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Krolo I, Behaegel J, Termote K, de Bruyn B, De Schepper M, Oellerich S, Ní Dhubhghaill S. The role of topical insulin in ocular surface restoration: A review. Surv Ophthalmol 2024:S0039-6257(24)00031-6. [PMID: 38609022 DOI: 10.1016/j.survophthal.2024.04.003] [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: 01/02/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024]
Abstract
Corneal epithelial defects are one of the most common ocular disorders. Restoring corneal integrity is crucial to reduce pain and regain function, but in cases of neurotrophic or desensitized corneas, healing can be significantly delayed. Treating neurotrophic corneas is challenging for ophthalmologists, and surgical intervention is often indicated to manage refractory cases that are unresponsive to medical therapy. Over the last decade, as more expensive therapeutics reach the market, topical insulin has returned to the forefront as an affordable option to improve corneal wound healing. There is still a paucity of data on the use and the efficacy of topical insulin, with no consensus regarding its indications, preparation, or posology. Here we review the literature on topical insulin for corneal and ocular surface pathologies, with a focus on the current evidence, its mechanisms of action, and its safety profile. Additionally, we share our experience in the field and provide a potential framework for future research.
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Affiliation(s)
- Iva Krolo
- Department of Ophthalmology, Universitair Ziekenhuis Brussel, Jette, Belgium; Department of Medicine and Pharmacology, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Oftalmología Médica y Quirúrgica (OMIQ) Research, Barcelona, Spain.
| | - Joséphine Behaegel
- Department of Ophthalmology, Universitair Ziekenhuis Brussel, Jette, Belgium; Department of Medicine and Pharmacology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Karolien Termote
- Department of Ophthalmology, Universitair Ziekenhuis Brussel, Jette, Belgium; Department of Medicine and Pharmacology, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Department of Ophthalmology, Imelda Hospital, Bonheiden, Belgium
| | - Barbara de Bruyn
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium; Department of Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Manon De Schepper
- Department of Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Silke Oellerich
- Department of Ophthalmology, Universitair Ziekenhuis Brussel, Jette, Belgium; Department of Medicine and Pharmacology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sorcha Ní Dhubhghaill
- Department of Ophthalmology, Universitair Ziekenhuis Brussel, Jette, Belgium; Department of Medicine and Pharmacology, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium; Department of Medicine, Antwerp University Hospital, Antwerp, Belgium
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Ballet B, Behaegel J, Reppe S, Consejo A, Aass HC, Utheim TP, Koppen C, Ní Dhubhghaill S. Ocular Surface Homeostasis After Scleral Lens Usage. Eye Contact Lens 2023; 49:459-463. [PMID: 37651199 DOI: 10.1097/icl.0000000000001027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVES The aim of this prospective study is to examine the effects of 5 hours of well-fitted, mini-scleral contact lens (mini-SL) wear on the tear film cytokine expression in healthy eyes. METHODS Twenty-three healthy participants were included in the study. One eye of each participant was selected at random, and a mini-SL measuring 16.5 mm in diameter was fitted by an experienced contact lens specialist. The contact lens remained in place for 5 hours. Precorneal tear fluid was collected using capillary tubes at three different time points: baseline before SL insertion (T0), after 5 hours of SL wear (T1), and 3 hours after SL removal (T2). The concentration of 40 inflammatory cytokines at the three different time points was determined using multiplex bead assay. RESULTS Mini-scleral lens wear did not result in significant changes in the cytokine-to-protein ratio after 5 hours of wear on a healthy eye. CONCLUSIONS Although a well-fitted mini-SL reduces the rate at which the precorneal tear film is refreshed, 5 hours of lens wear did not appear to significantly affect the tears cytokine-to-protein ratio, suggesting that scleral lenses have minimal impact on corneal cytokine expression.
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Affiliation(s)
- Brice Ballet
- Department of Ophthalmology (B.B., J.B., C.K., S.N.D.), Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health Sciences (B.B., C.K., S.N.D.), University of Antwerp, Wilrijk, Belgium; Department of Medical Biochemistry (S.R., H.C.A., T.P.U.), Oslo University Hospital, Oslo, Norway; Department of Plastic and Reconstructive Surgery (S.R., T.P.U.), Oslo University Hospital, Oslo, Norway; and Department of Applied Physics (A.C.), University of Zaragoza, Zaragoza, Spain
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McGlacken-Byrne A, Behaegel J, Gaffney B. Retrobulbar Haemorrhage Post Thrombolysis for Myocardial Infarction. Ir Med J 2022; 115:549. [PMID: 35420011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
| | - J Behaegel
- Sligo University Hospital, The Mall, Rathquarter, Sligo, Ireland
| | - B Gaffney
- Galway University Hospital, Newcastle Rd, Galway, Ireland
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Behaegel J, Tassignon MJ, Lagali N, Consejo A, Koppen C, Ní Dhubhghaill S. Outcomes of Human Leukocyte Antigen-Matched Allogeneic Cultivated Limbal Epithelial Transplantation in Aniridia-Associated Keratopathy-A Single-Center Retrospective Analysis. Cornea 2022; 41:69-77. [PMID: 33928920 PMCID: PMC8647694 DOI: 10.1097/ico.0000000000002729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/08/2021] [Accepted: 02/13/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess the efficacy and safety of human leukocyte antigen-matched allogeneic cultivated limbal epithelial stem cell grafts in the treatment of aniridia-associated keratopathy (AAK). METHODS Six eyes of 6 patients with severe AAK received an allogeneic stem cell graft between January 2010 and March 2017. Anatomical and functional results were assessed at 6 months, 1 year, 2 years, and the final follow-up visit available. Safety analysis was performed by considering all perioperative and postoperative adverse events and additional surgeries required during the follow-up period. RESULTS The mean follow-up was 53.6 months (range 24-104 months). In most patients (80%), there was an early improvement of the keratopathy postoperatively, which slowly regressed during longer follow-up. At the final follow-up, 4 of the eyes were graded as failure and 1 eye was graded as partial success. Grading the sixth eye was not possible because of an adverse event. None of the patients maintained a total anatomical success in the long-term. Only 1 patient maintained a modest improvement in best-corrected visual acuity from hand motion to counting fingers. Four serious adverse events were recorded in 2 patients. CONCLUSIONS Severe AAK remains a challenging condition to manage. Transplantation of allogenic ex vivo cultivated limbal stem cells may provide a temporary improvement in ocular surface stability, but anatomical and functional results are poor in the long-term. The eyes are prone to adverse events, and any surgical treatment should take this into consideration.
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Affiliation(s)
- Joséphine Behaegel
- Ophthalmology, Visual Optics and Visual Rehabilitation, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Marie-José Tassignon
- Ophthalmology, Visual Optics and Visual Rehabilitation, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Neil Lagali
- Division of Ophthalmology, Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linkoping University, Linköping, Sweden; and
| | - Alejandra Consejo
- Department of Applied Physics, University of Zaragoza, Zaragoza, Spain
| | - Carina Koppen
- Ophthalmology, Visual Optics and Visual Rehabilitation, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Sorcha Ní Dhubhghaill
- Ophthalmology, Visual Optics and Visual Rehabilitation, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
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Behaegel J, Ní Dhubhghaill S, Draper H. Ethical issues in living-related corneal tissue transplantation. J Med Ethics 2019; 45:430-434. [PMID: 31123188 PMCID: PMC6691871 DOI: 10.1136/medethics-2018-105146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 01/03/2019] [Accepted: 02/13/2019] [Indexed: 05/13/2023]
Abstract
The cornea was the first human solid tissue to be transplanted successfully, and is now a common procedure in ophthalmic surgery. The grafts come from deceased donors. Corneal therapies are now being developed that rely on tissue from living-related donors. This presents new ethical challenges for ophthalmic surgeons, who have hitherto been somewhat insulated from debates in transplantation and donation ethics. This paper provides the first overview of the ethical considerations generated by ocular tissue donation from living donors and suggests how these might be addressed in practice. These are discussed in the context of a novel treatment for corneal limbal stem cell deficiency. This involves limbal cell grafts which are transplanted, either directly or after ex vivo expansion, onto recipient stem cell-deficient eyes. Where only one eye is diseased, the unaffected eye can be used as a source of graft tissue. Bilateral disease requires an allogenic donation, preferably from a genetically related living donor. While numerous papers have dealt with the theory, surgical approaches and clinical outcomes of limbal stem cell therapies, none has addressed the ethical dimensions of this form of tissue donation.
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Affiliation(s)
- Joséphine Behaegel
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, Dept of Ophthalmology, Visual Optics and Visual Rehabilitation, University of Antwerp, Wilrijk, Belgium
| | - Sorcha Ní Dhubhghaill
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, Dept of Ophthalmology, Visual Optics and Visual Rehabilitation, University of Antwerp, Wilrijk, Belgium
| | - Heather Draper
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Consejo A, Behaegel J, Van Hoey M, Iskander DR, Rozema JJ. Scleral asymmetry as a potential predictor for scleral lens compression. Ophthalmic Physiol Opt 2018; 38:609-616. [DOI: 10.1111/opo.12587] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/16/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Alejandra Consejo
- Department of Ophthalmology; Antwerp University Hospital; Edegem Belgium
- Department of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Department of Biomedical Engineering; Wroclaw University of Science and Technology; Wroclaw Poland
| | - Joséphine Behaegel
- Department of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Department of Ophthalmology; Brussels University Hospital; Jette Belgium
| | - Maarten Van Hoey
- Department of Ophthalmology; Antwerp University Hospital; Edegem Belgium
| | - D Robert Iskander
- Department of Biomedical Engineering; Wroclaw University of Science and Technology; Wroclaw Poland
| | - Jos J Rozema
- Department of Ophthalmology; Antwerp University Hospital; Edegem Belgium
- Department of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
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Haagdorens M, Behaegel J, Rozema J, Van Gerwen V, Michiels S, Ní Dhubhghaill S, Tassignon MJ, Zakaria N. A method for quantifying limbal stem cell niches using OCT imaging. Br J Ophthalmol 2017; 101:1250-1255. [PMID: 28228408 PMCID: PMC5574400 DOI: 10.1136/bjophthalmol-2016-309549] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 08/24/2016] [Revised: 12/16/2016] [Accepted: 12/31/2016] [Indexed: 12/13/2022]
Abstract
Aims To evaluate the efficacy of Fourier domain-optical coherence tomography (FD-OCT) in imaging and quantifying the limbal palisades of Vogt and to correlate these images with histological findings. Methods The superior and inferior limbal region of both eyes of 50 healthy volunteers were imaged by FD-OCT. Images were processed and analysed using Matlab software. In vitro immunofluorescent staining of a cadaveric donor limbus was analysed to correlate the presence of stem cells in the visualised structures. Results FD-OCT could successfully visualise limbal crypts and the palisades of Vogt in the limbus region. Fluorescent labelling confirmed the presence of stem cells in these structures. The mean palisade ridge width (ΔPR) and the mean interpalisade epithelial rete peg width (ΔERP) were both of the order of 72 μm, leading to a palisade density (PD) of about 7.4 palisades/mm. A significant difference in ΔPR, ΔERP and PD was seen between the inferior and superior sides of the right eye and the superior sides of the left and right eye(p<0.05.). A significant influence of iris colour on parameters ΔPR, ΔERP and PD was found, and of age on PD and ΔERP (p<0.05). Conclusions In vivo OCT imaging is a safe and effective modality to image the limbus and can be used to visualise the palisades of Vogt. Image processing using Matlab software enabled quantification and density calculation of imaged limbal palisades of Vogt. This technique may enhance targeted limbal biopsies for transplantation.
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Affiliation(s)
- Michel Haagdorens
- Faculty of Medicine and Health Sciences, Department of Ophthalmology, Visual Optics and Visual Rehabilitation, Antwerp University, Antwerp, Wilrijk, Belgium.,Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Joséphine Behaegel
- Faculty of Medicine and Health Sciences, Department of Ophthalmology, Visual Optics and Visual Rehabilitation, Antwerp University, Antwerp, Wilrijk, Belgium.,Department of Ophthalmology, University Hospital Brussels, Brussels, Belgium
| | - Jos Rozema
- Faculty of Medicine and Health Sciences, Department of Ophthalmology, Visual Optics and Visual Rehabilitation, Antwerp University, Antwerp, Wilrijk, Belgium.,Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Veerle Van Gerwen
- Faculty of Medicine and Health Sciences, Department of Ophthalmology, Visual Optics and Visual Rehabilitation, Antwerp University, Antwerp, Wilrijk, Belgium
| | - Sofie Michiels
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Sorcha Ní Dhubhghaill
- Faculty of Medicine and Health Sciences, Department of Ophthalmology, Visual Optics and Visual Rehabilitation, Antwerp University, Antwerp, Wilrijk, Belgium.,Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Marie-José Tassignon
- Faculty of Medicine and Health Sciences, Department of Ophthalmology, Visual Optics and Visual Rehabilitation, Antwerp University, Antwerp, Wilrijk, Belgium.,Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Nadia Zakaria
- Faculty of Medicine and Health Sciences, Department of Ophthalmology, Visual Optics and Visual Rehabilitation, Antwerp University, Antwerp, Wilrijk, Belgium.,Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium.,Center for Cell Therapy and Regenerative Medicine, Antwerp University Hospital, Edegem, Belgium
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Behaegel J, Ni Dhubhgaill S, Koppen C, Tassignon M, Zakaria N. Long-term results of the phase I/II clinical trial: standardized, non-xenogenic, cultivated limbal stem cell transplantation. Acta Ophthalmol 2015. [DOI: 10.1111/j.1755-3768.2015.0550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - C. Koppen
- Ophthalmology; UZ Brussel; Brussels Belgium
| | | | - N. Zakaria
- Ophthalmology; UZ Brussel; Brussels Belgium
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Behaegel J, De Waele E, Mattens S, Noerens K, Honoré P, Laubach M, Leyder M, Spapen H. PP291-MON: Long-Term Home Total Parenteral Nutrition During Pregnancy. A Case Report and Review of the Literature. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50625-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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