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@#AIM:To investigate the clinical efficacy and safety of trans-epithelial accelerated corneal collagen cross-linking in the treatment of progressive keratoconus.METHODS: A prospective before-after self-control study. A total of 47 eyes of 37 patients with progressive keratoconus who underwent trans-epithelial accelerated corneal collagen cross-linking in our hospital from August 2016 to November 2019 were collected. Uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), refractive status, corneal transparency, maximum keratometry value of the anterior corneal surface, thinnest corneal thickness, corneal endothelial cell counts and intraocular pressure(IOP)were analysed preoperatively and at 1, 3, 6 and 12mo postoperative.RESULTS: UCVA of patients 1, 3, 6 and 12mo after surgery was higher than that before surgery, but there was no difference(<i>F</i>=1.372, <i>P</i>=0.261). BCVA at 1, 3, 6 and 12mo after surgery was higher than that before surgery, the difference was statistically significant(<i>F</i>=3.308, <i>P</i>=0.019). There were no differences in the spherical and cylindrical power, Kmax and thickness of the thinnest point of cornea at 1, 3, 6 and 12mo postoperatively compared with those before surgery(<i>F</i>=0.293, 1.378, 2.448, 1.970; <i>P</i>=0.881, 0.258, 0.061, 0.116). There was no difference in corneal endothelial cell counts between 1mo after surgery and before surgery(<i>t</i>=1.156, <i>P</i>=0.25). There was no difference in IOP at all postoperative time points compared with that before surgery(<i>F</i>=1.221, <i>P</i>=0.321). The corneal Haze(grade 1-2)appeared in 7 eyes after surgery, and subsided in 5 eyes from 3-6mo after surgery, and the corneal transparency recovered. The corneal nebula remained in 1 eye, and the corneal central stroma linear opacity existed in 1 eye, but the visual acuity of both eyes was not affected.CONCLUSION: Trans-epithelial accelerated corneal collagen cross-linking can significantly improve BCVA, stabilize refractive status, corneal morphology and thickness, prevent or delay the progression of keratoconus, and enable patients to obtain better visual function. At the same time, the operation time is short, postoperative complications are less, and the operation has good safety.
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@#AIM:To evaluate the mitomycin-C(MMC)0.02% efficacy in preventing haze after trans-epithelial photorefractive keratectomy(Trans-PRK)in the treatment of the high myopia. <p>METHODS: Retrospective case series. Trans-PRK were performed on 142 eyes with a preoperative spherical equivalent. They were divided into with 0.02% MMC(MMC group)and without MMC(control)groups. In MMC group there were 94 eyes with MMC 0.02%; in control group there were 48 eyes. Patients were treated with an intraoperative application of MMC 0.02% for 30-45s depending on refractive error in MMC group. After surgery, fluorometholone 0.1% eye drops were used for 4mo in all groups. The mean follow-up time was 6mo. The regression trees were used to analyse the relationship between different related factors and haze. <p>RESULTS:Haze was quantified with Fantes. Incidence of haze was 8.5% eyes in MMC group and 33.3% in without MMC group(<i>P</i>=0.001). In the regression trees, optical zone and ablation depth MAX were related to haze(<i>P</i><0.01). It was possibility induce haze when optical zone is ≤5.6mm. When optical zone is >5.6mm, ablation depth MAX becomes the main factor for haze.<p>CONCLUSION: The design of optical zone and ablation depth MAX in Trans-PRK should be considered for the treatment of the high myopia with thin cornea and abnormal corneal morphology. MMC 0.02% was effective in preventing haze after Trans-PRK in the treatment of the high myopia.
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Self-microemulsifying drug delivery systems (SMEDDSs) have recently returned to the limelight of academia and industry due to their enormous potential in oral delivery of biomacromolecules. However, information on gastrointestinal lipolysis and trans-epithelial transport of SMEDDS is rare. Aggregation-caused quenching (ACQ) fluorescent probes are utilized to visualize the
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·AIM:To observe the effects of small incision lenticule extraction (SMILE) and trans-epithelial photorefractive keratectomy (Trans-PRK) on corneal horizontal coma, vertical coma, and spherical aberration and total higher order aberrations after refractive correction for myopia. ·METHODS: This was a prospective non-randomized cohort study. The cohort included 40 patients (80 eyes) with myopia, who received refraction correction surgery from December 2016 to February 2017 in Leshan Ophthalmic Center. Twenty patients (40 eyes) received SMILE surgery and the other 20 patients (40 eyes) received Trans-PRK surgery. Corneal aberrations were determined by a high-resolution Pentacam Scheimpflug camera before the surgery and at 1 and 3mo after the operation. Statistical analyses were performed using analysis of variance of repeated measures. · RESULTS: At 1 and 3mo post - operation, the uncorrected visual acuity in both groups was better than or equal to the preoperative best corrected visual acuity. The preoperative corneal aberrations showed no significant difference between the two groups (P>0.05). Significantly higher aberration was found after the surgery in both groups (P < 0. 05), however, no significant difference in higher aberration was found between 1 and 3mo post - operation (P > 0. 05). Post - operation, horizontal and vertical coma had no significant difference between the two groups (P>0.05), while SMILE group showed lower spherical aberration and lower total higher order aberration than Trans-PRK group (P<0.05). ·CONCLUSION: Both SMILE and Trans-PRK increase corneal aberration and their effects on horizontal and vertical coma are similar. However, SMILE has a minor influence on spherical aberration and total high order aberration than Trans-PRK.
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AIM: To report the long- term clinical outcomes of accelerated trans-epithelial corneal cross-linking ( CXL ) protocols using KXL System ( Avedro, USA ) in the treatment of progressive keratoconus. · METHODS: Totally 52 patients ( 102 eyes ) with progressive keratoconus between December 2014 and February 2017 [ maximum keratometry values ( Kmax) ≤60.0D, minimum corneal thickness(Thk) ≥400m] were treated with an accelerate trans-epithelial CXL protocol (UV-A irradiation intensity 45mW/cm2 with a total fluence of 7. 2J/cm2 ) using KXL system ( Avedro, USA ) in Southwest Hospital. The average follow-up time was 11. 65mo (range: 9-26mo). Uncorrected distance visual acuity ( UDVA) , corrected distance visual acuity ( CDVA) , intra- ocular pressure ( IOP ) , slit-lamp microscope examination, Kmax and average keratometry values ( AveK ) , corneal stromal demarcation line depth and endothelial cell density ( ECD) were evaluated. ·RESULTS:The 52 patients (102 eyes) were included in this research, male 36 (70 eyes) and female 16 (32 eyes), average age was 19. 5±4. 6 years. Preoperative CDVA was 0. 84±0. 89 (LogMAR), postoperative CDVA was 0. 69±0. 72 ( P = 0. 398 ). Preoperative UDVA was 1. 02 ± 0. 62 (LogMAR), postoperative UDVA was 0. 85 ± 0. 59 ( P =0. 154 ). Preoperative IOP was 12. 95 ± 4. 40mmHg, postoperative IOP was 11.92±3. 66mmHg (P=0. 272). No statistical difference (P=0. 552) has been found between preoperative and postoperative ECD. Nevertheless, on the Sirius anterior system ( Sirius, CSO, Itlay) , significant statistical difference (P=0. 017) was confirmed between preoperative Kmax ( 50. 83 ± 3. 48D ) and postoperative Kmax (52. 05±3. 63D). Meanwhile, the postoperative Avek (47.74±2. 51D) was significantly lower (P=0. 041) than the preoperative Avek ( 48. 73 ± 4. 33D ). The average corneal stromal demarcation line depth ( 192 ± 23. 6μm ) was detected by the anterior segment OCT. No statistical difference ( P = 0. 816 ) has been found between preoperative and postoperative Thk. No severe complication was observed in all cases. ·CONCLUSION: Accelerated trans-epithelial CXL was effective in decreasing keratometry values for progressive keratoconus in this research, and the outcomes remained stable during the follow-up time. No endothelium damage or other severe complications were observed in this clinical research. The accelerated trans-epithelial CXL is as effective as the standard CXL.
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Aim: To define the putative anti-inflammatory and cytotoxic effects of ibidì®, a new phytotherapeutic formulation composed of three extracts: Punica granatum L, pericarpum; Boswellia serrata Roxb., resina; Curcuma longa L,. rhizome, using Caco-2 cells, an in vitro model of human intestinal epithelium. Methodology: cytotoxicity and capacity of ibidì® to induce cell proliferation were assessed respectively by 2,3-Bis-(2-Methoxy-4-Nitro-5-Sulfophenyl)-2H-Tetrazolium-5- Carboxanilide (XTT) assay and nucleotide 5-bromo-2’-deoxyuridine (BrdU) incorporation. Cell migration was evaluated by scratch wound assay. COX-2, IL-6, IL-8 and MCP-1 protein levels were measured in the supernatant of cells stimulated with or without TNFalfa or IL-1 beta in presence or in absence of ibidì® using ELISA assays. Finally, the influence of ibidì® on the integrity, paracellular permeability, and viability of Caco-2 cell monolayers was monitored by measuring the transepithelial electrical resistance (TEER) in presence or in absence of TNF- stimulation. Results: No dose-response toxicity was observed after 48 h incubation with ibidì®. Interestingly the cell proliferation rate was generally lower in presence of ibidì® than vehicle at all concentrations tested, while ibidì® had no effects on cell migration. Ibidì® markedly inhibited TNF-alfa-induced production of IL-8 at all concentrations tested in a dose-response manner, while that of IL-6 and MCP-1 only at highest ibidì® concentrations. Importantly ibidì® in a range of concentration between 145 and 9 μg/ml not only abrogated TNF-alfa-dependent TEER depression, but also promoted higher resistance values than untreated cells. Conclusion: These data demonstrate that ibidì® exerts anti-inflammatory and protective effects on intestinal epithelial cells by blocking the production of IL-8, IL-6 and MCP-1, and unveil that the synergism of the three extracts regulates epithelial barrier function.