Insulina tópica en el tratamiento del defecto epitelial persistente posúlcera corneal grave

El tratamiento del defecto epitelial refractario es un reto y está sujeto al desarrollo de estudios preclínicos y clínicos con el objetivo de obtener tratamientos eficaces, entre los que emerge la insulina tópica. El objetivo del presente artículo fue describir la respuesta cicatrizal del epitelio corneal bajo tratamiento con colirio de insulina. Se presentan dos pacientes con diagnóstico de defecto epitelial persistente posúlcera corneal. Se indicó insulina tópica una gota cada 6 horas, con evolución hacia la epitelización corneal total a los 10 días de iniciado el tratamiento. Se sugiere el mecanismo por el cual la insulina promueve la cicatrización corneal al lograr la restauración de los nervios corneales y favorecer la migración de células epiteliales. En ambos casos el colirio de insulina logró la promover la cicatrización epitelial total de la córnea por lo que se es útil en el tratamiento de defecto epitelial persistente.

The treatment of refractory epithelial defect is a challenge and depends upon the development of preclinical or clinical studies aimed at obtaining effective treatments, among which topical insulin emerges. The objective of this article was to describe the healing response of the corneal epithelium under treatment with insulin eye drops. The cases are presented of two patients with a diagnosis of persistent post-corneal ulcer epithelial defect. Topical insulin was prescribed at one drop every six hours, with evolution towards total corneal epithelialization ten days after the treatment started. The mechanism is suggested by which insulin promotes corneal healing, thus restoring corneal nerves and favoring epithelial cell migration. In both cases, the insulin eye drops were able to promote total epithelial healing of the cornea, making it useful in the treatment of persistent epithelial defect.

Insulina colirio en afecciones de la superficie ocular

Cuando se produce una erosión corneal y fracasa la epitelización corneal surgen los defectos epiteliales corneales persistentes, cuyo tratamiento es un desafío para el oftalmólogo. Es muy frecuente el fracaso del tratamiento convencional por lo que se mantiene el interés en la búsqueda de otros factores de crecimiento para la cicatrización epitelial tales como los colirios de insulina. La insulina es un péptido estrechamente relacionado con el factor de crecimiento similar a la insulina 1. Su mecanismo de acción no es bien comprendido, sin embargo se acepta que es capaz de inducir migración y proliferación de las células epiteliales corneales, por lo que promueve y acelera la reepitelización de defectos epiteliales persistentes refractarios a tratamiento. La ausencia de una presentación comercial de colirio de insulina, hace necesario conocer su estabilidad físicoquímica y microbiológica así como la eficacia, efectividad y seguridad del colirio de insulina a diferentes concentraciones. De ahí la motivación para realizar una revisión de la literatura existente sobre el empleo del colirio de insulina en el tratamiento del defecto epitelial corneal persistente. Se realizó la búsqueda en bases de datos electrónicas como PubMed Central, EBSCO, Clinical Trials.gov, MEDLINE OVID, EMBASE OVID con el objeto de identificar artículos relacionados con el tema.

When corneal erosion occurs and corneal epithelialization fails, persistent corneal epithelial defects arise, whose treatment is a challenge for the ophthalmologist. The failure of conventional treatment is very frequent; therefore, there is still interest in the search for other growth factors for epithelial healing, such as insulin eye drops. Insulin is a peptide closely related to insulin-like growth factor 1. Its mechanism of action is not well understood; however, it is accepted that it is capable of inducing migration and proliferation of corneal epithelial cells, thereby promoting and accelerating reepithelialization of persistent epithelial defects refractory to treatment. The absence of a commercial presentation for insulin eye drops makes it necessary to know its physicochemical and microbiological stability, as well as the efficacy, effectiveness and safety of insulin eye drops at different concentrations; hence the motivation to review the existing literature on the use of insulin eye drops in the treatment of persistent corneal epithelial defects. The search was carried out in electronic databases such as PubMed Central, EBSCO, Clinical Trials.gov, MEDLINE OVID, EMBASE OVID, with the aim of identifying relevant articles related to the topic.

Autologous serum eye drops in dry eye disease: Preferred practice pattern guidelines

Autologous serum eye drops provide lubrication and promote epithelial healing. They have been successfully used in the management of ocular surface disorders such as dry eye disease, persistent epithelial defects and neurotrophic keratopathy for many decades. A great deal of variation in the methods of preparation of autologous serum eye drops, the end concentration and the duration of use exists in published literature. In this review, simplified recommendations for preparation, transport, storage and use of autologous serum are described. Evidence for the use of this modality in aqueous deficient dry eye disease is summarized, along with expertise-based rationale.

New progress in pathogenesis and diagnosis in the treatment of persistent corneal epithelial defect / 国际眼科杂志(Guoji Yanke Zazhi)

@#Persistent corneal epithelial defect(PED)can occur after corneal herpes simplex virus infection, corneal transplantation, and intraocular surgery in diabetic patients. Although the incidence is not high, it can cause serious consequences if not properly managed, such as corneal infection or exacerbation, stromal ulcers, perforation, scarring, and even loss of vision. The pathogenic causes of PED are diverse and can be mediated by multiple mechanisms. In clinical practice, even with aggressive treatment, the corneal epithelium in PED eyes is difficult to heal and presents a challenge for treatment. At present, the standard treatment for PED management mainly includes the use of bandage soft contact lenses and artificial tears, aiming at the barrier protection for the corneal epithelium. The new treatment mainly focuses on epithelial regeneration and corneal nerve re-innervation. In addition, several drugs and methods with potential therapeutic value have emerged in recent years. In this review, we talk about how are the PEDs spread, what causes them, how are they diagnosed and how are they treated. We also talk about some new therapies and research process.

Progress in research on persistent corneal epithelial defects / 国际眼科杂志(Guoji Yanke Zazhi)

@#Persistent corneal epithelial defect(PED/PCEDs)is an eye disease that fails to form corneal epithelium rapidly even after 10-14d of corneal injury. Corneal protective epithelial destruction and stromal layer damage can easily lead to eye infection, stromal ulcer, perforation, scar formation, and even blindness. At present, clinicians still face considerable challenges in treating PED patients. Standard treatments such as wearing bandaged contact lenses and using artificial tears, while newly developed drugs can promote the formation of various growth factors to re-form the cornea, and further cooperate with the corresponding surgery to provide innervation for the cornea. In order to achieve the effect of treatment. In addition, treatment should be carried out as soon as possible after the diagnosis of PED to avoid secondary complications. This article reviews the epidemiology, etiology, diagnosis, clinical manifestation, treatment and prognosis of persistent corneal epithelial defect.

Ocular chemical burns from accidental exposure to topical dermatological medicinal agent

We report a case of accidental ocular chemical injury by self-medication with a single application of a topical ayurvedic medication containing salicylic acid, phenol, and tincture iodine, which is being used in developing countries for treatment of various dermatological conditions.

Clinical observation of silicone hydrogel soft contact lens in the treatment of persistent corneal epithelial defect / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the effect of silicone hydrogel soft contact lens in the treatment of persistent corneal epithelial defect. <p>METHODS: The clinical data of 56 patients(56 eyes)with persistent corneal epithelial defect treated in our hospital from January 2014 to January 2017 were retrospectively analyzed; 21 patients in the control group received hydrogel contact lenses, and 35 patients in the observation group received silicone hydrogel soft contact lens. Then the clinical effect, the classification of corneal opacity, the improvement of visual acuity, the subjective comfort and complications of the patients were recorded. <p>RESULTS: Wilcoxon rank sum test showed that there were significant differences in the clinical efficacy between the two groups(<i>P</i>=0.042). The total effective rate of the observation group was significantly lower than that of the control group(94% <i>vs</i> 76%). There was no significant difference in Haze classification between the groups after 3d of treatment(<i>P</i>>0.05); after 1wk and 1mo of treatment, there were significant differences in Haze classification between groups(<i>P</i><0.05); after 1mo of treatment, the proportion of Haze grading 0 in the observation group was significantly higher than that in the control group(49% <i>vs</i> 19%), there was significant difference between the two groups(<i>χ</i>²=4.481, <i>P</i>=0.027). There was a significant difference in visual acuity between the two groups(<i>Z</i>=-3.347, <i>P</i><0.05); the visual acuity of 91.43% in the observation group were improved, which was significantly lower than that of the control group(52.38%, <i>P</i>=0.002). There was no significant difference in the comfort scores between the two groups before treatment(<i>P</i>>0.05). After the first day of treatment, the comfort scores of both groups increased. The comfort scores of the observation group after treatment 1d, 3d and 1wk were significantly lower than those of the control group(<i>t</i>=-17.422, -15.827, -16.588; <i>P</i><0.01). The average healing time of corneal epithelium in the observation group was 4.25±1.05d, and the control group was 5.96±2.16d(<i>t</i>=-3.395, <i>P</i><0.05). The incidence of adverse reactions in the observation group was lower than that in the control group(<i>P</i><0.05). <p>CONCLUSION: Silicon hydrogel soft corneal contact lens can be used in the treatment of persistent corneal epithelial defect.

Uso de plasma rico em plaquetas em úlceras de córnea em cães / Use of platelet rich plasma on corneal ulcers in dogs

Este trabalho teve por objetivo avaliar, clínica e macroscopicamente, o tratamento adjuvante com plasma rico em plaquetas na forma de colírio ou tampão, em úlceras de córnea de cães atendidos no Serviço de Oftalmologia Veterinária. Foram analisados 20 olhos com diagnóstico de ceratite ulcerativa, distribuídos em dois grupos experimentais. O grupo colírio (GC) foi constituído por olhos tratados topicamente com colírio autólogo de plasma rico em plaquetas (PRP), e o grupo tampão (GT) por olhos submetidos ao tratamento à base de tampão sólido de PRP, associado ao recobrimento com terceira pálpebra para retenção deste. Os grupos foram avaliados, por meio de avaliação clínica, macroscópica e análise da redução do defeito epitelial, em diferentes momentos, aos três, cinco, dez, 15 e 30 dias, com exceção do terceiro dia no GT. O recobrimento da terceira pálpebra foi removido no quinto dia no GT. Em ambos os grupos, houve redução dos sinais de inflamação, melhora na sensibilidade ocular e adequada reparação do defeito epitelial. Todos os olhos do GT apresentaram completa cicatrização no quinto dia e 70% no GC, atingindo a totalidade no 10º dia. O PRP na forma de colírio ou tampão é uma excelente terapia adjuvante a ser instituída no tratamento clínico da úlcera de córnea em cães, pois atua na diminuição dos sinais inflamatórios, da dor ocular e auxilia potencialmente na cicatrização do defeito epitelial...

This study aims to clinically and macroscopically evaluate the adjuvant therapy with platelet-rich plasma in the form of eyedrops or clot, for corneal ulcers in dogs treated at the Veterinary Ophthalmology Service. We analyzed 20 eyes diagnosed with ulcerative keratitis, divided into two experimental groups. The eyedrop group (GC) was composed of eyes treated topically with eyedrops of autologous platelet-rich plasma (PRP), and the clot group (GT) was composed of eyes treated with a platelet-rich clot and covered with a third eyelid for retention of the clot. The groups were evaluated by clinical and macroscopic analysis and by the analysis of epithelial defect reduction, at different times, at three, five, ten, 15 and 30 days, except for the third day in GT. The coverage of the third eyelid was removed on the fifth day. In both groups the inflammation signs reduced, there was an improvement in ocular sensibility and proper repair of epithelial defect. All GT eyes and 70% GC eyes showed complete healing on the fifth day, the remainder of GC completed healing on the tenth day. PRP in the form of eyedrops and clot is an excellent adjuvant therapy to be instituted in the clinical treatment for corneal ulcer in dogs, because it decreases the inflammatory signs and the ocular pain and it potentially assists in healing epithelial defects...

Clinical research of protein-free calf blood extract eye gel for corneal epithelial defect / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To evaluate the clinical effect of 200g/L protein-free calf blood extract eye gel for corneal epithelial defect.METHODS: One hundred and sixty - eight cases of corneal epithelial defect ( 58 cases with herpes simplex keratitis; 24 cases with chemical injury; 85 cases with pterygium operation injury ) were randomly divided into two groups: 84 eyes were treated with protein-free calf blood extract eye gel; 84 cases were treated with basic fibroblast growth factor eye gel ( bFGF ) . The bFGF and protein-free calf blood extract eye gels were used 4 times a day. The treatment course was 7d. Epithelial defect restoration, local symptom and sign were observed. RESULTS: The difference between pre-treatment and post-treatment was significant ( P CONCLUSlON: Protein-free calf blood extract eye gels is valuable and safe for corneal epithelial defect.

Spontaneous Bilateral Corneal Perforation in Stevens- Johnsons Syndrome–A Challenge in Management

A 42-year-old man from Ghana presented with bilateral painful corneal perforations following ingestion of a sulphur-based antibiotic. Emergency bilateral penetrating keratoplasty was performed, with restoration of globe integrity. However, surgical complications arose such as non-healing epithelial defect, secondary infection, graft dehiscence, and mounting intraocular pressure. This case illustrates the challenges faced in managing corneal grafts in patients with already compromised ocular surfaces.

A Case of Meibomian Gland Dysfunction after Cosmetic Eyelid Tattooing Procedure

PURPOSE: To report a case of meibomian gland dysfunction as a chronic complication of eyelid tattooing and the corneal epithelial defect as an acute complication of eyelid tattooing well healed with proper treatment. CASE SUMMARY: A 31-year-old woman presented with severe eye pain, irritation and epiphora in both eyes. The patient underwent an eyelid tattooing procedure 2 hours before and dark pigments were placed on the inner eyelid margin. Slit lamp examination showed conjunctival injection and inferior corneal epithelial defect in both eyes. After 2 months, dry eye symptom still remained although the cornea was completely epithelialized. After 1 year, the patient improved completely, but still showed decreased tear film breakup time (TBUT). CONCLUSIONS: Due to the increased number of people who undergo cosmetic eyelid tattooing procedures, the number of reports associated with complications has increased and acute complications such as corneal epithelial defect can occur. Moreover, chronic discomfort associated with dry eye syndrome can occur when pigmentation is placed on the eyelid inner margin and lead to the destruction of meibomian glands. Thus, eyelid tattooing should be performed after careful consideration of possible complications.

Therapeutic Effect of Umbilical Cord Serum Eyedrops for Persistent Corneal Epithelial Defect

PURPOSE: To evaluate the therapeutic effect of umbilical cord serum in the treatment of persistent epithelial defect of the cornea. METHODS: Fourteen eyes of 14 patients with persistent epithelial defect that had persisted for at least 2 weeks despite conventional treatment were treated with 20% umbilical cord serum eyedrops six times a day. The images of the epithelial defects were captured using a camera attached to a slit lamp biomicroscope and the areas of the epithelial defects were calculated. Treatment was considered effective for epithelial defect healing within 2 weeks, partially effective for healing within 2 to 4 weeks, and ineffective for healing requiring either more than 1 month or additional measures. RESULTS: Mean duration of epithelial defect before treatment was 7.2+/-6.3 weeks, and mean area was 7.86+/-7.32 mm2. Umbilical cord serum therapy was effective in 6 eyes (42.9%), partially effective in 6 (42.9%), and ineffective in 2 (14.2%). Nevertheless, the epithelial defects in both the ineffective eyes were eventually healed within 8 weeks. Mean healing time in effective or partially effective cases was 2.75+/-1.06 weeks. CONCLUSIONS: The use of umbilical cord serum eyedrops for the treatment of persistent epithelial defect is effective.

Phototherapeutic Keratectomy for the Treatment of Persistent Epithelial Defect

Persistent epithelial defect (PED) is an important ocular surface disorder. These defects can be frustrating chronic diseases as in the cases of inflammation, chemical burn, denervated cornea, tear deficiency and radiation keratitis. Therapeutic modalities that have been utilized in the treatment of PED included topical steroid, patching, bandage soft contact lenses, superficial keratectomy and anterior stromal puncture. We reported here the use of 193 nm excimer laser phototherapeutic keratectomy (PTK) for the treatment of indolent and persistent epithelial defect as the new Therapeutic device for PED. Twelve eyes diagnosed as PED were treated with Summit excimer laser phototherapeutic keratectomy. All cases were failed to cover the epithelium with therapeutic contact lenses. The laser treatments(diameter 1mm, depth 5micrometer) were delivered to sites surrounding the epithelial defect area for promoting of the epithelial ingrowth. All cases received PTK were covered with new epithelium in two or three days as shown by photorefractive keratectomy and remained completely healed through at least three months follow-up period. We found PTK with the 193 nm excimer laser to be a safe, effective treatment modeling for PED that is unresponsive to conventional therapy.

Topical fibronectin treatment in persistent corneal epithelial defects and corneal ulcers

Topical fibronectin, autologous and homologous, was used to treat nine patients (eleven eyes) with persistent corneal epithelial defects and corneal ulcers that failed to improve with standard therapy. The fibronectin was purified from autologous and homologous plasma by gelatin-Sepharose 4B affinity chromatography and administered topically, 500 micrograms/ml five times a day, for three weeks. Complete or nearly complete reepithelialization was achieved in all patients regardless of the source of fibronectin, autologous or homologous. But healing times varied. The average healing time was 41.7 +/- 14.7 days (35.7 +/- 12.4 days for autologous, 50.8 +/-14.4 days for homologous). Ocular symptoms were relieved significantly, and no side effects were observed. Over an average follow-up period of 5.2 months, no recurrences were noted. The results showed that homologous, as well as autologous, fibronectin was effective in patients with persistent corneal epithelial defects and corneal ulcers.

Topical Autologous Fibronectin in the Treatment of Persistent Corneal Epithelial defects

Fibronectin, a glycoprotein, is present in plasma and extracellular matrix and is responsible for cellular adhesion. Fibronectin was purified from autologous plasma of two persistent corneal epithelial defect patients by affinity chromatogaphy and administered topically 500 micro ml, 2 dropsper time, five times a day for 3 weeks. Reepithelization began three to seven days after initiation of treatment with autologous purified fibronectin eyedrops, and epithelial defects healed nearly completely and subjective symptoms were relieved. No side effects were observed. Over a follow-up period of 4 to 23 wks, no recurrences were noted.