RESUMO

PURPOSE: To evaluate the prevalence and clinical characteristics of neurotrophic keratopathy (NK) in northeastern Mexico. METHODS: Retrospective cross-sectional study in which NK patients admitted to our ophthalmology clinic between 2015 and 2021 were consecutively enrolled. Data regarding demographics, clinical characteristics, and comorbidities were collected at the time diagnosis of NK was made. RESULTS: In the period from 2015 to 2021, a total of 74,056 patients were treated and of these 42 had a diagnosis of neurotrophic keratitis. The prevalence found was 5.67 [CI95 3.95-7.38] in 10,000 cases. The mean age observed was 59 ± 17.21 years occurring more frequently in males in 59% and with corneal epithelial defects in 66.7%. The most frequent antecedents were the use of topical medications in 90%, the presence of diabetes mellitus 2 in 40.5% and systemic arterial hypertension in 26.2%. A higher proportion of male patients with corneal alterations and a higher proportion of female patients with corneal ulcerations and/or perforation were observed. CONCLUSION: Neurotrophic keratitis is an underdiagnosed disease with a broad clinical spectrum. The antecedents that were contracted corroborate what was reported in the literature as risk factors. The prevalence of the disease in this geographical area was not reported, so it is expected to increase over time when searching for it intentionally.

Assuntos

RESUMO

Corneal opacities are a leading cause of visual impairment that affect 4.2 million people annually. The current treatment is corneal transplantation, which is limited by tissue donor shortages. Corneal engineering aims to develop membranes that function as scaffolds in corneal cell transplantation. Here, we describe a method for producing transplantable corneal constructs based on a collagen vitrigel (CVM) membrane and corneal endothelial cells (CECs). The CVMs were produced using increasing volumes of collagen type I: 1X (2.8 µL/mm2), 2X, and 3X. The vitrification process was performed at 40% relative humidity (RH) and 40 °C using a matryoshka-like system consisting of a shaking-oven harboring a desiccator with a saturated K2CO3 solution. The CVMs were characterized via SEM microscopy, cell adherence, FTIR, and manipulation in an ex vivo model. A pilot transplantation of the CECs/CVM construct in rabbits was also carried out. The thickness of the CVMs was 3.65-7.2 µm. The transparency was superior to a human cornea (92.6% = 1X; 94% = 2X; 89.21% = 3X). SEM microscopy showed a homogenous surface and laminar organization. The cell concentration seeded over the CVM increased threefold with no significant difference between 1X, 2X, and 3X (p = 0.323). The 2X-CVM was suitable for surgical manipulation in the ex vivo model. Constructs using the CECs/2X-CVM promoted corneal transparency restoration.

RESUMO

An exhaustive search of the world's literature was performed to analyze all case reports and series on the modified osteo-odonto-keratoprosthesis (MOOKP) published up to January 2022. The demographic profile, the primary indication for surgery, surgical technique variations, postoperative medical management, long-term functional and anatomical outcomes, and intra- and postoperative complications were analyzed and compared. Additionally, some of the authors' (GI, VP, and GA) unpublished MOOKP cases were studied. An extensive literature search yielded 37 case series and case reports. Overall, 958 patients were analyzed. The most common indication for surgery was autoimmune disease (39.1%), closely followed by chemical injury (38.8%). The most common intraoperative complications (21.67%) included maxillofacial, vitreous hemorrhage/vitritis, and mucosal. The most common postoperative complications (78.4%) were lamina and oral mucosa-associated, secondary glaucoma, and choroid/retinal detachment. Follow-up periods ranged from one to 364 months (median: 36.7 months). Altogether, 78% of patients achieved a visual acuity of 20/400 or better at the end of the follow-up period, and 91.2% improved at least temporarily after MOOKP surgery. Mean anatomic success at the end-of-follow-up for all patients was 88.25% (range, 50-100%). The long-term anatomic and functional success of the MOOKP makes it a reliable option for visual rehabilitation in patients with bilateral corneal blindness and end-stage ocular surface disease. This review aims to describe the evolution of the MOOKP procedure, analyzing all published case series for its long-term reliability, visual and anatomical outcomes, complications, and future directions.

Assuntos

RESUMO

BACKGROUND: Sedum dendroideum has antioxidant effects that are beneficial for different diseases. We aimed to analyze the antiproliferative activity of S. dendroideum in human pterygium fibroblasts (HPFs). METHODS: HPFs were treated for 24 h with 0-1000 µg/mL of S. dendroideum lyophilized to analyze its effect on cell viability using the CellTiter assay. RNA from HPF treated with 250 µg/mL of S. dendroideum lyophilized was isolated, and the expression of VEGF and CTGF genes was evaluated by qPCR. A dermal fibroblast cell line (HDFa) was used as a healthy control. The total phenolic content, antioxidant activity, and chemical profile of S. dendroideum lyophilized were determined. RESULTS: Viability of HPF decreased after 24 h treatment of S. dendroideum in a dose-dependent manner. The expression of VEGF and CTGF significantly decreased (P < 0.01) in HPF treated with 250 µg/mL of S. dendroideum when compared with untreated HPF. The total phenolic concentration in the S. dendroideum lyophilized was 33.67 mg gallic acid equivalents (GAE)/g. Antioxidant activity was 384.49 mM Trolox equivalents/mL. The main phenolic compounds identified by HPLC analysis were the kaempferol-3-O-glycoside, kaempferol-3-O-rhamnoside, kaempferol-3-O-neohesperidoside-7-O-α-rhamnopyranoside, and kaempferol-3-O-glycoside-7-O-rhamnoside. CONCLUSIONS: S. dendroideum decreases the proliferation of HPF and the expression of VEGF and CTGF. The phenolic compound concentration, antioxidant activity, and phytochemical profile may play a role in these effects.

Assuntos

RESUMO

Background: The role of scleral contact lenses (SCLs) has increasingly expanded since the first lens was fitted more than a century ago. While it was initially prescribed for the management of severely compromised corneas, the indications for modern SCL use have expanded to include less severe diseases. In this review, we aimed to provide an up-to-date overview of the current indications, complications, and outcomes for the various types of SCLs. Methods: In this narrative review, we thoroughly searched the PubMed/MEDLINE database for literature published from January 1980 to November 2021. Only relevant up-to-date English references were included. Furthermore, the figures in this manuscript were derived from our unit's patient documentation. Results: Currently, SCLs can successfully be used to manage ocular surface diseases, visually rehabilitate irregular corneas, and correct irregular refractive errors. Although newer materials have yielded the same visual outcomes with fewer complications, these consequences still occur in approximately one-third of contact lens wearers, including difficulties in insertion and/or removal, discomfort or pain, and developing either halos, blurriness, or haze. Even though most of these complications are minor and can be easily treated, a good practice is essential to avoid sight-threatening complications such as microbial keratitis. Conclusions: SCLs are indispensable in ophthalmic clinics. The development of better-quality SCLs has increased the number of indications and improved the achievable visual rehabilitation. The future of developing improvements in SCL design, materials, and fit, and the expansion of their indication range is promising.

RESUMO

Neurotrophic keratopathy (NK) is a degenerative corneal disease produced by different factors, including infection, trauma, and neurogenesis, that lead to trigeminal nerve damage and impaired corneal sensitivity. Extensive epithelial breakdown, impaired corneal epithelial healing and corneal ulceration, stromal melting, and perforation are main NK features. The proliferation of the corneal epithelium is endogenously regulated by a balance between adrenergic cAMP-dependent and cholinergic cGMP-dependent pathways. A careful balance of epitheliotropic neuromediators and neurotrophic factors expressed by corneal nerves and epithelial cells, respectively, is required to maintain corneal homeostasis. Even in its early stages, NK can cause reduced vision secondary to epithelial disturbance. Diagnosing NK is challenging, requiring the acquisition of a thorough clinical history and a comprehensive neurological and ophthalmic examination. Following suspicion of a clinical NK diagnosis, corneal sensitivity must be assessed qualitatively with the wisp of the cotton-tipped applicator and quantitatively through Cochet-Bonnet esthesiometry (CBE). A myriad of therapies is used for NK, and new, more specific modalities are being developed and investigated. Medical treatment with topical recombinant human nerve growth factor and surgical treatment through corneal neurotization are promising therapies aiming to target NK pathophysiology. Coexistent ocular surface disorders must be managed concomitantly to improve its prognosis. This review describes the up-to-date knowledge of the molecular basis regarding the pathogenesis of NK, and the novel target-specific therapeutic approaches based on this molecular mechanism.

Assuntos

RESUMO

PURPOSE: To report the visual and topographic outcomes of two pulsed-light-accelerated CXL (A-CXL) protocols at a 12-month follow-up and their correlation with the corneal stromal demarcation line (DL) depth. PATIENTS AND METHODS: Retrospective comparative cohort of patients with documented progressive keratoconus were included. Two epi-off pulsed-light [1s on-1s off] A-CXL protocols were compared: irradiance 30*8 and 45*5:20 (fluence 7.2 J/cm2). UDVA, CDVA, spherical equivalent (SE), topographic astigmatism, Kmin, Kmax, Km, central corneal thickness (CCT), thinnest pachymetry (TCT) and endothelial cell density (ECD) were measured preoperatively and months 1, 3, 6 and 12 postoperative. Corneal DL was measured 1 month postoperatively using anterior segment optical coherence tomography. RESULTS: Fifty eyes (27 patients): 22 eyes in group A-CXL (30*8), 28 eyes in group A-CXL (45*5:20). Mean age (years) was 19.04±4.71 and 20.32±4.57. DL depth (µm) at month 1 was 200.63±10.01 µm and 184.53±19.68 µm for group A-CXL (30*8) and group A-CXL (45*5:20), respectively (p<0.001). Significant improvement in CDVA, topographic astigmatism, Kmin, Kmax and Km was observed in both groups (no significant difference between groups) and no significant changes were observed in CCT, TCT and ECD with regard to baseline. Over 85% of the eyes in both protocols achieved stabilization or improvement in maximum K at the end of the follow-up. No significant correlations between DL and any visual or topographic outcomes were observed at 12 months. CONCLUSION: No correlation between DL depth and visual or topographic outcomes was observed on either protocol. Although significant improvement on CDVA, topographic astigmatism, Kmin, Kmax and Km was observed in both groups at 12 months, further research is needed to assure safety and effectiveness at stabilizing keratoconus progression.

RESUMO

Iridocorneal endothelial (ICE) syndrome is a progressive clinical spectrum of corneal endothelial abnormalities affecting the cornea, iris, and iridocorneal angle. Three clinical variations are recognized: essential (progressive) iris atrophy, Chandler syndrome, and Cogan-Reese syndrome. Direct slit-lamp visualization of the cornea and anterior segment in cases of ICE syndrome is inadequate for precise and objective assessment of the affected structures. We describe the evolution of corneal and anterior segment structural changes in a woman with Cogan-Reese syndrome using three different methods of image analysis: specular microscopy, anterior segment optical coherence tomography, and ultrasound biomicroscopy.

Assuntos