflavin and Ultraviolet-A (UVA) (3 mW/cm2 for 30 min). The cornea from the right eye was used as the control cornea. The cornea was removed from the eye and processed for transmission electron microscopy. A bottom mounted Quemesa camera was used to capture digital images and these images were analysed using iTEM software. In the control cornea, the GAGs area size was not significantly different in the anterior, middle, and posterior stroma. In the CXL treated rats the GAGs area size gradually increased from the anterior to the posterior stroma whereas the spacing between the GAGs gradually decreased. There were very large GAGs present in the posterior stroma of the CXL treated rats. When comparing the control and CXL cornea, the GAGs area in the CXL cornea was significantly higher and inter-GAGs-spacing was smaller than in the control cornea. In the control cornea, the collagen fibrils diameter was higher in the anterior stroma and lowest in the posterior stroma. In the CXL treated cornea, the CF diameter and the interfibrillar spacing gradually decreased from the anterior to the posterior stroma. On comparison between the control and the CXL treated cornea, the interfibrillar spacing was significantly smaller in the CXL treated cornea than the control cornea in the anterior, middle, and posterior stroma but there was no difference in the diameter. The CXL treatment significantly increased the GAGs area and decreased the inter-GAGs-spacing, and inter-CF-spacing. This could be due to the gradual decline in the availability of riboflavin, UVA, and oxygen in the middle and posterior stroma. Further studies are required to investigate the role of keratan sulphate and chondroitin sulphate by using monoclonal antibodies with immunogold technique.
Collapse
Affiliation(s)
- Saeed Akhtar
- College of Applied Medical Sciences, Inaya Medical College, Riyadh, Saudi Arabia; Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Adrian Smedowski
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland; Department of Ophthalmology, Professor K. Gibinski University Clinical Center, Medical University of Silesia, Katowice, Poland; GlaucoTech Co, Katowice, Poland
| | - Adnan Ali Khan
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Hind Debasi
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Hanan Mofty
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ramachandran Samivel
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Turki Almubrad
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
66
|
Kant R, Mishra N, Kandhari K, Saba L, Michel C, Reisdorph R, Tewari-Singh N, Pantcheva MB, Petrash JM, Agarwal C, Agarwal R. Dexamethasone targets actin cytoskeleton signaling and inflammatory mediators to reverse sulfur mustard-induced toxicity in rabbit corneas. Toxicol Appl Pharmacol 2024; 483:116834. [PMID: 38266871 PMCID: PMC10923037 DOI: 10.1016/j.taap.2024.116834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE Sulfur mustard (SM), a bi-functional alkylating agent, was used during World War I and the Iran-Iraq war. SM toxicity is ten times higher in eyes than in other tissues. Cornea is exceptionally susceptible to SM-injuries due to its anterior positioning and mucous-aqueous interphase. Ocular SM exposure induces blepharitis, photosensitivity, dry eye, epithelial defects, limbal ischemia and stem cell deficiency, and mustard gas keratopathy leading to temporary or permanent vision impairments. We demonstrated that dexamethasone (Dex) is a potent therapeutic intervention against SM-induced corneal injuries; however, its mechanism of action is not well known. Investigations employing proteomic profiling (LC-MS/MS) to understand molecular mechanisms behind SM-induced corneal injury and Dex efficacy were performed in the rabbit cornea exposed to SM and then received Dex treatment. PEAKS studio was used to extract, search, and summarize peptide identity. Ingenuity Pathway Analysis was used for pathway identification. Validation was performed using immunofluorescence. One-Way ANOVA (FDR < 0.05; p < 0.005) and Student's t-test (p < 0.05) were utilized for analyzing proteomics and IF data, respectively. Proteomic analysis revealed that SM-exposure upregulated tissue repair pathways, particularly actin cytoskeleton signaling and inflammation. Prominently dysregulated proteins included lipocalin2, coronin1A, actin-related protein2, actin-related protein2/3 complex subunit2, actin-related protein2/3 complex subunit4, cell division cycle42, ezrin, bradykinin/kininogen1, moesin, and profilin. Upregulated actin cytoskeleton signaling increases F-actin formation, dysregulating cell shape and motility. Dex reversed SM-induced increases in the aforementioned proteins levels to near control expression profiles. Dex aids corneal wound healing and improves corneal integrity via actin cytoskeletal signaling and anti-inflammatory effects following SM-induced injuries.
Collapse
Affiliation(s)
- Rama Kant
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Neha Mishra
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Kushal Kandhari
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Laura Saba
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Cole Michel
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Richard Reisdorph
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Neera Tewari-Singh
- Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Mina B Pantcheva
- Department of Ophthalmology, School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - J Mark Petrash
- Department of Ophthalmology, School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Chapla Agarwal
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Rajesh Agarwal
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA.
| |
Collapse
|
67
|
Villabona-Martinez V, Dutra BAL, Sampaio LP, Santhiago MR, Wilson SE. Corneal stromal localization of TGF beta isoforms in spontaneous persistent epithelial defects after PRK in rabbits. Exp Eye Res 2024; 239:109794. [PMID: 38237715 DOI: 10.1016/j.exer.2024.109794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/21/2024]
Abstract
The purpose of this study was to evaluate transforming growth factor beta (TGFβ) isoform localization in rabbit corneas with spontaneous persistent epithelial defects (PEDs) after photorefractive keratectomy (PRK). Four cryofixed corneas from a previously reported series of PEDs in rabbits that had PRK were evaluated with triplex immunohistochemistry (IHC) for TGFβ3, myofibroblast marker alpha-smooth muscle actin (α-SMA) and mesenchymal marker vimentin. One cornea had sufficient remaining tissue for triplex IHC for TGFβ1, TGFβ2, or TGFβ3 (each with α-SMA and vimentin) using isoform-specific antibodies. All three TGFβ isoforms were detected in the subepithelial stroma at and surrounding the PED. Some of each TGFβ isoform co-localized with α-SMA of myofibroblasts, which could be TGFβ isoform autocrine production by myofibroblasts or TGFβ-1, -2, and -3 binding to these myofibroblasts.
Collapse
Affiliation(s)
| | - Barbara A L Dutra
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Ophthalmology at University of Sao Paulo, Sao Paulo, Brazil
| | - Lycia P Sampaio
- Department of Ophthalmology at University of Sao Paulo, Sao Paulo, Brazil
| | | | | |
Collapse
|
68
|
Ward KW. Targeting the NRF2 pathway: A promising approach for corneal endothelial dysfunction. Curr Opin Pharmacol 2024; 74:102429. [PMID: 38171062 DOI: 10.1016/j.coph.2023.102429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024]
Abstract
Maintaining corneal endothelial function is required for vision, and corneal endothelial dysfunction is a major cause of visual deficits and blindness worldwide. To date there has been a dearth of innovation for therapeutics targeting the corneal endothelium. However, recent advances in understanding the role of oxidative stress and mitochondrial dysfunction have revealed potential avenues for the development of new therapies. This review summarizes recent developments in elucidating the role of the NRF2 pathway in corneal endothelial health and disease, focusing specifically on Fuchs' endothelial corneal dystrophy and the loss of corneal endothelial cells associated with cataract surgery. The pro-mitochondrial and antioxidant phenotype elicited by NRF2 activation offers a promising opportunity for new therapeutics for the diseased corneal endothelium.
Collapse
Affiliation(s)
- Keith W Ward
- Kuria Therapeutics, Inc, 6834 Cantrell Road, Suite 1651, Little Rock, AR 72207, USA.
| |
Collapse
|
69
|
Li GY, Feng X, Yun SH. Simultaneous tensile and shear measurement of the human cornea in vivo using S0- and A0-wave optical coherence elastography. Acta Biomater 2024; 175:114-122. [PMID: 38101555 PMCID: PMC10872441 DOI: 10.1016/j.actbio.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/09/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
Understanding corneal stiffness is valuable for improving refractive surgery, detecting corneal abnormalities, and assessing intraocular pressure. However, accurately measuring the elastic properties, specifically the tensile and shear moduli that govern mechanical deformation, has been challenging. To tackle this issue, we have developed guided-wave optical coherence elastography that can simultaneously excite and analyze symmetric (S0) and anti-symmetric (A0) elastic waves in the cornea at around 10 kHz frequencies, enabling us to extract tensile and shear properties from measured wave dispersion curves. We verified the technique using elastomer phantoms and ex vivo porcine corneas and investigated the dependence on intraocular pressure using acoustoelastic theory that incorporates corneal tension and a nonlinear constitutive tissue model. In a pilot study involving six healthy human subjects aged 31 to 62, we measured shear moduli (Gzx) of 94±20 kPa (mean±standard deviation) and tensile moduli (Exx) of 4.0±1.1 MPa at central corneas. Our preliminary analysis of age-dependence revealed contrasting trends: -8.3±4.5 kPa/decade for shear and 0.30±0.21 MPa/decade for tensile modulus. This OCE technique has the potential to become a highly useful clinical tool for the quantitative biomechanical assessment of the cornea. STATEMENT OF SIGNIFICANCE: This article reports an innovative elastography technique using two guided elastic waves, demonstrating the measurement of both tensile and shear moduli in human cornea in vivo with unprecedented precision. This technique paves the way for comprehensive investigations into corneal mechanics and holds clinical significance in various aspects of corneal health and disease management.
Collapse
Affiliation(s)
- Guo-Yang Li
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, 50 Blossom St., Boston, MA 02114, USA
| | - Xu Feng
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, 50 Blossom St., Boston, MA 02114, USA
| | - Seok-Hyun Yun
- Harvard Medical School and Wellman Center for Photomedicine, Massachusetts General Hospital, 50 Blossom St., Boston, MA 02114, USA; Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA 02139, USA.
| |
Collapse
|
70
|
Zhao L, Yu JJ, Liu Y, Zuo T, Zhou H, Ju P, Li Y, Cao Y, Dong B. An enhanced model for environmental dry eye: Exploring pathological features and underlying factors. Exp Eye Res 2024; 239:109744. [PMID: 38072354 DOI: 10.1016/j.exer.2023.109744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/17/2023] [Accepted: 11/27/2023] [Indexed: 12/31/2023]
Abstract
This study aimed to develop an enhanced environmental dry eye (EDE) model that accurately reproduces the etiology of prolonged visual fatigue and investigates the underlying pathological features. A total of 40 adult SPF-grade Wistar rats were randomly assigned to control (n = 20) and model (n = 20) groups. Rats in the control group were maintained under normal conditions, while rats in the model group were exposed to a controlled frontal airflow of 2-4 m/s from a fan for 7.5 h daily while placed on a suspended cylindrical wire mesh frame. Various assessments were performed at different time points during the 14-day experiment, including blink frequency, tear secretion (phenol red thread test), tear film breakup time (BUT), fluorescein staining (FL), corneal epithelial status (light microscopy), ultrastructure of corneal epithelial cells (electron microscopy), and expression levels of inflammatory cytokines (IL-1β, TNF-α) in tears (enzyme-linked immunosorbent assay). Additionally, mRNA and protein expression levels of MMP-9, IL1β, IL6, TNF-α, IFN-γ, and caspase-3 in corneal tissues were quantified (real-time quantitative PCR and Western blotting). Compared to the control group, the model group rats exhibited significant decreases in blink frequency (P < 0.001), tear secretion (Schirmer I test) values (P < 0.001), and tear film breakup time levels (P < 0.001). There was also a significant increase in fluorescein staining scores (P < 0.001) in the model group. Histological examination revealed distinct differences of the corneal epithelium between groups. The corneal epithelium of the model group appeared thicker, with disorganized cell arrangement in the superficial and basal layers, partial defects or detachment of superficial epithelial cells, and a rough, uneven surface. Scanning electron microscopy observations showed a rough corneal epithelial surface with numerous cracks and scattered vesicular-like structures in the model group. Furthermore, the model group rats exhibited a significant increase in expression of IL-1β and TNF-α in tears (P < 0.001), and upregulated expression levels of MMP-9, TNF-α, IL-1β, caspase-3, IL-6, and IFN-γ at both the mRNA and protein levels in corneal tissues (P < 0.001). In conclusion, the modified "wire-meshing cylindrical board" model effectively overcomes the limitations of the traditional "jogging board " dry eye model and successfully simulates the etiology of prolonged visual fatigue. This innovative EDE model demonstrates a high degree of relevance to dry eye conditions resulting from prolonged visual tasks, with a high success rate of model induction. Moreover, it proves to be a simple, practical, and easily replicable model, making it highly suitable for further studies on prolonged visual fatigue and facilitating its widespread adoption in research and clinical applications.
Collapse
Affiliation(s)
- Lei Zhao
- Liaoning University of Traditional Chinese Medicine, China; Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, China
| | - Jj Jiajia Yu
- Liaoning University of Traditional Chinese Medicine, China
| | - Yulin Liu
- Liaoning University of Traditional Chinese Medicine, China
| | - Tao Zuo
- Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, China
| | - Huimin Zhou
- Liaoning University of Traditional Chinese Medicine, China
| | - Pin Ju
- Liaoning University of Traditional Chinese Medicine, China
| | - Yuexin Li
- Liaoning University of Traditional Chinese Medicine, China
| | - Yingyue Cao
- Liaoning University of Traditional Chinese Medicine, China
| | - Baoqiang Dong
- Liaoning University of Traditional Chinese Medicine, China.
| |
Collapse
|
71
|
Dogan AS, Gürdal C, Köşker M, Kesimal B, Kocamış SI. In vivo confocal microscopy findings of cornea and tongue mucosa in patients with Sjögren's syndrome. Arch Soc Esp Oftalmol (Engl Ed) 2024; 99:56-61. [PMID: 38043737 DOI: 10.1016/j.oftale.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/17/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION AND OBJECTIVES We aimed to investigate whether Sjögren's syndrome (SS) had distinctive findings in tongue confocal microscopy in a non-invasive manner. MATERIALS AND METHODS This retrospective case-control study evaluated corneal and tongue confocal microscopy findings of the right eyes of 25 patients with aqueous deficient dry eye and 12 healthy volunteers without dry eye findings. There were a total of 14 patients diagnosed with SS-associated dry eye (SSDE), while 11 cases were evaluated as non-Sjögren dry eye (NSDE). RESULTS A significant difference was observed in the dendritic cell count at the corneal subbasal nerve level between the SSDE and NSDE groups (P=.018). In SSDE group, the confocal microscopy images of dendritiform hyperreflective inflammatory cells in the tongue mucosa were in favor of inflammation. However, these findings were not found in patients with NSDE or in controls. CONCLUSIONS This study showed that confocal microscopy provided a non-invasive evaluation of the inflammatory cells in the tongue of SS patients.
Collapse
Affiliation(s)
- A S Dogan
- Ophthalmology Department, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - C Gürdal
- Ophthalmology Department, Dünya Göz Hospital, Ankara, Turkey
| | - M Köşker
- Ophthalmology Department, Dünya Göz Hospital, Ankara, Turkey
| | - B Kesimal
- Ophthalmology Department, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - S I Kocamış
- Ophthalmology Department, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
| |
Collapse
|
72
|
Chamberlain W, Lin CC, Li JY, Gensheimer W, Clover J, Jeng BH, Varnado N, Abdelrahman S, Arnold BF, Lietman TM, Rose-Nussbaumer J. Descemet Endothelial Thickness Comparison Trial 1 (DETECT 1): outcome masked, placebo-controlled trial comparing two types of corneal transplant surgeries and effect of rho kinase inhibitors on endothelial cell loss protocol. BMJ Open Ophthalmol 2024; 9:e001454. [PMID: 38286566 PMCID: PMC10826559 DOI: 10.1136/bmjophth-2023-001454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/31/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND It remains uncertain which endothelial keratoplasty (EK) technique yields the best outcomes while maintaining safety, particularly in eyes with coexisting ocular conditions. Moreover, the impact of endothelial cell loss (ECL) on long-term graft survival requires further investigation. Adjuvant ripasudil, a rho kinase inhibitor, may address the challenge of ECL in corneal transplantation. This paper presents the protocol for the Descemet Endothelial Thickness Comparison Trial 1 (DETECT 1), a multicentre, outcome-masked, randomised, placebo-controlled, four-arm clinical trial. METHODS A total of 160 eligible patients with endothelial dysfunction will be enrolled from five participating sites in the USA. The patients will be randomly assigned in a 2×2 factorial design to one of the following treatment groups: group 1-ultrathin Descemet stripping endothelial keratoplasty (UT-DSAEK) plus topical ripasudil 0.4%; group 2-UT-DSAEK plus topical placebo; group 3-Descemet membrane endothelial keratoplasty (DMEK) plus topical ripasudil 0.4% and group 4-DMEK plus topical placebo. Primary outcomes include the best spectacle-corrected visual acuity at 12 months and ECL at 12 months. Secondary outcomes include visual acuity at different time points, vision-related quality of life, endothelial cell morphology and cost-effectiveness. RESULTS The study outcomes will be analysed using mixed effects linear regression models, taking into account the treatment arms and relevant covariates. Adverse events, including rebubble procedures, graft failure and graft rejection, will be documented and analysed using appropriate statistical methods. CONCLUSION DETECT I aims to provide evidence on the comparative effectiveness of UT-DSAEK and DMEK, as well as the potential benefits of adjuvant topical ripasudil in reducing ECL. The results of this trial will contribute to optimising corneal transplantation techniques and improving long-term graft survival, while also exploring the cost-effectiveness of these interventions. Dissemination of findings through peer-reviewed publications and national/international meetings will facilitate knowledge translation and guide clinical practice in the field of corneal transplantation. ETHICS AND DISSEMINATION A data and safety monitoring committee (DSMC) has been empaneled by the NEI.All study protocols will be subject to review and approval by WCG IRB as the single IRB of record.This study will comply with the National Institute of Health (NIH) Data Sharing Policy and Policy on the Dissemination of NIH-Funded Clinical Trial Information and the Clinical Trials Registration and Results Information Submission rule. Data from the trial will be made available on reasonable request.
Collapse
Affiliation(s)
| | - Charles C Lin
- Ophthalmology, Stanford University, Stanford, California, USA
| | - Jennifer Y Li
- Department of Ophthalmology & Vision Science, University of California Davis, Davis, California, USA
| | - William Gensheimer
- Department of Ophthalmology, Geisel School of Medicine, Dartmouth, Massachusetts, USA
| | | | - Bennie H Jeng
- Department of Ophthalmology, Scheie Eye Institute, Philadelphia, Pennsylvania, USA
| | - Nicole Varnado
- Ophthalmology, Stanford University, Stanford, California, USA
| | - Sarah Abdelrahman
- F.I. Proctor Foundation at the University of California San Francisco, San Francisco, California, USA
| | - Benjamin F Arnold
- F.I. Proctor Foundation at the University of California San Francisco, San Francisco, California, USA
| | - Thomas M Lietman
- F.I. Proctor Foundation at the University of California San Francisco, San Francisco, California, USA
| | - Jennifer Rose-Nussbaumer
- Ophthalmology, Stanford University, Stanford, California, USA
- F.I. Proctor Foundation at the University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
73
|
Kawan S, Backlund MP, Immonen AT, Kivelä TT, Turunen JA. Functional consequences of pathogenic variant c.61G>C in the inflammasome gene NLRP3 underlying keratitis fugax hereditaria. Br J Ophthalmol 2024; 108:323-328. [PMID: 36385001 DOI: 10.1136/bjo-2022-321825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/30/2022] [Indexed: 11/17/2022]
Abstract
AIMS To elucidate the effect of NLRP3 variant c.61G>C on interleukin-1β (IL-1β) secretion in keratitis fugax hereditaria (KFH), a cryopyrin-associated periodic syndrome limited to the eye, and to probe the potential modifying role of prednisolone. METHODS Peripheral blood mononuclear cells (PBMCs) isolated from whole blood of patients with KFH and healthy controls were grown under steady-state conditions or primed with lipopolysaccharide (LPS) with or without prednisolone, and subsequently activated with ATP. Cell lysates and proteins precipitated from the cell culture media were separated by sodium dodecyl sulphate-polyacrylamide gel electrophoresis. NLRP3, procaspase-1, and IL-1β were visualised by western blotting. The concentration of secreted IL-1β in the culture media was quantified by ELISA. RESULTS Following priming of the NLRP3 inflammasome with LPS, a lower threshold for IL-1β secretion was observed in patient-derived PBMCs, compared with healthy controls (median, 124 vs 10 pg/mL, respectively). Interestingly, in PBMCs derived from patients with frequent KFH symptoms, LPS priming alone was able to trigger substantial IL-1β secretion (median, 522 pg/mL), whereas those of patients experiencing occasional KFH attacks showed a subtler release of IL-1β (median, 85 pg/mL). NLRP3 expression was significantly enhanced with LPS stimulation (p=0.03) whereas procaspase-1 expression was not affected. LPS and ATP treated PBMCs from patients with KFH showed significantly diminished IL-1β secretion with prednisolone treatment (p=0.04). CONCLUSIONS PBMCs from patients with KFH are more prone to secrete IL-1β, confirming the presumption that the c.61G>C is a gain-of-function variant. Furthermore, prednisolone is confirmed as a potent drug to reduce IL-1β secretion in KFH.
Collapse
Affiliation(s)
- Sabita Kawan
- Eye Genetics Group, Folkhälsan Research Center, Helsinki, Finland
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Annamari Tuulia Immonen
- Eye Genetics Group, Folkhälsan Research Center, Helsinki, Finland
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tero Tapani Kivelä
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Joni Antero Turunen
- Eye Genetics Group, Folkhälsan Research Center, Helsinki, Finland
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
74
|
Christensen M, Kartchner J, Giegengack M, Thompson AC. A Comparison of Black and Non-Black Patients in the Presentation and Treatment of Keratoconus. Clin Ophthalmol 2024; 18:259-267. [PMID: 38292854 PMCID: PMC10826705 DOI: 10.2147/opth.s447036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/15/2024] [Indexed: 02/01/2024] Open
Abstract
Purpose Patients with advanced keratoconus (KCN) are less likely to benefit from corneal cross-linking and may require a partial or full thickness keratoplasty. This study aimed to determine whether racial disparities exist in the clinical presentation and initial treatment recommendations for patients evaluated for KCN. Methods A single-center retrospective review was conducted on all patients who presented to the cornea department for initial evaluation of KCN between 2018 and 2020. Patients who had undergone prior corneal procedures or surgeries were excluded. Baseline sociodemographic and clinical information was collected and stratified according to black versus non-black race. Generalized estimating equations were used to examine the association between black race and presenting corrected distance visual acuity (CDVA), presence of corneal scarring, keratometry values, Belin ABCD score, and treatment recommendations. Multivariate models were adjusted for patient demographics. Results A total of 128 patients (251 eyes) were included in this study. In fully adjusted models, black individuals presented with significantly worse CDVA (p < 0.0001) and worse tomographic KCN staging according to the Belin ABCD criteria (p = 0.002) compared to non-blacks. Blacks were also more than four times as likely to present with a thinnest pachymetry <400 µm (p < 0.0001) and more than three times as likely to have corneal scarring (p = 0.001). Blacks were more than seven times more likely to have keratoplasty recommended as treatment than conservative management such as corneal cross-linking or contact lenses (p = 0.004). Conclusion Compared with their non-black counterparts, blacks presented with significantly more advanced KCN, which placed them at risk of requiring more invasive treatment plans. Future studies should investigate reasons for such late presentations and aim to mitigate disparities in the presentation and management of KCN.
Collapse
Affiliation(s)
| | - Jeffrey Kartchner
- Wake Forest University School of Medicine, Winston Salem, NC, USA
- Department of Surgical Ophthalmology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC, USA
- Arizona Eye Consultants, Tucson, AZ, USA
| | - Matthew Giegengack
- Wake Forest University School of Medicine, Winston Salem, NC, USA
- Department of Surgical Ophthalmology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Atalie C Thompson
- Wake Forest University School of Medicine, Winston Salem, NC, USA
- Department of Surgical Ophthalmology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC, USA
- Department of Gerontology and Geriatric Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| |
Collapse
|
75
|
Parekh M, Wallace AG, Airaldi M, Ruzza A, Ferrari S, Romano V, Ahmad S. Performance outcomes from a DMEK peeling and preparation wet lab. BMJ Open Ophthalmol 2024; 9:e001540. [PMID: 38272533 PMCID: PMC10824027 DOI: 10.1136/bmjophth-2023-001540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE To evaluate the Descemet membrane endothelial keratoplasty (DMEK) preparation performance of trainee surgeons in an ex vivo human donor cornea DMEK wet lab simulation setting. METHODS Human donor corneoscleral rims unsuitable for transplantation were obtained from Moorfields Lions Eye Bank. At the wet lab, graft stripping was performed by scoring the peripheral endothelium. The trypan blue positive cells (TBPC) and cell density (cells/mm2-reticule count) were counted manually before and after stripping. The procedural time, peripheral and central tears and complete peel-off were also recorded and analysed. RESULTS Eight trainee surgeons attended the wet lab each attempting three DMEKs. Between the first and last attempts a significant decrease was seen in the procedural time (17.6 min vs 10.6 min (p<0.05)) and the TBPC % (12.9% vs 3.8% (p<0.05)). The percentage of tears peripherally and centrally also reduced between the first and the last trials (50% vs 13% (p=0.2226) and 38% vs 0% (p=0.1327)). A significant correlation was found between longer peeling times and higher TBPC % (p<0.001) with a 0.7% endothelial mortality increase for each additional minute required to complete the peel. CONCLUSIONS DMEK wet labs provide a controlled risk-free learning opportunity for trainee surgeons to improve confidence and competence. Wet labs improve the success rate of DMEK graft preparation as well as flatten the learning curve. This emphasises the importance of continued support for the expansion of this valuable learning resource, promoting wider uptake of DMEK surgery.
Collapse
Affiliation(s)
- Mohit Parekh
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | | | - Matteo Airaldi
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Stefano Ferrari
- Fondazione Banca degli Occi del Veneto, Mestre, Venice, Italy
| | - Vito Romano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Sajjad Ahmad
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| |
Collapse
|
76
|
Hafezi NL, Aydemir ME, Lu NJ, Torres-Netto EA, Hillen M, Koppen C. Effect of accelerated high-fluence riboflavin and rose bengal-mediated corneal cross-linking on resistance to enzymatic digestion. BMC Ophthalmol 2024; 24:37. [PMID: 38267904 PMCID: PMC10809678 DOI: 10.1186/s12886-024-03293-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/14/2024] [Indexed: 01/26/2024] Open
Abstract
PURPOSE This study evaluated the effect of high-fluence accelerated corneal cross-linking on the resistance to enzymatic digestion, assessing two chromophore/light combinations: riboflavin/UV-A light (RF/UV-A) and rose bengal/green light (RB/green). METHODS Freshly prepared ex-vivo porcine corneas (n = 189) were divided into 8 groups groups. Group A corneas were unirradiated controls without chromophore soaking (A0), or soaked with riboflavin (A1) or rose bengal (A2). Group B corneas underwent accelerated epi-off RF/UV-A CXL at fluences of 5.4 J/cm² (B1), 10 J/cm² (B2), or 15 J/cm² (B3). Group C corneas underwent accelerated epi-off RB/green CXL at fluences of either 10 J/cm² (C1) or 15 J/cm² (C2). Following CXL, all corneas were digested in 0.3% collagenase-A solution, and the time until complete dissolution was measured. RESULTS Non-irradiated controls exposed to RF and RB enhanced corneal resistance to collagenase digestion, with RB having a stronger effect than RF. RF/UV-A-treated corneas showed significantly increased digestion resistance with increasing fluence levels. RB/green-treated corneas displayed enhanced digestion resistance with each increase in fluence up to 10 J/cm²; a 15 J/cm² fluence yielded similar digestion resistance times to a 10 J/cm² fluence, suggesting a plateau effect in accelerated RB/green CXL protocols. CONCLUSIONS When compared to standard-fluence treatments, high-fluence accelerated epi-off CXL using both riboflavin and rose bengal significantly increases resistance to enzymatic digestion. The optimal settings for clinical protocols might be 15 J/cm² (30 mW/cm² for 8 min 20 s) for RF/UV-A and 10 J/cm² (15 mW/cm² for 11 min 7 s) for RB/Green Light.
Collapse
Affiliation(s)
- Nikki L Hafezi
- Faculty of Medicine, University of Antwerp, Wilrijk, Antwerp, Belgium.
- ELZA Institute, Zurich, Switzerland.
| | | | - Nan-Ji Lu
- Faculty of Medicine, University of Antwerp, Wilrijk, Antwerp, Belgium
- ELZA Institute, Zurich, Switzerland
| | | | | | - Carina Koppen
- Faculty of Medicine, University of Antwerp, Wilrijk, Antwerp, Belgium
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Antwerp, Belgium
| |
Collapse
|
77
|
Hadrian K, Cursiefen C. The role of lymphatic vessels in corneal fluid homeostasis and wound healing. J Ophthalmic Inflamm Infect 2024; 14:4. [PMID: 38252213 PMCID: PMC10803698 DOI: 10.1186/s12348-023-00381-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/16/2023] [Indexed: 01/23/2024] Open
Abstract
The cornea, essential for vision, is normally avascular, transparent, and immune-privileged. However, injuries or infections can break this privilege, allowing blood and lymphatic vessels to invade, potentially impairing vision and causing immune responses. This review explores the complex role of corneal lymphangiogenesis in health and diseases. Traditionally, the cornea was considered devoid of lymphatic vessels, a phenomenon known as "corneal (lymph)angiogenic privilege." Recent advances in molecular markers have enabled the discovery of lymphatic vessels in the cornea under certain conditions. Several molecules contribute to preserving both immune and lymphangiogenic privileges. Lymphangiogenesis, primarily driven by VEGF family members, can occur directly or indirectly through macrophage recruitment. Corneal injuries and diseases disrupt these privileges, reducing graft survival rates following transplantation. However, modulation of lymphangiogenesis offers potential interventions to promote graft survival and expedite corneal edema resolution.This review underscores the intricate interplay between lymphatic vessels, immune privilege, and corneal pathologies, highlighting innovative therapeutic possibilities. Future investigations should explore the modulation of lymphangiogenesis to enhance corneal health and transparency, as well as corneal graft survival, and this benefits patients with various corneal conditions.
Collapse
Affiliation(s)
- Karina Hadrian
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine (CMMC), University of Cologne, Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, University of Cologne, Cologne, Germany.
- Center for Molecular Medicine (CMMC), University of Cologne, Cologne, Germany.
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.
| |
Collapse
|
78
|
Ueno Y, Oda M, Yamaguchi T, Fukuoka H, Nejima R, Kitaguchi Y, Miyake M, Akiyama M, Miyata K, Kashiwagi K, Maeda N, Shimazaki J, Noma H, Mori K, Oshika T. Deep learning model for extensive smartphone-based diagnosis and triage of cataracts and multiple corneal diseases. Br J Ophthalmol 2024:bjo-2023-324488. [PMID: 38242700 DOI: 10.1136/bjo-2023-324488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/17/2023] [Indexed: 01/21/2024]
Abstract
AIM To develop an artificial intelligence (AI) algorithm that diagnoses cataracts/corneal diseases from multiple conditions using smartphone images. METHODS This study included 6442 images that were captured using a slit-lamp microscope (6106 images) and smartphone (336 images). An AI algorithm was developed based on slit-lamp images to differentiate 36 major diseases (cataracts and corneal diseases) into 9 categories. To validate the AI model, smartphone images were used for the testing dataset. We evaluated AI performance that included sensitivity, specificity and receiver operating characteristic (ROC) curve for the diagnosis and triage of the diseases. RESULTS The AI algorithm achieved an area under the ROC curve of 0.998 (95% CI, 0.992 to 0.999) for normal eyes, 0.986 (95% CI, 0.978 to 0.997) for infectious keratitis, 0.960 (95% CI, 0.925 to 0.994) for immunological keratitis, 0.987 (95% CI, 0.978 to 0.996) for cornea scars, 0.997 (95% CI, 0.992 to 1.000) for ocular surface tumours, 0.993 (95% CI, 0.984 to 1.000) for corneal deposits, 1.000 (95% CI, 1.000 to 1.000) for acute angle-closure glaucoma, 0.992 (95% CI, 0.985 to 0.999) for cataracts and 0.993 (95% CI, 0.985 to 1.000) for bullous keratopathy. The triage of referral suggestion using the smartphone images exhibited high performance, in which the sensitivity and specificity were 1.00 (95% CI, 0.478 to 1.00) and 1.00 (95% CI, 0.976 to 1.000) for 'urgent', 0.867 (95% CI, 0.683 to 0.962) and 1.00 (95% CI, 0.971 to 1.000) for 'semi-urgent', 0.853 (95% CI, 0.689 to 0.950) and 0.983 (95% CI, 0.942 to 0.998) for 'routine' and 1.00 (95% CI, 0.958 to 1.00) and 0.896 (95% CI, 0.797 to 0.957) for 'observation', respectively. CONCLUSIONS The AI system achieved promising performance in the diagnosis of cataracts and corneal diseases.
Collapse
Affiliation(s)
- Yuta Ueno
- Department of Ophthalmology, University of Tsukuba, Tsukuba, Japan
| | - Masahiro Oda
- Information Technology Center, Nagoya University, Nagoya, Japan
- Graduate School of Informatics, Nagoya University, Nagoya, Japan
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Hideki Fukuoka
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Yoshiyuki Kitaguchi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Vusual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masato Akiyama
- Department of Ocular Pathology and Imaging Science, Kyushu University, Fukuoka, Japan
| | | | - Kenji Kashiwagi
- Department of Ophthalmology, University of Yamanashi, Kofu, Japan
| | - Naoyuki Maeda
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Hisashi Noma
- Department of Data Science, Institute of Statistical Mathematics, Tokyo, Japan
| | - Kensaku Mori
- Information Technology Center, Nagoya University, Nagoya, Japan
- Graduate School of Informatics, Nagoya University, Nagoya, Japan
- National Institute of Informatics, Tokyo, Japan
| | - Tetsuro Oshika
- Department of Ophthalmology, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|
79
|
Dong Y, Hou J, Zhang J, Lei Y, Yang X, Sun F. Epithelial thickness remodeling after small incision lenticule intrastromal keratoplasty in correcting hyperopia measured by RTVue OCT. BMC Ophthalmol 2024; 24:13. [PMID: 38191381 PMCID: PMC10773066 DOI: 10.1186/s12886-023-03272-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024] Open
Abstract
PURPOSE To characterize the in vivo corneal epithelial thickness (CET) remodeling profile in a population of eyes after small incision lenticule intrastromal keratoplasty (SMI-LIKE) for hyperopia. METHODS The CET profile was measured by RTVue-100 Fourier-domain OCT system across the central 6-mm diameter of the cornea of 17 eyes from 12 subjects (five males and seven females) who accepted corneal stromal lens implantation surgery for correcting hyperopia. The CET were measured at positions with a radius of 0-1.0 mm, 1.0-2.5 mm (divided into eight quadrants) and 2.5-3.0 mm (divided into eight quadrants) from the corneal center. Corneal maximum simulated keratometry (Km) was measured by Pentacam HR anterior segment analyzer to analyze CET changes. The examination data of subjects were collected in four time periods, which were preoperative, short-term postoperative (one week after surgery), mid-term postoperative (the last review within 3-6 months after surgery), and long-term postoperative (the last review over 1-2.5 years after surgery). The changes of CET were compared and analyzed in the four time periods. RESULTS Mean CET in 0-1.0 mm, 1.0-2.5 mm and 2.5-3.0 mm of the cornea decreased in one week after surgery, respectively, as compared to CET in the preoperative period, which turned from 55.06 ± 0.82 μm、54.42 ± 0.75 μm、53.46 ± 0.60 μm to 51.18 ± 1.05 μm (P = 0.005), 49.38 ± 0.70 μm (P = 0.000), 51.29 ± 0.59 μm (P = 0.025). In the mid-term postoperative period, mean CET in 0-1.0 mm and 1.0-2.5 mm areas kept thinner than mean CET in the preoperative period, CET in 0-1.0 mm is 50.59 ± 0.76 μm (P = 0.000),CET in 1.0-2.5 mm is 50.23 ± 0.57 μm (P = 0.000), while mean CET in 2.5-3.0 mm area recovered to the same thickness as the preoperative level, which is 54.36 ± 0.66 μm (P = 1.000), until the long-term period, CET stabilized in the above doughnut pattern. CONCLUSIONS After stromal lenticule implantation for hyperopia, CET showed a remodeled form of thinning in the 0-2.5 mm area and thickening in the 2.5-3.0 mm area, and remained stable within one year after surgery.
Collapse
Affiliation(s)
- Yahui Dong
- Jinan Mingshui Eye Hospital, Number 5601, Longquan Road, Zhangqiu District, Jinan, 250200, China
| | - Jie Hou
- Jinan Mingshui Eye Hospital, Number 5601, Longquan Road, Zhangqiu District, Jinan, 250200, China
| | - Jing Zhang
- Jinan Mingshui Eye Hospital, Number 5601, Longquan Road, Zhangqiu District, Jinan, 250200, China
| | - Yulin Lei
- Jinan Mingshui Eye Hospital, Number 5601, Longquan Road, Zhangqiu District, Jinan, 250200, China.
| | - Xinghua Yang
- Jinan Mingshui Eye Hospital, Number 5601, Longquan Road, Zhangqiu District, Jinan, 250200, China
| | - Fangfang Sun
- Jinan Mingshui Eye Hospital, Number 5601, Longquan Road, Zhangqiu District, Jinan, 250200, China
| |
Collapse
|
80
|
Wykrota AA, Hamon L, Daas L, Seitz B. Descemet Membrane Endothelial Keratoplasty after failed penetrating keratoplasty- case series and review of the literature. BMC Ophthalmol 2024; 24:15. [PMID: 38191393 PMCID: PMC10775423 DOI: 10.1186/s12886-023-03279-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 12/27/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND This study aims to evaluate visual outcome, central corneal thickness, and re-bubbling rate in a cohort with undersized sequential Descemet Membrane Endothelial Keratoplasty (DMEK) due to endothelial graft decompensation following primary penetrating keratoplasty (PK). METHODS All patients who received a sequential DMEK (n = 16) or triple DMEK (n = 2) after failed primary PK between November 2020 and June 2022 were retrospectively evaluated. Analyzed parameters were corrected distance visual acuity (CDVA), central corneal thickness (CCT), re-bubbling rate and graft survival. RESULTS 18 eyes of 18 patients were included. All patients underwent a DMEK with undersized graft after failed PK(s). Mean time between the last PK and DMEK was 102 ± 82 weeks. Mean follow-up time was 8.9 ± 4.6 months. CDVA increased significantly from 1.12 ± 0.60 logMAR preoperatively to 0.64 ± 0.49 logMAR 6 weeks postoperatively (p = 0.013). Mean CCT decreased significantly from 807 ± 224 μm before to 573 ± 151 μm 6 weeks after DMEK (p = 0.003). Re-bubbling was necessary in eight eyes (44.4%) after a median time of 7 days. The 12-month Kaplan Meier survival was 66.7%. CONCLUSION In case of endothelial graft decompensation without stromal scars after primary PK, a DMEK can be performed for selected patients who had satisfying CDVA before the endothelial decompensation. Prior to DMEK indication, an AS-OCT should routinely be performed to circularly search for posterior steps at the PK graft margin, as well as shortly after DMEK to exclude a detachment of the endothelial graft. All patients should be informed about a higher re-bubbling rate in comparison to primary DMEK.
Collapse
Affiliation(s)
- Agata Anna Wykrota
- Department of Ophthalmology, Saarland University Medical Center (UKS), Kirrberger Straße 100, Building 22, 66421, Homburg/Saar, Germany.
| | - Loïc Hamon
- Department of Ophthalmology, Saarland University Medical Center (UKS), Kirrberger Straße 100, Building 22, 66421, Homburg/Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center (UKS), Kirrberger Straße 100, Building 22, 66421, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center (UKS), Kirrberger Straße 100, Building 22, 66421, Homburg/Saar, Germany
| |
Collapse
|
81
|
Santana-Garrido Á, Durán-Lobato M, Mate A, Martín-Banderas L, Vázquez CM. Ophthalmic wild olive (ACEBUCHE) oil nanoemulsions exert oculoprotective effects against oxidative stress induced by arterial hypertension. Int J Pharm 2024; 649:123602. [PMID: 37967686 DOI: 10.1016/j.ijpharm.2023.123602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/07/2023] [Accepted: 11/11/2023] [Indexed: 11/17/2023]
Abstract
Oxidative stress plays a key role in several systemic and ocular diseases, including hypertensive eye diseases. In this context, we previously showed that oral administration of wild olive (acebuche, ACE) oil from Olea europaea var. sylvestris can counteract ocular damage secondary to arterial hypertension by modulating excess reactive oxygen species (ROS) produced by the enzyme nicotinamide adenine dinucleotide phosphate (NADPH) oxidase. Therefore, this work describes the development of an ACE oil-based formulation for ocular administration as a local therapy to counteract hypertension-related oxidative damage. Specifically, ACE oil nanoemulsions (NEs) were successfully produced and characterized, exhibiting appropriate features for ophthalmic administration, including a nanometer size (<200 nm), moderate negative ZP, adequate osmolality and pH, and colloidal stability in biorelevant fluids. Likewise, the NEs presented a shear thinning behavior, especially convenient for ocular instillation. In vivo evaluation was performed through either intravitreal injection or topical ophthalmic administration in mice with hypertension induced via administration of Nω-nitro-L-arginine-methyl-ester (L-NAME). Both routes of administration reduced hypertensive morphological alterations and demonstrated a noticeable antioxidant effect thanks to the reduction of the activity/expression of NADPH oxidase in cornea and retina. Thus, an ACE oil ophthalmic formulation represent a promising therapy for ocular pathologies associated with arterial hypertension.
Collapse
Affiliation(s)
- Á Santana-Garrido
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla. CL Profesor García González 2, 41012 Sevilla, Spain; Epidemiología Clínica y Riesgo Cardiovascular, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío - Consejo Superior de Investigaciones Científicas - Universidad de Sevilla. Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
| | - M Durán-Lobato
- Departamento de Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Universidad de Sevilla. CL Profesor García González 2, 41012 Sevilla, Spain
| | - A Mate
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla. CL Profesor García González 2, 41012 Sevilla, Spain; Epidemiología Clínica y Riesgo Cardiovascular, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío - Consejo Superior de Investigaciones Científicas - Universidad de Sevilla. Avda. Manuel Siurot s/n, 41013 Sevilla, Spain.
| | - L Martín-Banderas
- Departamento de Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Universidad de Sevilla. CL Profesor García González 2, 41012 Sevilla, Spain.
| | - C M Vázquez
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla. CL Profesor García González 2, 41012 Sevilla, Spain; Epidemiología Clínica y Riesgo Cardiovascular, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío - Consejo Superior de Investigaciones Científicas - Universidad de Sevilla. Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
| |
Collapse
|
82
|
Colombo-Barboza GN, Rodrigues PF, Colombo-Barboza FDP, Moscovici BK, Colombo-Barboza LR, Colombo-Barboza MN, Nose W. Radial keratotomy: background and how to manage these patients nowadays. BMC Ophthalmol 2024; 24:9. [PMID: 38178013 PMCID: PMC10768088 DOI: 10.1186/s12886-023-03261-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024] Open
Abstract
In this review, we presented the principles of radial keratotomy (RK), its evolution, enhancement, and complications, and strategies to manage the consequences of RK in the present day. It is essential to understand the RK procedure f, the theoretical background that supported this surgery, the current effect on the cornea, and how to approach patients needing vision improvement. These patients are developing cataracts that need to be handled well, from the IOL calculation to the surgical procedure. Guided keratorefractive surgery is the most accurate procedure to improve these patient's vision and life. Nevertheless, some patients may need other approaches, such as sutures, penetrating keratoplasty, corneal rings, and pinhole implants, depending on the degree of irregularity of the cornea, ablation depth for guided surgery or if the sutures are open.
Collapse
Affiliation(s)
- Guilherme Novoa Colombo-Barboza
- Department of Ophthalmology, Hospital Oftalmológico Visão Laser, São Paulo, Santos, Brazil.
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
- Department of Ophthalmology, Santos Medical Sciences (UNILUS), Santos, Brazil.
- Department of Ophthalmology, UNIMES Medicine College, Santos, Brazil.
| | - Pablo Felipe Rodrigues
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Bernardo Kaplan Moscovici
- Department of Ophthalmology, Hospital Oftalmológico Visão Laser, São Paulo, Santos, Brazil
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Marcello Novoa Colombo-Barboza
- Department of Ophthalmology, Hospital Oftalmológico Visão Laser, São Paulo, Santos, Brazil
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Ophthalmology, Santos Medical Sciences (UNILUS), Santos, Brazil
| | - Walton Nose
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| |
Collapse
|
83
|
Huang R, Su C, Zhang N, Shi C, Pu G, Ding Y, Wei W, Chen J. Cord blood-derived biologics lead to robust axonal regeneration in benzalkonium chloride-injured mouse corneas by modulating the Il-17 pathway and neuropeptide Y. Mol Med 2024; 30:2. [PMID: 38172658 PMCID: PMC10763178 DOI: 10.1186/s10020-023-00772-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Umbilical cord blood-derived therapeutics, such as serum (UCS) and platelet-rich plasma (UCPRP), are popular treatment options in clinical trials and can potentially be utilized to address a clinically unmet need caused by preservatives, specifically benzalkonium chloride (BAK), present in ophthalmic formulations. As current clinical interventions for secondary injuries caused by BAK are suboptimal, this study will explore the feasibility of utilizing UCS and UCPRP for cornea treatment and investigate the underlying mechanisms associated with this approach. METHODS Mice's corneas were administered BAK to induce damage. UCS and UCPRP were then utilized to attempt to treat the injuries. Ocular tests were performed on the animals to evaluate recovery, while immunostaining, RNA-seq, and subsequent bioinformatics analysis were conducted to investigate the treatment mechanism. RESULTS BAK administration led to widespread inflammatory responses in the cornea. Subsequent treatment with UCS and UCPRP led to the downregulation of immune-related 'interactions between cytokine receptors' and 'IL-17 signaling' pathways. Although axonal enhancers such as Ngf, Rac2, Robo2, Srgap1, and Rock2 were found to be present in the injured group, robust axonal regeneration was observed only in the UCS and UCPRP treatment groups. Further analysis revealed that, as compared to normal corneas, inflammation was not restored to pre-injury levels post-treatment. Importantly, Neuropeptide Y (Npy) was also involved in regulating immune responses, indicating neuroimmune axis interactions. CONCLUSIONS Cord blood-derived therapeutics are feasible options for overcoming the sustained injuries induced by BAK in the cornea. They also have potential applications in areas where axonal regeneration is required.
Collapse
Affiliation(s)
- Ruojing Huang
- The First Affiliated Hospital of Jinan University, Tianhe District, Guangzhou, 510630, Guangdong Province, China
| | - Caiying Su
- The First Affiliated Hospital of Jinan University, Tianhe District, Guangzhou, 510630, Guangdong Province, China
- Peking University Shenzhen Hospital, Futian District, Shenzhen, 518036, Guangdong Province, China
| | - Na Zhang
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 62 Nanyang Dr, Singapore, 637459, Singapore
| | - Congying Shi
- Institution of Guangdong Cord Blood Bank, Guangdong Women and Children Hospital, Guangzhou, 510705, Guangdong Province, China
- Department of Experimental Center, Guangzhou Municipality Tianhe Nuoya Bio-Engineering Co., Ltd, Guangzhou, 510705, Guangdong Province, China
| | - Guangming Pu
- Jinan University Affiliated Heyuan Hospital, Guangzhou, 517000, Guangdong Province, China
| | - Yong Ding
- The First Affiliated Hospital of Jinan University, Tianhe District, Guangzhou, 510630, Guangdong Province, China
| | - Wei Wei
- Institution of Guangdong Cord Blood Bank, Guangdong Women and Children Hospital, Guangzhou, 510705, Guangdong Province, China.
- Department of Experimental Center, Guangzhou Municipality Tianhe Nuoya Bio-Engineering Co., Ltd, Guangzhou, 510705, Guangdong Province, China.
| | - Jiansu Chen
- Institute of Ophthalmology, Medical College, Jinan University, Guangzhou, 510630, Guangdong Province, China.
| |
Collapse
|
84
|
Niazi S, del Barrio JA, Doroodgar F, Sanginabadi A, Alinia C, Hashemian SJ, Hashemi H, Alio JL. Biomechanical changes in keratoconus after customized stromal augmentation. Taiwan J Ophthalmol 2024; 14:59-69. [PMID: 38654988 PMCID: PMC11034678 DOI: 10.4103/tjo.tjo-d-23-00155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/01/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE To verify corneal biomechanical changes, poststromal augmentation using myopic small-incision lenticule extraction's (SMILEs) lenticules in advanced keratoconus (KCN) through Corvis ST (Oculus, Wetzlar, Germany). MATERIALS AND METHODS A clinical trial enrolled 22 advanced KCN patients. We implanted lenticules exceeding 100 μ according to a nomogram and evaluated biomechanical factors through Corvis ST at 3-, 6-, and 24-month postimplantation. We examined parameters during the first applanation (A1), second applanation (A2), highest concavity (HC)/max concavity events, and Vinciguerra screening parameters, as recently established criteria derived from the ideal blend of diverse biomechanical and ocular factors and formulated through the application of logistic regression. Regression analyses explored relationships with age, mean keratometry value, thickness, sphere, cylinder, and best-corrected visual acuity. RESULTS Patients were well matched for age, intraocular pressure, and central corneal thickness (CCT). The mean spherical equivalent decreased from -13.48 ± 2.86 Diopters (D) to -8.59 ± 2.17 D (P < 0.007), and mean keratometry decreased from 54.68 ± 2.77 D to 51.95 ± 2.21 D (P < 0.006). Significant increases were observed in HC time (HCT), Radius-central curvature radius at the HC state-, peak distance (PD) during HC state, CCT, first applanation time, and stiffness parameter (A1T and SP-A1), whereas HC deformation amplitude, maximum deformation amplitude ratio at 2 mm, Corvis Biomechanical Index (CBI), integrated radius (IR), second applanation deformation amplitude (A2DA), first applanation velocity and deflection amplitude (A1V and A1DeflA) significantly decreased postlenticule implantation. Multivariable regression revealed age positively correlated with SP-A1 (P = 0.003) and negatively with HC delta Arc length (P = 0.007). Mean K positively correlated with CCT (P = 0.05) and negatively with CBI (P = 0.032). Best-corrected visual acuity positively correlated with HCT (P = 0.044), and the cylinder positively correlated with PD (P = 0.05) and CCT (P = 0.05) whereas negatively with IR (P = 0.025). CONCLUSIONS Stromal augmentation using myopic SMILE lenticules induces significant corneal biomechanical changes in KCN.
Collapse
Affiliation(s)
- Sana Niazi
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Farideh Doroodgar
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azad Sanginabadi
- Department of Optometry, Iran University of Medical Sciences, Tehran, Iran
| | - Cyrus Alinia
- Department of Public Health, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Seyed Javad Hashemian
- Eye Research Center, Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Jorge L. Alio
- Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
- Vissum Miranza Alicante, Alicante, Spain
| |
Collapse
|
85
|
Gururani H, Chittajallu SNSH, Doulatramani M, Manoharan R, Basu S, Chinthapenta V. Intraoperative collagen imaging of sutured cornea: A way towards managing post-penetrating keratoplasty astigmatism. Med Eng Phys 2024; 123:104076. [PMID: 38365329 DOI: 10.1016/j.medengphy.2023.104076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 02/18/2024]
Abstract
The birefringent nature of the human cornea plays an important role in comprehending its structural behavior in both diseased and surgical conditions. During corneal transplantation, irregular astigmatism is a common post-surgical complication that depends on the characteristics of suturing. Four human cadaver corneas are subjected to an in-vitro model of a typical full-thickness penetrating keratoplasty (PK) procedure using 16 simple interrupted 10-0 vicyrl sutures. The birefringence of these four corneas is analyzed using digital photoelasticity and compared with the control cornea (without PK). It is found that the sutures and their mutual interaction influence the morphology of the peripheral birefringence of the cornea. The findings of the present investigation are pertinent to intraoperative suture management during PK. Results suggest conserving the typical diamond-shaped morphology of peripheral birefringence would ensure uniform distribution of sutures. Therefore, birefringence imaging could be useful in suture management to ensure proper apposition of the graft-host junction, thus minimizing the risk of irregular astigmatism.
Collapse
Affiliation(s)
| | - Sai Naga Sri Harsha Chittajallu
- Micro-Mechanics Lab, IIT Hyderabad, Kandi, Sangareddy 502284, India; Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India
| | | | - Ramji Manoharan
- Engineering Optics Lab, IIT Hyderabad, Kandi, Sangareddy 502284, India
| | - Sayan Basu
- Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad 500034, India; The Cornea Institute, LV Prasad Eye Institute, Hyderabad 500034, India
| | | |
Collapse
|
86
|
Torras-Sanvicens J, Rodríguez-Calvo-de-Mora M, Figueras-Roca M, Amescua G, Carletti P, Casaroli-Marano RP, Patel SV, Rocha-de-Lossada C. Translation and validation of the Visual Function and Corneal Health Status (V-FUCHS) questionnaire into Spanish language. Arch Soc Esp Oftalmol (Engl Ed) 2024; 99:9-15. [PMID: 37944642 DOI: 10.1016/j.oftale.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/07/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To translate and validate the V-FUCHS questionnaire into Spanish in a population of patients with Fuchs endothelial dystrophy (DEF). METHODS The V-FUCHS consists of 15 short, easily understandable questions that assess visual aspects of quality of life in patients with DEF, which can be gathered into a group of seven that assess the "Visual Difficulty" factor and another group of eight that assess the "Glare Factor". For the translation and cultural adaptation, the standardized norms for this process were followed, among other phases, a translation, a back-translation and an application in patients with DEF. RESULTS In the first phase, consensus was reached on the Spanish translation of the V-FUCHS. Subsequently, 25 patients were included to carry out the pre-test phase with the aim of assessing the applicability and feasibility of the test. The score obtained a minimum value of -0.88 and a maximum value of +2.44, according to the Rasch probabilistic scale. The mean value obtained from the Visual Difficulty factor was 0.61 (±0.71), while the mean for the Glare Factor was 0.41 (±0.51). CONCLUSION The validation of the V-FUCHS questionnaire, after its translation and adaptation into Spanish, proved to be a useful tool for assessing the visual quality of patients with DEF. Patients with a more advanced stage of the disease presented a greater severity in the test result. Likewise, the Glare Factor (Glare) correlates better with the pachymetric increase than with the visual acuity of the patient.
Collapse
Affiliation(s)
- J Torras-Sanvicens
- Service of Ophthalmology, Hospital Clínic de Barcelona, Barcelona, Spain; Department of Surgery, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - M Rodríguez-Calvo-de-Mora
- Qvision, Ophthalmology Department, VITHAS Almería Hospital, Almería, Spain; Ophthalmology Department, VITHAS Málaga, Málaga, Spain; Ophthalmology Department, Hospital Regional Universitario Málaga, Málaga, Spain
| | - M Figueras-Roca
- Service of Ophthalmology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - G Amescua
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, FL, United States; University of Miami-Miller, School of Medicine, Miami, FL, United States
| | - P Carletti
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, FL, United States; University of Miami-Miller, School of Medicine, Miami, FL, United States
| | - R P Casaroli-Marano
- Service of Ophthalmology, Hospital Clínic de Barcelona, Barcelona, Spain; Department of Surgery, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - S V Patel
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States
| | - C Rocha-de-Lossada
- Qvision, Ophthalmology Department, VITHAS Almería Hospital, Almería, Spain; Ophthalmology Department, VITHAS Málaga, Málaga, Spain; Ophthalmology Department, Hospital Regional Universitario Málaga, Málaga, Spain; Departamento de Cirugía, Área de Oftalmología, Universidad de Sevilla, Sevilla, Spain.
| |
Collapse
|
87
|
Tachikawa T, Ueno R, Mita T, Yuzurihara D, Noda T. Corneal refractive error and astigmatism in patients aged 6 to 18 years with a history of retinopathy of prematurity and birth weight of <1500 g. Jpn J Ophthalmol 2024; 68:42-49. [PMID: 38001368 DOI: 10.1007/s10384-023-01026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/05/2023] [Indexed: 11/26/2023]
Abstract
PURPOSE To investigate corneal refractive power (CR) and astigmatism (AS) in 6- to 18-year-old children with a history of retinopathy of prematurity (ROP) and birth weight of <1500 g who either did or did not undergo retinal photocoagulation (PC). STUDY DESIGN Retrospective study. METHODS We examined 143 eyes of 77 children in 2021. The children were divided into three groups for evaluation of CR and AS: those with a birth weight of ≥2500 g (normal birth weight [NBW] group, 13 eyes) as controls, those with spontaneously resolved ROP (sr-ROP group, 27 eyes), and those who underwent PC for treatment of ROP (PC-ROP group, 103 eyes). Swept-source anterior segment optical coherence tomography was used to analyze the cornea. RESULTS The median CR in the NBW, sr-ROP, and PC-ROP groups was 42.2 (41.3, 42.8) diopters (D), 44.5 (43.2, 45.5) D, and 45.2 (43.8, 46.6) D, respectively. The median AS in the NBW, sr-ROP, and PC-ROP groups was 1.2 (1.0, 1.5) D, 1.1 (0.8, 1.6) D, and 2.1 (1.4, 2.7) D. In the PC-ROP group, the with-the-rule astigmatic axis was 97%. In all three groups, a strong positive correlation was found between the mean anterior and posterior CR (NBW: r=0.795, sr-ROP: r=0.842, PC-ROP: r=0.890) and AS (NBW: r=0.883, sr-ROP: r=0.841, PC-ROP: r=0.860). CONCLUSION CR was significantly higher in the sr-ROP (p=0.013) and PC-ROP (p<0.001) groups than in the NBW group. The PC-ROP group had significantly more AS than the sr-ROP group. There was a strong correlation between the anterior and posterior CR and AS.
Collapse
Affiliation(s)
- Takako Tachikawa
- Department of Ophthalmology, Tokyo Metropolitan Ohtsuka Hospital, Minami-Ohtsuka 2-8-1, Toshima-ku, Tokyo, 170-8476, Japan.
| | - Ritsuko Ueno
- Department of Ophthalmology, Tokyo Metropolitan Ohtsuka Hospital, Minami-Ohtsuka 2-8-1, Toshima-ku, Tokyo, 170-8476, Japan
| | - Tetsuko Mita
- Department of Ophthalmology, Tokyo Metropolitan Ohtsuka Hospital, Minami-Ohtsuka 2-8-1, Toshima-ku, Tokyo, 170-8476, Japan
| | - Daisuke Yuzurihara
- Department of Ophthalmology, Tokyo Metropolitan Ohtsuka Hospital, Minami-Ohtsuka 2-8-1, Toshima-ku, Tokyo, 170-8476, Japan
| | - Toru Noda
- Department of Ophthalmology, NHO Tokyo Medical Center, Tokyo, Japan
| |
Collapse
|
88
|
Chameettachal S, Pati F. Preparation of Corneal Tissue Matrix Bioink for 3D Bioprinting. Methods Mol Biol 2024; 2764:15-20. [PMID: 38393585 DOI: 10.1007/978-1-0716-3674-9_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
There are many protocols available to decellularize tissues for the preparation of bioink for 3D bioprinting purposes. Almost all the methods comprise multiple chemicals and enzymes in different combinations. Here we describe the usage of sodium chloride that enables the decellularization of corneal tissues from human and animal sources, which is a simple, rapid, and detergent-free method, unlike conventional decellularization protocols. The method described here is for cornea tissue decellularization and its digestion and bioink preparation for 3D bioprinting applications. We demonstrate the efficient decellularization of tissues by retaining the extracellular matrix.
Collapse
Affiliation(s)
- Shibu Chameettachal
- Department of Biomedical Engineering, Indian Institute Technology Hyderabad, Sangareddy, Telangana, India
| | - Falguni Pati
- Department of Biomedical Engineering, Indian Institute Technology Hyderabad, Sangareddy, Telangana, India.
| |
Collapse
|
89
|
Kono M, Takaishi M, Okuda T, Fujihara M, Noguchi S, Ishihara Y. A simple air-liquid interface exposure system for exposing cultured human 3D epidermis and cornea to PM2.5 collected through cyclonic separation. J Toxicol Sci 2024; 49:61-68. [PMID: 38296530 DOI: 10.2131/jts.49.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Particulate matter (PM) is among the major air pollutants suspended in the atmosphere. PM2.5 has a particle size of 2.5 µm; it is known to cause inflammation, especially in the respiratory tract and skin. Since the skin acts a primary barrier against harmful environmental substances that may enter the body, it is highly exposed to PM2.5 present in the environment. However, the adverse health effects of PM2.5 exposure on human skin have not been accurately examined due to the lack of a system that exposes human epidermal tissue to the actual environmental concentration of PM2.5. In this study, we developed an air-liquid interface exposure system for exposing cultured human 3D epidermis and cornea to PM2.5 collected through cyclonic separation. PM2.5 suspension was nebulized in an acrylic chamber, and the resulting mist was pumped through a diffusion dryer into a glass exposure chamber. A particle counter was connected to the exposure chamber to continuously measure the spatial mass concentration of PM. Human 3D epidermis was cultured in the exposure chamber. Exposure of the human 3D epidermis to PM aerosol increased interleukin-8 release into the media around 50 µg/m3. Mass concentrations above 100 µg/m3 caused cell death. Furthermore, a human corneal model showed similar responses against PM2.5 exposure as 3D epidermis. The air-liquid interface exposure system developed in this study is considered useful for evaluating the health effects induced by environmental PM2.5 and can be used as an alternative to experiments involving actual human or animals.
Collapse
Affiliation(s)
- Maori Kono
- Laboratory of Advanced Cosmetic Science, Graduate School of Pharmaceutical Sciences, Osaka University
- Advanced Technology Institute, Mandom Corporation
| | - Masayuki Takaishi
- Laboratory of Advanced Cosmetic Science, Graduate School of Pharmaceutical Sciences, Osaka University
- Advanced Technology Institute, Mandom Corporation
| | | | | | - Seisuke Noguchi
- Manufacturing Division, Technical Center, Hiroshima University
| | - Yasuhiro Ishihara
- Program of Biomedical Science, Graduate School of Integrated Sciences for Life, Hiroshima University
| |
Collapse
|
90
|
Niazi S, del Barrio JA, Doroodgar F, Javadi MA, Alió JL. Main issues in deep anterior lamellar keratoplasty: A systematic narrative review. Taiwan J Ophthalmol 2024; 14:34-43. [PMID: 38654987 PMCID: PMC11034680 DOI: 10.4103/tjo.tjo-d-23-00175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/01/2024] [Indexed: 04/26/2024] Open
Abstract
Deep anterior lamellar keratoplasty (DALK) has emerged as a transformative approach in managing corneal pathologies, notably keratoconus (KC), providing a viable alternative to penetrating keratoplasty (PK). This systematic review explores the intricacies of DALK, comparing its preoperative, intraoperative, and postoperative considerations with PK. Extensive literature searches revealed a wealth of data regarding DALK's advantages and challenges, with an emphasis on graft survival, visual outcomes, and complications. In the preoperative phase, DALK showcases its versatility, catering to a wide spectrum of patients, including those with KC and ocular surface disorders. Intraoperatively, it offers innovative techniques to address emphysema, bubble formation, and Descemet's membrane perforation, all while maintaining a strong focus on patient-centered outcomes. Postoperatively, DALK's lower rejection rates and decreased complications underscore its potential superiority over PK, although unique challenges such as graft failure from nonimmunologic factors demand vigilant management. This comprehensive review not only serves as a valuable resource for ophthalmic surgeons but also sheds light on the evolving landscape of corneal transplantation, highlighting DALK's role as a transformative force in the field.
Collapse
Affiliation(s)
- Sana Niazi
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jorge Alió del Barrio
- Department of Cornea, Cataract and Refractive Surgery, Vissum Corporación, Alicante, Spain
| | - Farideh Doroodgar
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Javadi
- Ophthalmic Research Center, Labbafinezhad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jorge L. Alió
- Division of Ophthalmology, Miguel Hernández University of Elche, Alicante, Spain
- Vissum Miranza, Alicante, Spain
| |
Collapse
|
91
|
Leitão M, Cabral D. Isolated corneal involvement by Lichen Planus - multi-modal evaluation. Eur J Ophthalmol 2024; 34:NP48-NP53. [PMID: 37192672 DOI: 10.1177/11206721231174931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
PURPOSE To describe a case of ocular Lichen Planus, successfully managed using a multimodal evaulation, including Anterior Segment OCT (AS-OCT). OBSERVATIONS A female patient in her forties with a history of cutaneous Lichen Planus presents with blurred vision and burning eye sensation. Anterior segment evaluation revealed bilateral punctate keratitis, stromal haze and subepithelial pigmented dots. AS-OCT was pivotal for diagnosis, showing anterior stromal hyperreflective dots. A diagnosis of ocular Lichen Planus was estabilished and the patient was treated with topical hydrocortisone, with complete subsidence of the complaints. CONCLUSIONS AND IMPORTANCE Ocular Lichen Planus can present as isolated corneal involvement independent from severe cicatrizing conjunctivitis. Appropriate and timely treatment can prevent irreversible ocular surface disease. Ophthalmologists should be aware of Lichenoid Tissue Reaction (LTR) disorders, especially in patients with relentless blepharitis and/or ocular surface disease.
Collapse
Affiliation(s)
- Miguel Leitão
- Department of Ophthalmology, Instituto de Oftalmologia Dr. Gama Pinto, Lisboa, Portugal
| | - Diogo Cabral
- Department of Ophthalmology, Hospital Garcia de Orta, Almada, Portugal
| |
Collapse
|
92
|
Naranjo A, Manche EE. A comprehensive review on corneal crosslinking. Taiwan J Ophthalmol 2024; 14:44-49. [PMID: 38654993 PMCID: PMC11034691 DOI: 10.4103/tjo.tjo-d-23-00055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/01/2023] [Indexed: 04/26/2024] Open
Abstract
Corneal crosslinking (CXL) represents a paradigm shift in the management of corneal ectatic disorders. Before CXL was introduced, patients would need specialty contact lenses and possible corneal transplantation. CXL involves a biochemical reaction in which ultraviolet A light is used in conjunction with Riboflavin to form crosslinks in between corneal stromal collagen. This leads to strengthening and stabilizing of the collagen lamellae, resulting in mechanical stiffening of the cornea. Multiple protocols have been proposed including epithelium on versus off and varying light intensity and duration of treatment. All protocols appear to be safe and effective with few reported complications including infection, stromal haze, scarring, and endothelial toxicity. Overall, CXL has demonstrated to halt the progression of the disease clinically and in keratometry readings and improve the quality of life for patients. It is a minimally invasive, cost-effective procedure that can be performed in an outpatient setting with a fast recovery time and long-lasting results.
Collapse
Affiliation(s)
- Andrea Naranjo
- Department of Ophthalmology, The Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Edward E. Manche
- Department of Ophthalmology, The Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| |
Collapse
|
93
|
Krzemiński P, Misiewicz-Krzemińska I, Grodzik M, Padzińska-Pruszyńska I, Kucharzewska P, Ostrowska A, Sawosz E, Pomorski P. The protective effect of silver nanoparticles' on epithelial cornea cells against ultraviolet is accompanied by changes in calcium homeostasis and a decrease of the P2X7 and P2Y2 receptors. Biomed Pharmacother 2024; 170:116090. [PMID: 38169187 DOI: 10.1016/j.biopha.2023.116090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE The aim of the study was to evaluate the effect of silver nanoparticles hydrocolloids (AgNPs) on human corneal epithelial cells. Epithelial cells form the outermost and the most vulnerable to environmental stimuli layer of the cornea in the eye. Mechanical stress, UV radiation, and pathogens such as bacteria, viruses, and parasites challenge the fragile homeostasis of the eye. To help combat stress, infection, and inflammation wide portfolio of interventions is available. One of the oldest treatments is colloidal silver. Silver nanoparticle suspension in water is known for its anti-bacterial anti-viral and antiprotozoal action. However, AgNPs interact also with host cells, and the character of the interplay between corneal cells and silver seeks investigation. METHODS The human epithelial corneal cell line (HCE-2) was cultured in vitro, treated with AgNPs, and subjected to UV. The cell's viability, migration, calcium concentration, and expression/protein level of selected proteins were investigated by appropriate methods including cytotoxicity tests, "wound healing" assay, Fluo8/Fura2 AM staining, qRT-PCR, and western blot. RESULTS Incubation of human corneal cells (HCE-2) with AgNP did not affect cells viability but limited cells migration and resulted in altered calcium homeostasis, decreased the presence of ATP-activated P2X7, P2Y2 receptors, and enhanced the expression of PACAP. Furthermore, AgNPs pretreatment helped restrain some of the deleterious effects of UV irradiation. Interestingly, AgNPs had no impact on the protein level of ACE2, which is important in light of potential SARS-CoV-2 entrance through the cornea. CONCLUSIONS Silver nanoparticles are safe for corneal epithelial cells in vitro.
Collapse
Affiliation(s)
- Patryk Krzemiński
- Department of Nanobiotechnology, Insitute of Biology, Warsaw University of Life Sciences, Ciszewskiego 8, bldg. 23, 02-786 Warsaw, Poland.
| | - Irena Misiewicz-Krzemińska
- Plasma Cell Neoplasm Laboratory, Department of Experimental Haematology, Institute of Hematology and Blood Transfusion, Chocimska 5, 00-791 Warsaw, Poland
| | - Marta Grodzik
- Department of Nanobiotechnology, Insitute of Biology, Warsaw University of Life Sciences, Ciszewskiego 8, bldg. 23, 02-786 Warsaw, Poland
| | - Irena Padzińska-Pruszyńska
- Department of Cancer Biology, Institute of Biology, Warsaw University of Life Sciences, Ciszewskiego 8, bldg. 23, 02-786 Warsaw, Poland
| | - Paulina Kucharzewska
- Department of Cancer Biology, Institute of Biology, Warsaw University of Life Sciences, Ciszewskiego 8, bldg. 23, 02-786 Warsaw, Poland
| | - Agnieszka Ostrowska
- Department of Nanobiotechnology, Insitute of Biology, Warsaw University of Life Sciences, Ciszewskiego 8, bldg. 23, 02-786 Warsaw, Poland
| | - Ewa Sawosz
- Department of Nanobiotechnology, Insitute of Biology, Warsaw University of Life Sciences, Ciszewskiego 8, bldg. 23, 02-786 Warsaw, Poland
| | - Paweł Pomorski
- Laboratory of Molecular Basis of Cell Motility, Nencki Institute of Experimental Biology, Pasteura 3, 02-093 Warsaw, Poland
| |
Collapse
|
94
|
Song D, Yang Q, Li X, Chen K, Tong J, Shen Y. The role of the JAK/STAT3 signaling pathway in acquired corneal diseases. Exp Eye Res 2024; 238:109748. [PMID: 38081573 DOI: 10.1016/j.exer.2023.109748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/05/2023] [Accepted: 12/05/2023] [Indexed: 01/02/2024]
Abstract
Acquired corneal diseases such as dry eye disease (DED), keratitis and corneal alkali burns are significant contributors to vision impairment worldwide, and more effective and innovative therapies are urgently needed. The Janus kinase/signal transducer and activator of transcription 3 (JAK/STAT3) signaling pathway plays an indispensable role in cell metabolism, inflammation and the immune response. Studies have shown that regulators of this pathway are extensively expressed in the cornea, inducing significant activation of JAK/STAT3 signaling in specific acquired corneal diseases. The activation of JAK/STAT3 signaling contributes to various pathophysiological processes in the cornea, including inflammation, neovascularization, fibrosis, and wound healing. In the context of DED, the hypertonic environment activates JAK/STAT3 signaling to stimulate corneal inflammation. Inflammation and injury progression in infectious keratitis can also be modulated by JAK/STAT3 signaling. Furthermore, JAK/STAT3 signaling is involved in every stage of corneal repair after alkali burns, including acute inflammation, angiogenesis and fibrosis. Treatments modulating JAK/STAT3 signaling have shown promising results in attenuating corneal damage, indicating its potential as a novel therapeutic target. Thus, this review emphasizes the multiple roles of the JAK/STAT3 signaling pathway in common acquired corneal disorders and summarizes the current achievements of JAK/STAT3-targeting therapy to provide new insights into future applications.
Collapse
Affiliation(s)
- Dongjie Song
- Department of Ophthalmology, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, China
| | - Qianjie Yang
- Department of Ophthalmology, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xiang Li
- Department of Ophthalmology, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Kuangqi Chen
- Department of Ophthalmology, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.
| | - Jianping Tong
- Department of Ophthalmology, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.
| | - Ye Shen
- Department of Ophthalmology, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.
| |
Collapse
|
95
|
Mazouchi M, Hassanpour K, Esfandiari H, Sadoughi MM. Late-Onset Haze and Severe Corneal Flattening after Combined Corneal Collagen Cross-Linking and Photorefractive Keratectomy (CXL Plus): A Case Report. Case Rep Ophthalmol 2024; 15:56-62. [PMID: 38234306 PMCID: PMC10794048 DOI: 10.1159/000535987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024] Open
Abstract
Introduction Significant corneal flattening and haze are important complications that can occur after combined corneal collagen cross-linking (CXL) and photorefractive keratectomy (PRK) procedures (CXL Plus). Case Presentation We present a 24-year-old man who underwent combined standard CXL and PRK. The patient experienced satisfactory vision for approximately 4 years after the surgery. However, after this period, he began to complain of visual blurring. Subsequent examination revealed significant corneal haze, excessive flattening in both eyes, and thinning (thinnest point 227 μm in the right eye, 244 μm in the left eye) 4 years postoperatively. Upon presentation, the corrected distance visual acuity (CDVA) was 20/200 in the right eye and 20/400 in the left eye. The presenting refraction was +2.50 sph, -3.50 cyl *114 in the right eye and +11.5 sph, -9.75 cyl *81 in the left eye. With rigid gas permeable contact lenses, the corrected visual acuity was 20/50 in both eyes. Before the CXL Plus surgery, initial refraction and CDVA were 20/50 in the right eye (-5.50 sph, -3.00 cyl *175) and 20/30 in the left eye (-5.50 sph, -2.75 cyl *175). The patient was treated by penetrating keratoplasty. The CDVA reached 20/30 at the final follow-up. Conclusion Our report highlights significant corneal haze and flattening that occurred 4 years after combined CXL and PRK treatment. These findings suggest that this procedure might not be safe in suspected patients of keratoconus. Further long-term follow-up research is necessary to evaluate the safety of combined CXL and PRK procedures.
Collapse
Affiliation(s)
- Marjan Mazouchi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kiana Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Labbafinejad Medical Center, Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Esfandiari
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mehdi Sadoughi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Labbafinejad Medical Center, Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
96
|
Uhm SY, Do TP, Montoya RH, Lam B, Kheirkhah A. Comparison of corneal tomographic parameters between Hispanic and non-Hispanic patients. Graefes Arch Clin Exp Ophthalmol 2024; 262:143-148. [PMID: 37493776 DOI: 10.1007/s00417-023-06167-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 05/28/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023] Open
Abstract
PURPOSE To compare corneal tomographic parameters between Hispanic White and non-Hispanic White patients using Pentacam data. METHODS This retrospective study evaluated preoperative Pentacam data from 641 patients 50 years or older who underwent surgery for senile cataract and self-identified as Hispanic or non-Hispanic White. Patients of non-White race or multiethnic groups, or a history of surgery, trauma, or any abnormality of the cornea or anterior segment were excluded. Cornea and anterior segment parameters, as measured with Pentacam, were then compared between Hispanics and non-Hispanics. RESULTS There were 352 Hispanic White and 289 non-Hispanic White patients. These included 231 men and 410 women, with a mean age of 69.5 ± 8.2 years. There were no significant differences between Hispanics and non-Hispanics in front or back keratometry or amount of front astigmatism. However, Hispanics had a greater amount of back astigmatism (0.36 ± 0.19 vs 0.32 ± 0.17 diopter, P = 0.04). Moreover, there was a statistically significant difference in front steep axis of the left eyes between Hispanics and non-Hispanics (97.8 ± 47.9 vs 108.2 ± 48.9 deg, P = 0.01), and a marginally significant difference in front steep axis of the right eyes (81.0 ± 48.2 vs 73.5 ± 49.9 deg, P = 0.06). Hispanics also had a lower vertex pachymetry (548.1 ± 34.5 vs 553.4 ± 37.4 μm, P = 0.04) and a smaller anterior chamber volume (134.7 ± 39.0 vs 146.1 ± 39.9 mm3, P < 0.001). CONCLUSIONS There are some differences in cornea and anterior segment parameters between Hispanics and non-Hispanics 50 years or older who underwent surgery for senile cataract. However, such differences may not be clinically significant.
Collapse
Affiliation(s)
- So Yeon Uhm
- Department of Ophthalmology, UT Health San Antonio, San Antonio, TX, USA
| | - Trong Phat Do
- Department of Ophthalmology, UT Health San Antonio, San Antonio, TX, USA
| | | | - Brandon Lam
- Department of Ophthalmology, UT Health San Antonio, San Antonio, TX, USA
| | - Ahmad Kheirkhah
- Department of Ophthalmology, UT Health San Antonio, San Antonio, TX, USA.
- Medical Arts and Research Center, 8300 Floyd Curl Dr., San Antonio, TX, USA.
| |
Collapse
|
97
|
Feng J, Zhang Y. The potential benefits of polyphenols for corneal diseases. Biomed Pharmacother 2023; 169:115862. [PMID: 37979379 DOI: 10.1016/j.biopha.2023.115862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/30/2023] [Accepted: 11/05/2023] [Indexed: 11/20/2023] Open
Abstract
The cornea functions as the primary barrier of the ocular surface, regulating temperature and humidity while providing protection against oxidative stress, harmful stimuli and pathogenic microorganisms. Corneal diseases can affect the biomechanical and optical properties of the eye, resulting in visual impairment or even blindness. Due to their diverse origins and potent biological activities, plant secondary metabolites known as polyphenols offer potential advantages for treating corneal diseases owing to their anti-inflammatory, antioxidant, and antibacterial properties. Various polyphenols and their derivatives have demonstrated diverse mechanisms of action in vitro and in vivo, exhibiting efficacy against a range of corneal diseases including repair of tissue damage, treatment of keratitis, inhibition of neovascularization, alleviation of dry eye syndrome, among others. Therefore, this article presents a concise overview of corneal and related diseases, along with an update on the research progress of natural polyphenols in safeguarding corneal health. A more comprehensive understanding of natural polyphenols provides a novel perspective for secure treatment of corneal diseases.
Collapse
Affiliation(s)
- Jing Feng
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
| | - Yangyang Zhang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China.
| |
Collapse
|
98
|
Cadavid Usuga JC, Maya Naranjo MI, Mesa Mesa S, Rivera AI, Hincapié MP, Granados MF, Betancur C, Donado Gomez JH. Characterization of cornea donors at a tissue center in the city of Medellin, Colombia. Cell Tissue Bank 2023:10.1007/s10561-023-10124-x. [PMID: 38141131 DOI: 10.1007/s10561-023-10124-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023]
Abstract
The cornea transplant is considered the most frequently performed type of transplant in the world, with a demand that has been increasing in recent years. An observational descriptive study was conducted, focusing on the ocular tissue extracted from cadaveric donors from January 2019 to December 2021 at the Red Cross Eye Bank in Medellin, Colombia. This is the first epidemiological characterization of corneal donor tissues within the eye banks of our city, where high rates of violence-related deaths explain that tissue donors are mostly young individuals. This, in turn, results in excellent counts of endothelial cells and tissue viability in their microscopic studies. Additionally, there are lower rates of discarded tissues compared to similar studies.
Collapse
Affiliation(s)
- Juan Camilo Cadavid Usuga
- Department of Ophthalmology, Pontifical Bolivarian University, Medellín, Colombia.
- Ophthalmology Research Group, Pontifical Bolivarian University, Medellín, Colombia.
- , Girardota, Colombia, 051030.
| | - María Isabel Maya Naranjo
- Department of Ophthalmology, Pontifical Bolivarian University, Medellín, Colombia
- Ophthalmology Research Group, Pontifical Bolivarian University, Medellín, Colombia
| | - Sara Mesa Mesa
- Department of Ophthalmology, Pontifical Bolivarian University, Medellín, Colombia
- Ophthalmology Research Group, Pontifical Bolivarian University, Medellín, Colombia
| | - Ana Isabel Rivera
- Eye Bank Department, Colombian Red Cross, Antioquia Section, Medellín, Colombia
| | - María Paula Hincapié
- Ophthalmology Research Group, Pontifical Bolivarian University, Medellín, Colombia
| | | | - Catalina Betancur
- Ophthalmology Research Group, Pontifical Bolivarian University, Medellín, Colombia
| | - Jorge Hernando Donado Gomez
- Research Department, Pablo Tobón Uribe Hospital, Medellín, Colombia
- Pontifical Bolivarian University, Medellín, Colombia
| |
Collapse
|
99
|
Okumura Y, Inomata T, Fujimoto K, Fujio K, Zhu J, Yanagawa A, Shokirova H, Saita Y, Kobayashi Y, Nagao M, Nishio H, Sung J, Midorikawa-Inomata A, Eguchi A, Nagino K, Akasaki Y, Hirosawa K, Huang T, Kuwahara M, Murakami A. Biological effects of stored platelet-rich plasma eye-drops in corneal wound healing. Br J Ophthalmol 2023; 108:37-44. [PMID: 36162968 DOI: 10.1136/bjo-2022-322068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/08/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS This study aimed to assess the efficacy and sterility of stored platelet-rich plasma (PRP) eye-drops for corneal epithelial wound healing compared with those of autologous serum (AS) eye-drops. METHODS At our single institution, PRP and AS eye-drops were prepared using peripheral blood obtained from six healthy volunteers and stored at 4°C. Platelet and leucocyte counts and transforming growth factor (TGF)-β1, epidermal growth factor (EGF), and fibronectin levels were assessed during storage for up to 4 weeks. Sterility was assessed by culturing 4-week poststorage samples. PRP, AS, and phosphate-buffered saline (PBS) eye-drop efficacies were compared using corneal epithelial wound healing assays in vitro and in vivo and monitoring wound areas under a microscope every 3 hours. RESULTS Higher platelet and lower leucocyte counts were seen in PRP than in whole blood on the day of preparation. After storage, TGF-β1, EGF, and fibronectin levels were significantly higher in PRP than in AS eye-drops. In vitro and in vivo, PRP eye-drops used on the day of preparation significantly promoted corneal epithelial wound healing compared with PBS. Moreover, PRP eye-drops stored for 4 weeks significantly promoted corneal wound healing compared with PBS and AS eye-drops. CONCLUSION PRP eye-drops stored at 4°C for 4 weeks promoted corneal epithelial wound healing with higher levels of growth factors than those observed in AS eye-drops, while maintaining sterility, suggesting that this preparation satisfies the unmet medical needs in the treatment of refractory keratoconjunctival epithelial disorders.
Collapse
Affiliation(s)
- Yuichi Okumura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Takenori Inomata
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- AI Incubation Farm, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Keiichi Fujimoto
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kenta Fujio
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Jun Zhu
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Ai Yanagawa
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hurramhon Shokirova
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yoshitomo Saita
- Department of Sports and Regenerative Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopedics, Juntendo University Faculty of Medicine, Bunkyo-ku, Japan
| | - Yohei Kobayashi
- Department of Sports and Regenerative Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopedics, Juntendo University Faculty of Medicine, Bunkyo-ku, Japan
| | - Masahi Nagao
- Department of Sports and Regenerative Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopedics, Juntendo University Faculty of Medicine, Bunkyo-ku, Japan
- Department of Medical Technology Innovation Center, Juntendo University, Bunkyo-ku, Japan
| | - Hirofumi Nishio
- Department of Sports and Regenerative Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopedics, Juntendo University Faculty of Medicine, Bunkyo-ku, Japan
| | - Jaemyoung Sung
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- University of South Florida College of Medicine, Tampa, Florida, USA
| | - Akie Midorikawa-Inomata
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Atsuko Eguchi
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Ken Nagino
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yasutsugu Akasaki
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kunihiko Hirosawa
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Tianxiang Huang
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Mizu Kuwahara
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
100
|
Borderie VM, Georgeon C, Sandali O, Bouheraoua N. Long-term outcomes of deep anterior lamellar versus penetrating keratoplasty for keratoconus. Br J Ophthalmol 2023; 108:10-16. [PMID: 37890880 PMCID: PMC10803977 DOI: 10.1136/bjo-2023-324230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/03/2023] [Indexed: 10/29/2023]
Abstract
AIMS To compare the long-term outcomes of deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in keratoconus. METHODS Retrospective comparative case series (228 DALKs and 274 PKs). A biphasic linear model was used to describe the postoperative outcome of the endothelial cell density (ECD). Visual acuity, specular microscopy, corneal topography and optical coherence tomography findings were recorded. RESULTS Graft survival of the 502 keratoconus eyes was 96.7 at 10 years and 95.6% at 20 years. Visual acuity improved from 20/378±5.1 lines preoperatively to 20/32±2.1 lines at 30 months. The corneal ECD decreased from 2494±382 cells/mm2 to 1521±659 cells/mm2 at 10 years. The mean simulated keratometry increased from 44.88±2.54 D at 1 year to 46.60±3.0 D at 3 years. The mean follow-up was 103.4 months for DALKs and 106.1 months for PKs. The cumulated incidence of postoperative ocular hypertension requiring treatment was significantly higher in PKs than in DALKs. The early- and late-phase rates of ECD loss were significantly lower in DALKs than in PKs. These figures in DALKs were 50% of those observed in PKs. The simulated mean keratometry was significantly higher in DALKs than in PKs in the mid but not in the long term. No significant differences in visual acuity were observed between both groups. Manual dissection-DALK featured slower visual recovery than PK and big bubble-DALK, whereas big bubble-DALK and PK featured similar visual recovery. CONCLUSIONS DALK featuring higher endothelial survival and lower risk of postoperative ocular hypertension may be superior to PK when indicated for keratoconus.
Collapse
Affiliation(s)
- Vincent Michel Borderie
- Ophthalmology, Hôpital National des 15-20, Paris, Île-de-France, France
- GRC 32, Sorbonne Université, Paris, France
| | - Cristina Georgeon
- Ophthalmology, Hôpital National des 15-20, Paris, Île-de-France, France
- GRC 32, Sorbonne Université, Paris, France
| | - Otman Sandali
- Ophthalmology, Hôpital National des 15-20, Paris, Île-de-France, France
- GRC 32, Sorbonne Université, Paris, France
| | - N Bouheraoua
- Ophthalmology, Hôpital National des 15-20, Paris, Île-de-France, France
- GRC 32, Sorbonne Université, Paris, France
| |
Collapse
|