A comparison between the efficacy of human corneal lenticule with single blood donor fibrin glue versus sutures for sealing induced corneal penetrating wounds in porcine eyes

Objective@#To determine the efficacy of human corneal lenticule from small incision lenticule extraction (SMILE) with single blood donor fibrin glue as corneal patch for sealing induced corneal penetrating wounds in cadaveric porcine eyes compared to suturing using 2 simple interrupted nylon 10-0 sutures. @*Methodology@#This is an in vitro comparative experimental study using cadaveric porcine eyes. Twenty (20) porcine eyes were randomized into control and treatment groups. A 3-mm metal keratome was used to create a fullthickness incision with the keratome angled perpendicular to the central cornea. Seidel’s test was done to confirm leakage. An anterior chamber maintainer connected to the Centurion® Vision System (Alcon, USA) was inserted into a peripheral corneal incision with the infusion turned off. Induced corneal penetrating wounds were sealed by application of single blood donor fibrin glue and human corneal lenticule obtained from SMILE in the treatment group. In the control group, 2 simple interrupted nylon 10-0 sutures were used for wound closure. Intraocular pressure (IOP) was set at 30 mmHg using the Centurion® Vision System and IOP was increased by increments of 5 mmHg until leakage is documented. @*Results@#All porcine eyes in the control group showed no leakage immediately after sealing. One out of 10 eyes in the experimental group showed positive Seidel’s test after application of lenticule patch graft (odds ratio = 1.11 [0.904-1.336]). The mean leakage pressure for the suture group was significantly higher at 87.00 ± 4.83 mmHg compared to the lenticule group at 30.00 + 0.00 mmHg (p-value <0.001).@*Conclusion@#Human corneal lenticule from SMILE with single blood donor fibrin glue as cornel patch is less effective in sealing induced corneal penetrating wounds in cadaveric porcine eyes at IOP equal to or greater than 30 mmHg as compared to suturing using 2 simple interrupted nylon 10-0 sutures.

Comparison of tensile strength of Fibrin Glue,­ 2-Octyl Cyanoacrylate, liquid ocular bandage, and conventional nylon 10-0 sutures in corneal laceration repair in an animal model

Objective@#To compare the tensile strength of fibrin glue, 2-octyl cyanoacrylate, and liquid ocular bandage to conventional nylon 10-0 sutures in sealing central linear corneal lacerations.@*Methods@#An experimental in-vitro study was performed on 74 porcine eyes. A 27-gauge needle connected to an infusion system with balanced salt solution was inserted into the anterior chamber and the bottle height was adjusted accordingly. Full-thickness central corneal lacerations were created using a 3.2 mm keratome knife for the initial incision and enlarged by a 5.2 mm knife. The wounds were sealed with fibrin glue (Tisseel®), 2-octyl cyanoacrylate (Dermabond®), liquid ocular bandage (OcuSeal™), and nylon 10-0 with 3 sutures. Tensile strength of the wounds was measured by recording the bottle height above the level of the porcine eyes before leakage was detected and this was converted to IOP values. One-way ANOVA and post hoc t-test were used to analyze the data.@*Results@#Mean maximum IOP where leakage was resisted for the nylon 10-0 suture group was 52.37 ± 7.16 mm Hg. The mean maximum resisted IOP for the fibrin glue, 2-octyl cyanoacrylate, and liquid ocular bandage was 46.34 ± 12.64 mm Hg, 55.13 ± 10.46 mm Hg, and 56.99 ± 8.27 mm Hg respectively. There was no significant difference between the sutures and all of the adhesives groups (p=0.08, p=0.34, and p=0.08) and between 2-octyl cyanoacrylate and liquid ocular bandage (p=0.57). 2-Octyl cyanoacrylate and liquid ocular bandage demonstrated higher mean IOP as compared to the fibrin group (p = 0.024 and p = 0.007).@*Conclusion@#Fibrin glue, 2-octyl cyanoacrylate, and liquid ocular bandage were shown to be effective in sealing 5.2 mm linear corneal lacerations, with 2-octyl cyanoacrylate and liquid ocular bandage being superior to the fibrin glue.

Characteristics and Prognostic Factors of Open-Globe Injuries in Korea

PURPOSE: To characterize epidemiologically open-globe injuries and to identify prognostic factors for visual outcomes after open-globe injuries in Korea. METHODS: The medical records of 138 patients with open-globe injuries presenting to the Severance Hospital between January 2005 and June 2011 were retrospectively reviewed. RESULTS: Out of 138 patients, 85.5% were men. The types of injury included penetrating injury (44.2%), intraocular foreign body (15.9%), blunt injury (35.5%), and perforating injury (3.6%). The most common cause of injury was accidents at work (49.3%) and 60.9% of these injuries were a penetrating wound in zone I limited to the cornea. Predictors of poor visual outcome using univariate analysis included wound extended to posterior sclera, wound length of 10 mm or more, poor initial visual acuity of hand motion or less, and presence of associated ocular injuries at presentation including hyphema, lens injury, vitreous hemorrhage, and retinal detachment. Initial visual acuity and wound size were independent prognostic factors of visual outcome. CONCLUSIONS: Accidents at work are the most important cause of open-globe injuries in Korea. Accordingly, protective measures such as appropriate eyewear and safety education at work are warranted. Initial visual acuity and wound size predicted favorable visual outcome.

A Statistical Observation of Corneal Laceration and Factors Influencing Visual Prognosis

PURPOSE: To investigate the regional characteristics and the factors that influence final visual acuity in corneal laceration and use the results for prevention and treatment of corneal laceration. METHODS: Sixty-eight patients who visited the Chosun University Medical Center from January 1, 2006 to December 31, 2010 were retrospectively surveyed. The incidence of corneal laceration, sex, age, monthly and seasonal distribution, cause, site and length of corneal laceration, secondary operation, complications, and ocular trauma score were reviewed statistically. In additional, the factors influencing visual prognosis were investigated. RESULTS: The incidence was more common in males (94.1%) and in the 6th-decade of life (29.4%). The corneal laceration was more common in the summer (38.2%) and in September (26.5%) and the most common cause was stone (39.7%) and metal (35.3%), respectively. The corneal laceration tended to occur at the corneal center. The most common first operation was primary closure (81.9%), and the secondary operation was most often performed due to a traumatic cataract (32.1%). The factors that significantly influenced the final visual acuity were initial visual acuity, length and site of laceration, and secondary operation. CONCLUSIONS: The present survey investigated the regional characteristics and important factors influencing final visual acuity. Results show initial visual acuity, the length and site of laceration, and the secondary operation significantly influenced final visual acuity.

The Inhibitory Effect of TGF-beta Inhibitor on the Corneal Opacity After Corneal Laceration

PURPOSE: To evaluate the effects of TGF-beta inhibitor on the wound healing process after corneal laceration, and its inhibitory effect on corneal scar formation. METHODS: Forty Lewis rats were randomly divided into one control and three experimental groups (groups I, II, and III). After partial-thickness vertical linear corneal incision, a diluted solution with 10, 25, and 50 microgram of TGF-beta inhibitor was instilled into each eye of groups I, II, and III respectively. Corneal haze was measured by using slit-lamp biomicroscopic examination. Using histopathologic examination, we compared the number of stromal keratocytes and the arrangement of regenerated collagen fibers. We also performed immunohistochemistry to confirm the differential expression of fibronectin and alpha-smooth muscle actin in each group. RESULTS: Group III showed less corneal haze and more regular arrangement of regenerated collagen fibers than the other groups. The number of stromal keratocytes and immunoreactivity to fibronectin and alpha-smooth muscle actin decreased as the dose of TGF-beta inhibitor increased. CONCLUSIONS: TGF-beta inhibitor effectively reduced corneal haze during corneal healing processes after corneal laceration.

A Case of Chrysosporium Parvum Endophthalmitis

PURPOSE: To report a case of Chrysosporium parvum endophthalmitis after trauma. METHODS: A 42-year-old healthy woman visited our hospital complaining of ocular pain after trauma sustained with a wire used to tie grapes. She showed corneal laceration and iris prolapse of the right eye on slit lamp examination. She underwent primary suture of the corneal laceration. Two days later, she presented with hypopyon of the anterior chamber. She was treated with topical antibiotics and a topical steroid. On follow-up examination, she again presented with hypopyon of the anterior chamber. She was admitted for microbiologic examination and was again treated with topical antibiotics and a topical steroid. Unfortunately, no organisms were identified by culture. Later, she reported a recurrent history of the inflammation. After 9 months, she presented with increased hypopyon of the anterior chamber and was treated with anterior chamber irrigation and intracameral antibiotics injection on two different occasions. But, still no organisams were identified. After one year, the patient visited our clinic with ocular pain and decreased visual acuity. Her intraocular pressure was 72 mmHg and there was whitish infiltration and hypopyon around 360 degrees of the anterior chamber and angle. At the same time, the intraocular pressure and inflammation were uncontrolled. Ultimately, microscopic examination of specimens obtained directly from tissue after enucleation identified the organism as Chrysosporium parvum. CONCLUSIONS: We experienced a case of Chrysosporium parvum endophthalmitis after trauma. To our knowledge, this was the first report of a case of Chrysosporium parvum endophthalmitis in the world.

Clinical Analysis of Traumatic Cataract with Corneal Laceration in Children

PURPOSE: To evaluate the visual outcome according to the operation method, prognostic factor and postoperative complication in children with traumatic cataract and corneal laceration. METHODS: We retrospectively analyzed causes, duration between trauma and operation, size and extent of corneal laceration, operation method, complication, and final visual outcome in 34 children, 10 years old or younger, with traumatic cataract and corneal laceration undergoing operation with a minimum follow-up period of one year. RESULTS: Twenty-four eyes (70.6%) and 13 eyes (38.2%) demonstrated final visual acuity of 0.4 or better and 0.8 or better, respectively. Age, duration between trauma and operation, and size of corneal laceration had no relation to final vision, but visual prognosis was poor if there was the involvement of vitreous body or retina (P<0.05). Sixteen eyes (84.2%) of 19 eyes with intraocular lenses (IOL) and 8 eyes (53.3%) of 15 eyes without IOL achieved final visual acuity of 0.4 or better, and there was significant difference between the two groups (p<0.05). Postoperative complications were posterior capsular opacification (38.2%), pupillary capture (23.5%), etc., and there was poor final visual acuity in cases of endophthalmitis (8.8%) and retinal detachment (8.8%). CONCLUSIONS: In children with trauamtic cataract and corneal laceration, if the posterior segment or central cornea is not involved, cataract operation with IOL implantation results in satisfactory visual outcome.

Clinical Evaluation of Traumatic Cataract with Corneal Laceration

The cataract extraction in traumatic cataract with corneal laceration is likely to be different from the ordinary cataract extraction in several points. We tried to know the problems of the operation, the visual outcomes and the postoperative complications in these eyes. In 25 traumatic cataract with corneal laceration, we performed cataract extraction and corneal suture at the same time in 11 eyes and at different time in 14 eyes. The intraoperative problems were difficult anterior capsulotomy, corneal opacity, difficult lens delivery etc.The major postoperative complications were anterior chamber inflammation, corneal edema, posterior capsular opacity and exudative pupillary membrane. In 23 eyes[92%], the visual acuity was increased more than 2 lines. Cataract extraction in traumatic cataract with corneal laceration was very effective surgery, and cataract extraction after primary corneal suture has done had good results in severe corneal laceration with suspicious posterior capsular rupture and non-fitted preoperative preparation.

A Case of Traumatic Complete Aniridia with Corneal Laceration

Traumatic aniridia is usually accompanied by severe anterior segment disruption including corneal laceration, cataract, and vitreous prolapse into the anterior chamber. We experienced a case of complete traumatic aniridia following corneal laceration without capsular rupture of lens, which has not been reported in Korea. A 28-year-old man had a corneal laceration of his right eye from a screw driver at work, which resulted in complete aniridia with only a remnant of ciliary process and UCVA was 0.08. Primary closure of corneal laceration was performed. During surgery, lens capsule was intact. Visual acuity was reduced 10 days after surgery as cataract developed. Although UCVA was 0.3 at 1 month postoperatively, he was symtomatic with glare due to aniridia.

A Clinical Study of Penetrating Ocular Injuries

To evaluate the epidemiological features of penetrating ocular injuries and to indentify factors influencing visual outcome we analyzed retrospectively 410 eyes of 402 patients who were treated at St. Mary's hospital from January 1, 1984 to December 31, 1994. Three hundred thirty four (83.1%) of the patients were male and the peak age was the third decade in both sexes. Little seasonal variation was noted. The accidents occurred more frequently at 4-5 p.m. and 10-12 p.m. and the peak time varied according to the type of accidents. Home accidents(27.4%) were the most common and traffic accidents(24.9%), industrial accidents(22.4%) came next. Two hundred fourteen (53.2%) were inflicted by sharp objects such as spectacles or glass. The cornea(63.1%) was the most common site of perforation and the laceration tended to occur at corneal conter, 6-10mm in length (37.5%). Conjunctival laceration(21.7%), lid laceration(33.2%) and the lens damage(31.5%)were accompanied. The most common surgical procedures was primary closure(83.2%), followedby lid repair and lens aspiration. Evisceration was performed in 54 eyes(13.2%), and the traffic accidents and blunt trauma were the main cause of the procedure. Final visual acuity was better in eyes with only corneal laceration than in eyes with scleral involvement.

A Clinical Observation of Corneal Laceration with Traumatic Cataract

The clinical results of 20 patients(20 eyes) who were operated due to perforated corneal laceration with traumatic cataract between March 5, 1991 and July 14, 1994 were analysed for the predictors of postoperative good visual outcome and compared simultaneous cataract surgery and implantation with secondary implantation. The most significant predictor of postoperative good visual outcome was the location of corneal laceration. Timing of lens implantation didn't influence significantly final visual acuity and postoperative inflammation. But postoperative complication were less frequent in patients where secondary IOL implantation was performed as opposed to those simultaneous IOL implantated.