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Wang Q, Zhao X, Yu F, Fang PH, Liu L, Du X, Li W, He D, Bai Y, Li S, Yuan J. Photocurable and Temperature-Sensitive Bioadhesive Hydrogels for Sutureless Sealing of Full-Thickness Corneal Wounds. Small Methods 2024; 8:e2300996. [PMID: 37997553 DOI: 10.1002/smtd.202300996] [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] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/19/2023] [Indexed: 11/25/2023]
Abstract
Penetrating corneal wounds can cause severe vision impairment and require prompt intervention to restore globe integrity and minimize the risk of infection. Tissue adhesives have emerged as a promising alternative to suturing for mitigating postoperative complications. However, conventional water-soluble adhesives suffer formidable challenges in sealing penetrating corneal wounds due to dilution or loss in a moist environment. Inspired by the robust adhesion of mussels in aquatic conditions, an injectable photocurable bioadhesive hydrogel (referred to as F20HD5) composed of polyether F127 diacrylate and dopamine-modified hyaluronic acid methacrylate is developed for sutureless closure of corneal full-thickness wounds. F20HD5 exhibits high transparency, wound-sealing ability, proper viscosity, biodegradability, and excellent biocompatibility. It allows in situ cross-linking via visible light, thereby providing sufficient mechanical strength and adhesiveness. In vivo, the adhesive hydrogel effectively closed penetrating linear corneal incisions and corneal injuries with minimal tissue loss in rabbits. During the 56-day follow-up, the hydrogel facilitates the repair of the injured corneas, resulting in more symmetrical curvatures and less scarring in distinction to the untreated control. Thus, bioinspired hydrogel holds promise as an effective adhesive for sealing full-thickness corneal wounds.
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Affiliation(s)
- Qian Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510623, China
| | - Xuan Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510623, China
| | - Fei Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510623, China
| | - Po-Han Fang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510623, China
| | - Liu Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510623, China
| | - Xinyue Du
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510623, China
| | - Weihua Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510623, China
| | - Dalian He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510623, China
| | - Ying Bai
- Guangdong Engineering Technology Research Centre for Functional Biomaterials, School of Materials Science and Engineering, SunYat-sen University, Guangzhou, 510006, China
| | - Saiqun Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510623, China
| | - Jin Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510623, China
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Sims DT, Mattson NR, Huang LC, Lee MD, Bly RA, Gallagher ER, Baran FM, Cabrera MT. Hallermann-Streiff Syndrome in Concordant Monozygotic Twins With Congenital Cataracts, Exudative Retinal Detachments, and One Case of Corneal Perforation Requiring Keratoplasty. Cornea 2023; 42:899-902. [PMID: 37088900 PMCID: PMC10247501 DOI: 10.1097/ico.0000000000003286] [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: 05/13/2022] [Accepted: 03/06/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE We describe the management of Hallermann-Streiff syndrome in monozygotic female twins with congenital cataracts, exudative retinal detachments, and 1 case of corneal descemetocele with associated dellen and subsequent perforation. METHODS This study was a case report and review of the literature. RESULTS Twins 1 and 2 exhibited all 7 cardinal characteristics of Hallermann-Streiff syndrome, presenting with spontaneous lenticular resorption, anterior uveitis, and glaucoma. They underwent bilateral cataract extraction with near total capsulectomy. Both twins experienced recurrent glaucoma, for which twin 1 underwent successful endocyclophotocoagulation in both eyes and twin 2 in the left eye alone. The fellow eye developed 2 sites of perilimbal corneal descemetoceles with associated dellen at the inferotemporal limbal corneal junction leading to spontaneous perforation of 1 site, requiring a full-thickness corneal graft. Both twins developed recurrent bilateral exudative retinal detachments unresponsive to oral prednisolone. Twin 1's last best-corrected visual acuity with aphakic spectacles was 20/260 in the right eye and 20/130 in the left eye at age 4 years and 8 months. Twin 2's last best-corrected visual acuity was 20/130 in each eye at age 4 years and 11 months, over a year after right eye penetrating keratoplasty. CONCLUSIONS We describe 2 rare cases of Hallermann-Streiff syndrome in monozygotic twins complicated by corneal perforation requiring penetrating keratoplasty in 1 eye of 1 twin. Although corneal opacities have been described in this condition, this is the first case of corneal descemetocele in Hallermann-Streiff syndrome. The cornea was stabilized with a relatively favorable visual outcome over 1 year later.
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Affiliation(s)
- Deion T. Sims
- University of Washington School of Medicine, Seattle, WA, USA
| | - Nicole R. Mattson
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Laura C. Huang
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- Division of Ophthalmology, Seattle Children’s Hospital, Seattle, WA, USA
| | | | - Randall A. Bly
- Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle, WA, USA
- Department of Otolaryngology, University of Washington, Seattle, WA, USA
| | - Emily R. Gallagher
- Division of Craniofacial Medicine, Seattle Children’s Hospital, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Francine M. Baran
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- Division of Ophthalmology, Seattle Children’s Hospital, Seattle, WA, USA
| | - Michelle T. Cabrera
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
- Division of Ophthalmology, Seattle Children’s Hospital, Seattle, WA, USA
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Romanowski EG, Stella NA, Brazile BL, Lathrop KL, Franks JM, Sigal IA, Kim T, Elsayed M, Kadouri DE, Shanks RMQ. Predatory bacteria can reduce Pseudomonas aeruginosa induced corneal perforation and proliferation in a rabbit keratitis model. Ocul Surf 2023; 28:254-261. [PMID: 37146902 DOI: 10.1016/j.jtos.2023.05.002] [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: 03/01/2023] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE Pseudomonas aeruginosa keratitis is a severe ocular infection that can lead to perforation of the cornea. In this study we evaluated the role of bacterial quorum sensing in generating corneal perforation and bacterial proliferation and tested whether co-injection of the predatory bacteria Bdellovibrio bacteriovorus could alter the clinical outcome. P. aeruginosa with lasR mutations were observed among keratitis isolates from a study collecting samples from India, so an isogenic lasR mutant strain of P. aeruginosa was included. METHODS Rabbit corneas were intracorneally infected with P. aeruginosa strain PA14 or an isogenic ΔlasR mutant and co-injected with PBS or B. bacteriovorus. After 24 h, eyes were evaluated for clinical signs of infection. Samples were analyzed by scanning electron microscopy, optical coherence tomography, sectioned for histology, and corneas were homogenized for CFU enumeration and for inflammatory cytokines. RESULTS We observed that 54% of corneas infected by wild-type PA14 presented with a corneal perforation (n = 24), whereas only 4% of PA14 infected corneas that were co-infected with B. bacteriovorus perforate (n = 25). Wild-type P. aeruginosa proliferation was reduced 7-fold in the predatory bacteria treated eyes. The ΔlasR mutant was less able to proliferate compared to the wild-type, but was largely unaffected by B. bacteriovorus. CONCLUSION These studies indicate a role for bacterial quorum sensing in the ability of P. aeruginosa to proliferate and cause perforation of the rabbit cornea. Additionally, this study suggests that predatory bacteria can reduce the virulence of P. aeruginosa in an ocular prophylaxis model.
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Affiliation(s)
- Eric G Romanowski
- The Charles T. Campbell Laboratory, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nicholas A Stella
- The Charles T. Campbell Laboratory, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Bryn L Brazile
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kira L Lathrop
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jonathan M Franks
- Center for Biological Imaging, University of Pittsburgh School of Engineering, Pittsburgh, PA, USA
| | - Ian A Sigal
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Bioengineering, Swanson School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tami Kim
- Department of Oral Biology, Rutgers School of Dental Medicine, Newark, NJ, USA
| | - Mennat Elsayed
- Department of Oral Biology, Rutgers School of Dental Medicine, Newark, NJ, USA
| | - Daniel E Kadouri
- Department of Oral Biology, Rutgers School of Dental Medicine, Newark, NJ, USA
| | - Robert M Q Shanks
- The Charles T. Campbell Laboratory, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Donovan C, Sun M, Cogswell D, Margo CE, Avila MY, Espana EM. Genipin increases extracellular matrix synthesis preventing corneal perforation. Ocul Surf 2023; 28:115-123. [PMID: 36871831 PMCID: PMC10440284 DOI: 10.1016/j.jtos.2023.02.003] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 03/06/2023]
Abstract
PURPOSE Corneal melting and perforation are feared sight-threatening complications of infections, autoimmune disease, and severe burns. Assess the use of genipin in treating stromal melt. METHODS A model for corneal wound healing was created through epithelial debridement and mechanical burring to injure the corneal stromal matrix in adult mice. Murine corneas were then treated with varying concentrations of genipin, a natural occurring crosslinking agent, to investigate the effects that matrix crosslinking using genipin has in wound healing and scar formation. Genipin was used in patients with active corneal melting. RESULTS Corneas treated with higher concentrations of genipin were found to develop denser stromal scarring in a mouse model. In human corneas, genipin promoted stromal synthesis and prevention of continuous melt. Genipin mechanisms of action create a favorable environment for upregulation of matrix synthesis and corneal scarring. CONCLUSION Our data suggest that genipin increases matrix synthesis and inhibits the activation of latent transforming growth factor-β. These findings are translated to patients with severe corneal melting.
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Affiliation(s)
| | - Mei Sun
- Department of Ophthalmology, USA
| | | | - Curtis E Margo
- Department of Ophthalmology, USA; Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Marcel Y Avila
- Department of Ophthalmology, Universidad Nacional de Colombia, Bogota, Colombia
| | - Edgar M Espana
- Department of Ophthalmology, USA; Molecular Pharmacology and Physiology, USA.
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Mulder DC, Rijneveld WJ, van Eechoud R, Bartels MC. [Infectious keratitis and corneal transplantation in a 15-year-old patient wearing contact lenses]. Ned Tijdschr Geneeskd 2022; 166:D6921. [PMID: 36300441] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Soft contact lens wearing increases the risk of an infectious keratitis. A patient present with a red painfull eye, in which case a corneal erosion (coloring with fluorescein) was seen by the general practitioner. It is possible that the clinical course worsens in a few days with a corneal perforation as a result. In these cases a timely referral is necessary. CASE A fifteen year old soft contact lens wearing girl developed an infectious keratitis. Within a few days she developed a corneal perforation. As a result of an emergency transplantation within 24 hours the patient preserved her globe and her visual acuity recovered. CONCLUSION Emergency transplantations usually have a complicated course with a high risk of re-transplantation and long-term pharmacological therapy. Such an emergency transplantation is primarily performed to preserve the globe. In the Netherlands a separate pool of emergency donor transplants is available, so that a transplantation can be performed within 24 hours.
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Affiliation(s)
- Debora C Mulder
- Nederlandse Transplantantatie Stichting, Leiden
- Contact: Debora C. Mulder
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Liu JJ, Wang LL, Huang YF, Yuan SQ, Li S. [A case of Stevens-Johnson syndrome with binocular corneal perforation and multiple corneal transplantation which was difficult to control]. Zhonghua Yan Ke Za Zhi 2022; 58:624-628. [PMID: 35959607 DOI: 10.3760/cma.j.cn112142-20210824-00384] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The 31-year-old female patient was admitted to the General Hospital of the Chinese People's Liberation Army for 3 days after the corneal transplantation of her right eye for 5 months.Four years ago, the patient developed red eyes, pain, dryness and photophobia after intravenous drip of cefuroxime sodium and metronidazole due to pelvic inflammation, accompanied by high fever, systemic rash and epidermal exfoliation, fingernail peeling, and mucosal ulceration in the eyes and mouth.Later, the patient received systemic hormone shock and point eye treatment in a local hospital, and the dry eyes gradually worsened. Despite continuous artificial tears and bandage mirror treatment, the corneal ulcer perforation in both eyes still occurred successively. After several penetrating keratografts and drug therapy, the ulcer and dissolution could not be prevented. He was admitted to our hospital due to corneal perforation in both eyes.Ophthalmic examination: visual acuity manual/15 cm in the right eye, intraocular pressure T-2, conjunctival sac stenosis, extensive corneal opacity and edema, ulcer about 8 mm, corneal perforation near the corneal limbus about 2 mm×5 mm below.The left eye had no light perception, a central corneal ulcer of about 8 mm, bulge of the posterior elastic layer, no anterior chamber, and atrophy of the eyeball.B-ultrasound showed choroidal detachment of the right eye.On the second day, the patient received right eye intraocular exploration, vitrectomy, ecotopic keratoscleral carrier Boston Ⅱ artificial keratoplasty, glaucoma valve implantation, autogenous ear cartilage implantation, conjunctival occlusion, and left eye lamellar keratoplasty, conjunctival occlusion.Postoperative visual acuity of right eye was -6.50 DS=0.12, intraocular pressure TN, ocular surface was stable.The left eye has no light perception and the ocular surface is stable.
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Affiliation(s)
- J J Liu
- The Ophthalmology Division of Chinese PLA General Hospital, Beijing 100853, China
| | - L L Wang
- The Ophthalmology Division of Chinese PLA General Hospital, Beijing 100853, China
| | - Y F Huang
- The Ophthalmology Division of Chinese PLA General Hospital, Beijing 100853, China
| | - S Q Yuan
- Zhongshan Ophthalmic Centre, Sun Yat-sen University, State Key Laboratory of Ophthalmology, Guangzhou 510060, China
| | - Saiqun Li
- Zhongshan Ophthalmic Centre, Sun Yat-sen University, State Key Laboratory of Ophthalmology, Guangzhou 510060, China
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Gehlsen U, Faust C, Blecha C, Dietrich-Ntoukas T, Eberwein P, Issleib S, Meyer-Ter-Vehn T, Braun R, Westekemper H, Steven P. Outcomes and complications of cataract surgery in patients with chronic ocular graft-versus-host-disease-a multicenter, retrospective analysis. Graefes Arch Clin Exp Ophthalmol 2022; 260:2613-2622. [PMID: 35254513 PMCID: PMC9325851 DOI: 10.1007/s00417-022-05613-w] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the outcome of phacoemulsification in patients with chronic ocular Graft-versus-host disease (oGVHD) after allogeneic hematopoietic stem cell transplantation (aHSCT). METHODS Retrospective, observational multicenter study from 1507 oGVHD patients. From the patient files, data were collected including best-corrected visual acuity (BCVA), intraocular pressure (IOP), Schirmer's test I, tear film break-up time (TFBUT), corneal fluorescein staining score, postoperative complications, and pre- and post-operative topical therapy. RESULTS Seventy-three patients underwent cataract surgery in 104 eyes. In n = 84 eyes, the oGVHD NIH grade was documented; 12% (n = 12) of analyzed eyes were staged oGVHD NIH grade 1, 31% (n = 32) NIH 2 and 39% (n = 41) NIH 3. The mean BCVA improved in 82% of the eyes (n = 86 eyes). BCVA significantly increased from 0.7 ± 0.5 to 0.4 ± 0.4 LogMAR after surgery independent from oGVHD severity. The mean IOP decreased from 14 ± 4 to 13 ± 4 mmHg after surgery. Visual acuity was moderately correlated to the pre-operative degree of corneal staining (Pearson p = 0.26, p = 0.002, Cohen's effect size f = 0.29). The visual acuity decreased by 0.078 LogMar units (95% CI = 0.027-0.141) with each increase of corneal staining by one grade (p = 0.05). After surgery, corneal epitheliopathy increased significantly in 42% (n = 44) of the eyes. Postoperative complications included corneal perforation (n = 6, 6%), cystoid macular edema (n = 4, 4%), and endophthalmitis (n = 1, 1%). CONCLUSION Phacoemulsification in patients with chronic oGVHD significantly improves visual acuity, but is associated with an increased risk of complications in particular corneal epitheliopathy and corneal perforations.
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Affiliation(s)
- Uta Gehlsen
- Division for Dry-Eye and Ocular GvHD, Department of Ophthalmology, Medical Faculty, University and University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
- Cluster of Excellence: Cellular Stress Responses in Ageing-Associated Diseases, CECAD, University of Cologne, Cologne, Germany
| | - Christiane Faust
- Division for Dry-Eye and Ocular GvHD, Department of Ophthalmology, Medical Faculty, University and University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Christiane Blecha
- Department of Ophthalmology, University Hospital Regensburg, Regensburg, Germany
| | - Tina Dietrich-Ntoukas
- Department of Ophthalmology, Charité - Universitaetsmedizin Berlin, Corporate Member of Freie Universitaet Berlin, Humboldt Universitaet Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Philipp Eberwein
- Eye Center, University Medical Center Freiburg, Freiburg, Germany
- AugenCentrum Rosenheim, Rosenheim, Germany
| | - Susanne Issleib
- Eye Center, University Medical Center Freiburg, Freiburg, Germany
| | | | - Regine Braun
- Department of Ophthalmology, University Hospital Regensburg, Regensburg, Germany
| | - Henrike Westekemper
- Department of Ophthalmology, University Hospital Essen, University Duisburg Essen, Essen, Germany
| | - Philipp Steven
- Division for Dry-Eye and Ocular GvHD, Department of Ophthalmology, Medical Faculty, University and University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
- Cluster of Excellence: Cellular Stress Responses in Ageing-Associated Diseases, CECAD, University of Cologne, Cologne, Germany.
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Gupta Y, Lomi N, Patil VS, Yadav S. Intralenticular metallic foreign body 'locked-in' the posterior capsule and the utility of multimodal imaging. BMJ Case Rep 2021; 14:e244104. [PMID: 34588201 PMCID: PMC8483024 DOI: 10.1136/bcr-2021-244104] [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: 11/04/2022] Open
Abstract
Intraocular foreign bodies (FBs) are common ocular injuries reporting to the emergency services all over the world. The authors highlight the findings and surgical management of a case of intralenticular metallic FB following an injury while using chisel and hammer. The ocular path of the FB (2 mm) could be traced from a self-sealed corneal perforation, extending through the anterior capsule rupture, terminating at the posterior capsule, forming a posterior capsule tent with a part embedded in clear lens. Preoperative ultrasound biomicroscopy gave clues on posterior capsule integrity and the exact site of FB, and helped prognosticate and plan the surgical management of the case. The 'locked-in' FB was extracted after clear lens aspiration and posterior capsulorrhexis. The posterior capsule acted as a natural barrier between anterior and posterior segment, where the FB was found embedded.
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Affiliation(s)
- Yogita Gupta
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Neiwete Lomi
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay S Patil
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Saumya Yadav
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Mignot G, Bhattacharya Y, Reddy A. Ocular Leishmaniasis - A systematic review. Indian J Ophthalmol 2021; 69:1052-1060. [PMID: 33913831 PMCID: PMC8186621 DOI: 10.4103/ijo.ijo_2232_20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 11/13/2022] Open
Abstract
The incidence of leishmaniasis is reported to be up to 1 million per year. To date, there has been no comprehensive review describing the diversity of clinical presentations of ocular leishmaniasis (OL) and its treatment. This systematic review aims to address this knowledge gap and provide a summary of the clinical presentation, natural course, and treatment options for OL. Our study identified a total of 57 published articles as describing cases of OL involving: adnexa (n = 26), orbit (n = 1), retina (n = 7), uvea (n = 18) and cornea (n = 6). Though well described and easily treated, palpebral leishmaniasis is often misdiagnosed and may lead to chronic issues if untreated. The retinal manifestations of Leishmaniasis consist of self-resolving hemorrhages secondary to thrombocytopenia. Two main uveitis etiologies have been identified: uveitis in the context of active Leishmanial infection (associated with immunosuppression) and uveitis occurring as an immune reconstitution syndrome. Corneal involvement in most geographic areas generally follows an aggressive course, most often ending in corneal perforation if left untreated. In the Americas, a chronic indolent interstitial keratitis may also occur. Topical steroids are of little use in keratitis (systemic antileishmanials being the cornerstone of treatment). However, these are essential in cases of uveitis, with or without concomitant systemic antileishmanial therapy. In conclusion, though ocular involvement in Leishmaniasis is rare, severe sight-threatening consequences follow if left untreated. Early diagnosis, enthusiastic follow-up and aggressive treatment are essential for good outcomes.
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Lanfant L, Trone MC, Garcin T, Gauthier AS, Thuret G, Gain P. [ Corneal perforation with tyrosine kinase inhibitor chemotherapy: REGORAFENIB]. J Fr Ophtalmol 2021; 44:544-548. [PMID: 33612324 DOI: 10.1016/j.jfo.2020.06.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/26/2020] [Accepted: 06/08/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Tyrosine kinase inhibitors (TKIs) are active in a variety of metastatic cancers. They have a good general tolerance with mainly hepatic and dermatological side effects. Rarely, ophthalmologic side effects may occur: eyelash abnormalities, eyelids abnormalities, disorders of the ocular surface with ocular dryness or even corneal erosions that can even lead to perforation. Regorafenib is a new oral multi-targeted tyrosine kinase inhibitor that inhibits multiple protein kinases, including those involved in tumor angiogenesis, oncogenesis and tumor microenvironment. CASE DESCRIPTION We describe, to the best of our knowledge, the first case of complicated bilateral ulcers of corneal perforation in a patient under REGORAFENIB. OBSERVATION 20-year-old patient with metastatic chondrosarcomas of the pelvis, mandible and thorax received chemotherapy with REGORAFENIB. A few weeks after initiation of treatment, he experienced an increased dry eye syndrome associated with bilateral corneal ulcers complicated by perforation. Despite discontinuation of chemotherapy and maximal medical and surgical treatment (iterative amniotic membrane grafts and corneal transplantation), the progression was unfavorable. DISCUSSION This is the first known case of corneal perforation under REGORAFENIB. The pathophysiology is multifactorial. On the one hand, this chemotherapy targets angiogenesis (VEGFR), oncogenesis (KIT, RET, RAF1, BRAF) and the tumor microenvironment (PDGFR, FGFR). On the other hand, other triggers are added, namely mixed dry eye syndrome, hypovitaminosis A (anorexia), the neurotrophic component, as well as the toxicity of chemotherapy via tears. CONCLUSION First described case of corneal perforation under REGORAFENIB, non-regressive at the end of chemotherapy, and despite medical and surgical treatments. Ophthalmologic surveillance is therefore necessary for patients under chemotherapy with tyrosine kinase inhibitors, as serious ocular complications, especially corneal ones, may occur.
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Affiliation(s)
- L Lanfant
- Avenue Albert Raimond, 42055 Saint-Étienne cedex 1, France.
| | - M C Trone
- Avenue Albert Raimond, 42055 Saint-Étienne cedex 1, France
| | - T Garcin
- Avenue Albert Raimond, 42055 Saint-Étienne cedex 1, France
| | | | - G Thuret
- Avenue Albert Raimond, 42055 Saint-Étienne cedex 1, France
| | - P Gain
- Avenue Albert Raimond, 42055 Saint-Étienne cedex 1, France
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Trufanov SV, Krakhmaleva DA, Zaitsev AV, Salovarova EP, Tekeeva LY, Budnikova EA. [Mushroom keratoplasty in rosacea keratitis complicated by corneal perforation (a clinical case)]. Vestn Oftalmol 2019; 135:215-219. [PMID: 31691663 DOI: 10.17116/oftalma2019135052215] [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: 06/10/2023]
Abstract
Rosacea is a polyethiologic chronic inflammatory disease with varying clinical manifestations. It is primarily a dermatologic disease, which often manifests in the eyes affecting eyelids, cornea and conjunctiva. The leading role in the pathological process belongs to disruption of regulatory mechanisms in the vascular, immune and nervous systems. It is accompanied by increased levels of metalloproteinases and vascular endothelial growth factor (VEGF). Treatment depends on the severity of the disease and may vary from hygiene of the eyelid margins and use of artificial tears for dry eye disease management, to antibiotics and anti-inflammatory agents in moderate cases, and surgical treatment in severe or neglected state. A clinical case of severe rosacea shows that keratoplasty with mushroom-shaped profile of the surgical incision helps achieve good functional results and reduce the post-operative rehabilitation time, while significantly reducing the risk of postsurgical complications. Anti-VEGF therapy significantly reduces the risk of histoincompatibility reaction typical for rosacea keratitis.
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Affiliation(s)
- S V Trufanov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - D A Krakhmaleva
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - A V Zaitsev
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - E P Salovarova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - L Yu Tekeeva
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - E A Budnikova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
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M R K. Iatrogenic corneal perforation in Terrien Marginal Degeneration. Med J Malaysia 2013; 68:173-174. [PMID: 23629570] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This case report is about a rare disease with unusual presentation. Failure to recognise atypical presentation may lead to error in managing the patient and cause disastrous complications. Here we highlight a case of Terrien Marginal Degeneration in both eyes with atypical presentation; namely pseudopterygium. A 22 year old man was referred to our centre for iatrogenic right eye corneal perforation after having an atypical pterygium removed at another hospital. On arrival, his vision was 1/60 in both eyes with bilateral cornea Terrien Marginal Degeneration. His right eye anterior chamber was deep with a conjunctival flap covering the perforation site which was located from the 2.30 - 3.30 clock position nasally with no aqueous leak. However after a day his right eye anterior chamber became flat and there was fast aqueous leak from the perforation site. An emergency C shaped peripheral corneal lamellar keratoplasty was performed to seal the perforation. Post operatively his right eye improved to 6/24.
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Affiliation(s)
- Kursiah M R
- Hospital Sultanah Bahiyah, Ophthalmology Department, Alor Star, 05460 Kedah, Malaysia.
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FARNARIER G, HERVOUUET F. [KERATOMALACIA PERFORANS, SPONTANEOUS RELAPSING AND SYMMETRICAL CORNEAL PERFORATION]. Ann Ocul (Paris) 1964; 197:1033-44. [PMID: 14226004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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AMALRIC P, BESSOU P, VERGNES H. [SYRINGOMYELIA AND BILATERAL CORNEAL PERFORATION CAUSED BY NEUROTROPHIC KERATITIS]. Rev Otoneuroophtalmol 1964; 36:62-4. [PMID: 14185281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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HAVENER WH, STAMBAUGH NF, BEIL H. Corneal Perforation in Metaherpetic Keratitis with Virus Inclusions Treated with Alpha Chymotrypsin. Am J Ophthalmol 1962; 54:756-60. [PMID: 13961072 DOI: 10.1016/0002-9394(62)94156-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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HALLERMANN W. [Keratoplasty in corneal perforation and fistula]. Ber Zusammenkunft Dtsch Ophthalmol Ges 1961; 63:226-30. [PMID: 13903941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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GRAYSON M. Lamellar keratoplasty for traumatic necrotizing corneal perforation. Am J Ophthalmol 1959; 48:252-4. [PMID: 13670296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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FERRIE J. [Trichloracetic acid in the treatment of corneal perforations and pannus trachomatosus]. Rev Int Trach 1950; 27:183-8. [PMID: 14809019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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