Evaluation of the therapeutic effect of autologous serum on neurotrophic keratopathy with persistent corneal epithelial defect / 中华实验眼科杂志

Objective:To evaluate the outcomes of autologous serum eye drops on persistent corneal epithelial defect caused by neurotrophic keratopathy (NK).Methods:An observational case series study was performed.Twenty patients (20 eyes) diagnosed with NK and persistent corneal epithelial defect were enrolled in Beijing Tongren Hospital from January 2020 to January 2021.The affected eyes were graded according to the severity of the lesion and received individualized comprehensive treatment with domestic autologous serum eye drops as the main therapy.The healing time of the corneal epithelial defect after treatment was recorded.The diameter and area of the defect were marked by corneal fluorescein staining.Changes in the diameter and area of the defect before treatment and at 1, 2, 3, 4 and 8 weeks after treatment were observed by slit lamp microscopy at 10×.Logarithm of the minimum angle of resolution (LogMAR) visual acuity was recorded with a standard logarithmic visual chart before treatment and at 1, 2, 4, 12, and 24 weeks after treatment.Changes in corneal nerve fiber distribution and silk length of corneal perception were assessed by confocal laser scanning microscopy and Cochet-Bonnet esthesiometry, respectively, before treatment and at 4, 12, and 24 weeks after treatment.Influences of corneal defect characteristics on the healing time were analyzed by multiple linear regression analysis.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital Affiliated to Capital Medical University (No.TRECKY2021-110). Written informed consent was obtained from each subject.Results:The corneal epithelial defect was 5.00 (4.00, 5.75) mm in diameter and 15.50 (12.00, 20.00) mm 2 in area before treatment.There were 45% (9/20) with corneal stroma edema and 35% (7/20) with endothelial fold.One diabetic patient with uveitis had a corneal epithelial defect area greater than 8 mm×6 mm and accepted additional corneal clearance and amniotic membrane transplantation after 2 weeks of autologous serum eye drops application.The other 19 patients received autologous serum eye drops therapy.All eyes showed complete recovery.The pretreatment duration of autologous serum eye drops ranged from 2 weeks to 3 months, with a mean of (39.55±25.34) days.The repair time of corneal epithelium ranged from 12 to 42 days, with a mean of (19.68±9.25) days.There were statistically significant differences in corneal defect diameter and area between before and after treatment ( χ2=43.130, 28.265; both at P<0.001). Corneal defect area and diameter decreased at various time points after treatment compared to before treatment, and the differences were statistically significant (all at P<0.05). There were statistically significant differences in LogMAR visual acuity between before and after treatment ( χ2=84.229, P<0.001). LogMAR visual acuity improved at 1, 2, 4, 12, and 24 weeks after treatment compared to pretreatment, and the differences were statistically significant (all at P<0.05). There were statistically significant differences in silk length of corneal perception between before and after treatment ( χ2=55.295, P<0.001). Silk length of corneal perception improved at 4, 12 and 24 weeks compared to pretreatment, and the differences were statistically significant (all at P<0.05). Baseline corneal defect severity grade was positively correlated with healing time ( β=10.55, P=0.032). Corneal defect diameter and area had no influence on the healing time ( β=-2.02, P=0.501; β=0.49, P=0.199). Conclusions:Autologous serum eye drop therapy is safe and effective for persistent corneal defects caused by NK.Re-application of autologous serum eye drops is still effective in individual patients with recurrent corneal defects after discontinuation of serum treatment.It can be combined with surgery for intractable cases.

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.

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.

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.