Application of 3g/L sodium hyaluronate eye drops combined with corneal bandage contact lens in the early stage after pterygium excision surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the application value of 3g/L sodium hyaluronate eye drops combined with corneal bandage contact lens in the early stage of pterygium excision surgery.<p>METHODS: In this double blind randomized controlled study, 90 eyes of 90 patients with unilateral primary nasal pterygium who underwent surgical treatment from March 2017 to March 2018 were sorted into three groups, named as group A, group B and group C. Group A was treated with +3g/L sodium hyaluronate eye dropsand corneal bandage contact lens; group B was treated with +1g/L sodium hyaluronate eye drops and corneal bandage contact lens; and group C with +3g/L sodium hyaluronate and patching. Ocular surface irritation symptom scores, corneal epithelial healing time and conjunctival graft edema subsidence time of the three groups were compared after treatment.<p>RESULTS: Ocular surface irritation symptom scores in group A were lower than those in group C at all observation time points postoperatively(all <i>P</i><0.001); the corneal epithelial healing time(2.08±0.78d)and conjunctival graft edema subsidence time(4.62±1.17d)in group A were significantly shorter than those in group C with corneal epithelial healing time(5.13±2.34d)and conjunctival graft edema subsidence time(6.42±1.51d)(<i>P</i>=0.001, <i>P</i>=0.002). The corneal epithelial healing time was significantly shorterin group A when compared with group B(<i>P</i>=0.018), but there were no significant differences in ocular surface irritation symptom scores and conjunctival graft edema subsidence time between the two groups.<p>CONCLUSION: The combination of 3g/L sodium hyaluronate and corneal bandage contact lens has synergistic effect when applicated in the early stage after pterygium excision surgery, it can effectively shorten the corneal epithelial healing time as well as relieve irritation symptoms.

Effectiveness of autologous serum eye drops in corneal epithelial healing after photorefractive keratectomy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the effect of autologous serum in corneal epithelial healing after photorefractive keratectomy(PRK).<p>METHODS:Forty eyes from 20 myopic and myopic-astigmatic patients(9 male and 11 female)were included in this study. One eye of each patient was randomized to receive 20% autologous serum in artificial tears(study group)and one eye received conventional artificial tears(control group). An 8 mm alcohol well was placed centrally in all 40 eyes, and 20% alcohol was applied for 20s during PRK operation. Patients were followed up daily until epithelial closure, and at 1mo, 6mo, and 12mo. Time to epithelial healing was the main outcome measure. Uncorrected visual acuity(UCVA), manifest refraction, and haze were recorded.<p>RESULTS: The mean preoperative myopic spherical non-cycloplegic(dry)retinoscopy was not significantly different between two groups. The mean pain score in the study group was significantly lower than the control group on days 1, 2 and 3(<i>P</i><0.05). The mean horizontal and vertical epithelial defects in the study group was lower than in the control group in all follow up exams on days 1 and 3(<i>P</i><0.05). The mean total time to epithelial healing in the study group was about 0.7d less than in the control group(3.15±0.366d<i> vs</i> 3.85±0.587d, <i>P</i>=0.00).<p>CONCLUSION: This study demonstrated that using autologous serum eye drops, by accelerating corneal epithelial healing and reducing the pain, which improves recovery time in visual acuity and reduces discomfort, haziness and infection risk after PRK.

Study of bandage contact lens on cornea epithelial healing after Epi-LASIK / 局解手术学杂志

Objective To observe the effect of bandage contact lens on cornea epithelial healing after Epi-LASIK,and to evaluate the efficacy and safety.Methods Prospective case-control study.The 92 cases(181 eyes) performing Epi-LASIK were devided into observation group and control group.The 46 cases(91 eyes) of the control group were covered with routine nursing and the other 46 cases (90 eyes) of the observation group were served with bandage contact lens after Epi-LASIK.The symptoms and signs,time of corneal epithelial recovery,visual acuity and pain of postoperation of the two groups were examined within one week.Results After Epi-LASIK treatment,there was no significant difference in visual acuity between the two groups(P ＞ 0.05).At the 1 st,3rd,and 7th day after Epi-LASIK treatment,the ache grading results of the observation group were (2.53 ± 0.62),(1.39 ± 0.71),(0.07-± 0.25);and the ache grading results of control group were (3.22 ± 0.79),(1.74 ± 0.49),(0.26 ± 0.49).Pain scores of observation group were significantly lighter than that of the control group (P ＜ 0.05).After Epi-LASIK treatment,the average time of corneal wound healing in the observation group and control group were (2.80 ±0.86) days and (4.07 ±0.68) days respectively.The average time of postoperative corneal wound healing in the observation group was shorter than control group(P ＜ 0.05).Conclusion The application of bandage contact lens on cornea epithelial healing after Epi-LASIK treatment can reduce the pain of patients and promote the recovery of cornea in myopia patients.

Comparison of Clinical Results between Transepithelial Photorefractive Keratectomy and Brush Photorefractive Keratectomy

PURPOSE: To compare the results of transepithelial photorefractive keratectomy (trans PRK) and brush-assisted photorefractive keratectomy (brush PRK) for the treatment of myopia. METHODS: A total of 146 eyes from 78 patients who received brush PRK or trans PRK with the Schwind Amaris laser platform were included in the present study. Uncorrected distance visual acuity (UDVA) and manifest refraction spherical equivalent (MRSE) at postoperative 1 week, 1, 3, 6, and 12 months were compared between the 2 groups as well as epithelial healing time. RESULTS: The mean time to complete epithelial healing was 3.27 +/- 0.75 days in the trans PRK group and 3.67 +/- 0.93 days in the brush PRK group (P < 0.05). At 1 week after surgery, UDVA recovered more rapidly after trans PRK than brush PRK (brush PRK: 0.13 +/- 0.12 log MAR units, trans PRK: 0.09 +/- 0.08 log MAR units, P < 0.05), however, UDVA was not significantly different at 1, 3, 6, and, 12 months postoperatively between the 2 groups. CONCLUSIONS: Re-epithelialization and visual recovery were faster in the trans PRK group while visual outcome and postoperative complications were equivalent to the brush PRK group.

The Effect of Early Topical Steroid Treatment after Trans-Epithelial PRK

PURPOSE: To evaluate the clinical effects of early topical steroid treatment on corneal epithelium healing and postoperative corneal haziness after trans-epithelial photorefractive keratectomy (Trans PRK). METHODS: A total of 400 eyes from 200 patients who received Trans PRK with the Schwind Amaris laser platform (SCHWIND eye-tech solutions, Kleinostheim, Germany) were included in the present study. In 200 eyes (100 patients, early treated group) topical steroid was used from operation day but in the other 200 eyes (100 patients, late treated group) topical steroid was not used until therapeutic contact lenses were removed. The epithelial healing time, corneal haziness and visual acuity at postoperative 3, and 6 months were compared between the 2 groups. RESULTS: The therapeutic contact lenses could be removed at postoperative 3.50 +/- 1.46 days and 3.14 +/- 0.50 days in the early treated group and late treated group, respectively (p < 0.01). Breakdown of the epithelium after removal of therapeutic contact lenses occurred in 8 eyes, which were all in the early treated group. The difference of the visual acuity at postoperative 3 and 6 months between the 2 groups was not statistically significant. However, at postoperative 6 months, the corneal opacity developed in 12 eyes (6%) in the late treated group and 2 eyes (1%) in the early treated group (p = 0.01). CONCLUSIONS: Early treatment with topical steroid can delay corneal epithelial healing, especially the attachment of epithelium to stroma. However, the treatment can reduce the prevalence of corneal opacity after Trans PRK.

Comparison of Photorefractive Keratectomy and Laser Epithelial Keratomileusis for Low to Moderate Myopia

PURPOSE: To compare the efficacy and safety of photorefractive keratectomy with laser epithelial keratomileusis, for low to moderate myopia. METHODS: Patients with a manifest refraction less than -6.0 diopters were enrolled in this study. Patients were treated with photorefractive keratectomy (47 eyes) or laser epithelial keratomileusis (42 eyes). Preoperative and postoperative uncorrected visual acuity, refractive errors, keratometry, residual central corneal thickness, epithelial healing time, and corneal haze were evaluated for a 1 year follow-up period. RESULTS: There were no significant differences between photorefractive keratectomy and laser epithelial keratomileusis in uncorrected visual acuity, refractive errors or correction of refractive errors. Residual central corneal thickness increased until 6 months postoperative and thereafter in both photorefractive keratectomy and laser epithelial keratomileusis groups. There were no significant changes in keratometry after postoperative 1 month. Epithelial healing time of photorefractive keratectomy was shorter than that of laser epithelial keratomileusis. Corneal haze score had a peak at 1 month postoperative and then decreased rapidly until 3 months postoperative, it was stable after 6 months. Corneal haze score at 1 month was less than 0.5 in both groups and did not disturb visual acuity. CONCLUSIONS: Photorefractive keratectomy and laser epithelial keratomileusis have an equal effect in correction of visual acuity and refractive errors. They have equivalent levels of safety as measured by postoperative residual central corneal thickness and corneal haze. Both procedures are effective methods to correct low to moderate myopia.

Effects of Amniotic Membrane after LASEK on Epithelial Healing, Clinical and Refractive Outcomes

PURPOSE: To evaluate the effect of amniotic membrane (AM) on the outcome of laser subepithelial keratomileusis (LASEK). METHODS: One hundred fifty-two eyes of 84 patients with myopia or myopic astigmatism were evaluated. Following LASEK, AM was placed on the inferior limbus as a strip in 94 eyes of 54 patients. Fifty eight eyes of 30 patients served as control. Postoperative epithelial healing time, uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), manifest refraction and corneal haze were examined in both groups. RESULTS: AM-treated group showed shorter reepithelialization time (2.40 +/- 0.94 days vs 3.90 +/- 0.97 days, p<0.001) after LASEK. At 6 months, 48 eyes (82.8%) and 53 eyes (91.4%) of control group had a UCVA of 20/25 and 20/40 or better respectively. In AM-treated group, 86 eyes (91.5%) had 20/25 or better and 90 eyes (95.7%) had 20/40 or better. Mean spherical equivalents (SE) was 0.480.54 diopter (D) vs -0.94 +/- 0.60D (p<0.001). The corneal haze was significantly less in the AM-treated group than in the control group (p<0.001). CONCLUSIONS: The use of AM after LASEK induced rapid epithelial healing with more favorable visual and refractive outcome and reduced score in corneal haze, compared with conventional LASEK.

Optimal Concentration of hEGF for Epithelial Healing in Experimental Corneal Alkali Wounds

PURPOSE: An optimal concentration of hEGF to enhance epithelial healing was determined in the rabbit eyes after alkali wounds. METHODS: Alkali-injured corneas (=5.5 mm, 1N NaOH, 60s) were treated with 0 (control), 2, 5, 10, and 50microgram/ml hEGF 3 times per day. The measurement of epithelial healing rate, transmission electron microscopy and immunohistochemical observation were performed after 7 days treatment. RESULTS: No significant difference was observed in the rates of epithelial healing between control and each hEGF-treated group. Among the tested concentrations, 5microgram/ml hEGF induced the most active proliferation of basal cells and 50microgram/ml hEGF remarkably produced a vascular ingrowth to the central wound area. The number of epithelial layers was increased by hEGF in a concentration-dependent manner. CONCLUSIONS: A low concentration of hEGF may selectively enhance epithelial healing without inducing corneal neovascularization. The optimal concentration of hEGF for the stimulation of basal cell proliferation appears to be 5 microgram/ml in rabbit corneal alkali wounds.

The Effect of Amniotic Membrane on Epithelial Wound Healing in Rabbit Cornea after Phototherapeutic Keratectomy

To evaluate the effect of amniotic membrane on corneal wound healing, using the VISX 193-nanometer excimer laser, the wound model of 150 micrometer depth, 6.0 mmdiameter area was created in 30 white rabbits (60 eyes). The treatment of corneal wound was categorized into three groups :topicalantibiotics alone (control), therapeutic contact lens application and amniotic membrane graft. The area of epithelial defect, proliferation of epithelial cells and inflammatory cell infiltration were evaluated during the entire observation period. Epithelial healing rates calculated by radius regression in control, contact lens and amniotic membrane groups were 42.5 micrometer/hr, 33.4 micrometer/hr and 53.4micrometer/hr respectively thus the effect of amniotic membrane was significantly outstanding (P<0.05). The epithelium was healed almost within 72 hours in eyes of amniotic membrane group but significantly delayed in contact lens group. The number of inflammatory cells in stroma were significantly lower in amniotic membrane group than others. The number of PCNA (proliferating cell nuclear antigen) immunoreactive cells has increased in amniotic membrane group than other groups and regionally at basal cell layer of limbus comparing to wound margin at first, third days after treatment. In view of the above findings, amniotic membrane on corneal wound accelerates the process of wound healing, with minimal complications.

Treatment of Chronic Corneal Ulcer with Nd-YAG Laser

The marginal epithelium of corneal ulcer is occasionally edernatous and detached from corneal stroma in chronic corneal ulcer. This leads to retard healing of corneal epithelium because the migration and adhesion of corneal epithelium are prevented. We performed Nd-YAG laser in chronic corneal ulcer, 6 eyes of 6 patients from July 1996 to December 1996. It was used to improve the healing of corneal epithelium. The patiente were treated with Nd-YAG laser using 0.8 to 1. 2mJ per pulse applied to the region of Bowman`s membrane in the margin of corneal ulcer. The mean number of laser spots in one procedure was 22 and the rnean frequency of Nd-YAG laser use in each patient was 2. 3 times. The Nd-YAG laser induced adhesion of corneal epithelium in all patients and improved the healing of corneal epithelium. Therefore, the treatment of Nd-YAG laser can become 8 useful procedure for chronic corneal ulcer accompanied with corneal epithelial detachment.

Effects of 0.1% Dexamethasone on Experimental corneal Epithelial Healing Following Alkali Wounds

The effect of topical steroid on corneal alkali wound has been controversial due to a complexity of its mechanism and a risk of ulceration and perforation. In this study, the effect of topical 0,1% dexamethasone on corneal epithelial wound healing following alkali burn was evaluated quantitatively. 22 eyes wounded by alkali burn out of 22 white rabbits were divided into 3 groups ; A group treated with topical 0.1% dexamethasone for eight weeks, B grouptreated with topical 0.1% dexamethasone for the first one week followed by another seven weeks without treatment, C group with no treatment served as a control. The area of corneal epithelial defect was examined at 6, 18, 30, 42 hours following corneal alkali wound for initial wound healing and examined every other day from 4 days to 48 days following corneal alkali wound for late wound healing. In this study, it was found that topical 0.1% dexamethasone delayed corneal epithelial healing following corneal alkali burn in both stage of initial and late wound healing.

The Therapeutic Effect of Topically Applied 1% Sodium Hyaluronic Acid(Na-HA) on Corneal Alkali Burn

The effects of topically applied 1% Na-HA on corneal epithelial healing and visual outcomes were evaluated in 15 eyes of 12 corneal alkali-burned patients. 1 % Na-HA (Healon, Pharmacia, Sweden) together with antibiotics(Tarivid eye oint, Japan) in the treatment group and antibiotics ointment alone in the control group were given four times a day for the first one week and then antibiotics were used in both groups. For the assessment of the initial epitheilal healing, the eyes were examined at about 8 to 12 hours intervals during the first week. Individual epithelial healing rates were calculated by a linear regresion analysis from the epithelial defect areas. The best corrected visual acuity was compared between two groups. Initial epithelial healing rates were 0.81+/-0.53(mm2/hour) in the 1% Na-HA treated group and 0.40+/-0.21(mm2/hour) in the control group, respectively. A progressive improvement of visual acuity was observed in the 1% Na-HA treated group, while no change of vision was found in the control group. This clinical study suggests that topical application of 1 % Na-HA in combination with topical antibiotics could be considered for the management of corneal alkali wound.

Comparison of Central Corneal Epithelial Healing Rates Between Different Wound Conditions

The role of limbal epithelial cells on the initial re-surfacing of the central epithelial defect was evaluated. Central or peripheral corneal wounds were produced by using n-heptanol in New Zealand white rabbit, and the epithelial healing rates were evaluated. Central corneal wounds made by applying a filter paper soaked in 0.2 N NaOH with vs without limbal damage were produced for the paralleled set of experiment. A 5.5 mm round filter paper for central wound and a 2 mm filter paper strip for limbal damage were used for the initial wounding. Epithelial defect areas were photodocumented after fluorescein stainmg at 0.6, 18, 30, 42, 48 hours following initial damage. Epithelial healing rates were measured by linear regression analysis, The epithelial healing rates of central and peripheral heptatlol wounds were 0.71 +/- 0.14 mm2/h, and 0.79 +/- 0.10 mm2/h(p>0.05), respectively, NaOH central wound without limbal damage and with limbal damage were 0.77 +/- 0.11 mm2/h, and 0.76 +/- 0.11 mm2/h, respectively(p>0.05). These data suggest that the limbal epithelium has no influence on the initial re-surfacing of the central epithelial defect.