Use of Autologous Serum Eye Drops with Contact Lenses in the Treatment of Chemical Burn-Induced Bilateral Corneal Persistent Epithelial Defects.

OBJECTIVE: We aim to evaluate the clinical effect of combined topical 20% autologous serum eye drops (ASEs) along with silicone-hydrogel soft contact lenses (SCLs) in the treatment of chemical burn-induced bilateral corneal persistent epithelial defects (PEDs) and to review the literature of related studies. METHODS: From January 1, 2017, to December 31, 2019, we conducted a retrospective chart review of 8 patients with chemical burn-induced bilateral corneal PEDs who were unsuccessfully treated with conventional medical therapy and were then treated with combined topical 20% (v/v) ASEs and silicone-hydrogel CLs. The clinical effects and effectiveness of the combined treatment were evaluated. RESULTS: The bilateral corneal PEDs healed in all sixteen eyes of the eight patients within 2 weeks. The patients did not report any discomfort associated with the combined treatment. Improved ocular comfort/visual acuity and decreased conjunctival injection correlated with healing. No recurrent corneal epithelial breakdown was noted during the 3-month posttreatment follow-up. CONCLUSIONS: The combined treatment of silicone-hydrogel CLs and ASEs can help to stabilize the ocular surface and successfully treat chemical burn-induced bilateral corneal PEDs. It may be considered as an alternative treatment method for patients with bilateral chemical burn-induced corneal PEDs with potential corneal melting.

Autologous Serum Eye Drops Combined With Silicone Hydrogen Lenses for the Treatment of Postinfectious Corneal Persistent Epithelial Defects.

OBJECTIVE: To evaluate the clinical effect of combined topical autologous serum eye drops (ASEs) and silicone hydrogel contact lens (CLs) for the treatment of corneal persistent epithelial defects (PEDs) after infectious corneal ulcers. METHODS: We conducted a retrospective chart review of 12 patients with postinfectious corneal PEDs who were unsuccessfully treated with conventional medical management and were then treated with combined topical 20% (v/v) ASEs and silicone hydrogel CLs from July 1, 2011, to June 30, 2014. The corneal ulcers were all initially managed with antibiotic eye drops until the infiltrates resolved but the lesions failed to epithelialize. The clinical effects of the combined treatment were evaluated. RESULTS: The PEDs healed in all 12 patients within 2 weeks. The combined treatment was associated with an improvement of best-corrected visual acuity (BCVA) at the final 3-month follow-up examination. All patients responded well to the combined treatment and no adverse events were noted in any patient. CONCLUSIONS: The combined use of silicone hydrogel CLs and ASEs can successfully treat postinfectious corneal PEDs and prevent continuous corneal melting during acute disease.

Therapeutic outcomes of combined topical autologous serum eye drops with silicone-hydrogel soft contact lenses in the treatment of corneal persistent epithelial defects: A preliminary study.

PURPOSE: To evaluate the efficacy of the combination of topical 20% autologous serum eye drops (ASEs) and silicone-hydrogel soft contact lenses (SCLs) for the treatment of corneal persistent epithelial defects (PEDs), and to compare the recurrence of epithelial breakdown with or without continuous use of ASEs after silicone-hydrogel SCLs removal. METHODS: We conducted a prospective interventional study of 21 eyes of 21 patients with PEDs treated with combined ASEs and silicone-hydrogel SCLs from September 2014 to August 2015. SCLs were removed after total re-epithelialization and patients were subsequently randomized divided into two groups: (1) with and (2) without continuous use of ASEs for an additional 2 weeks. PEDs healing rate and epithelial defect recurrence were evaluated. RESULTS: PEDs healed in all eyes within 3 weeks. Recurrence was noted in five eyes (50%) in patients without continued use of ASEs for 2weeks after total re-epithelialization and SCLs removal during a 3-month follow-up (odds ratio: 23.0; P<0.05). Recurrent epithelial defects were successfully treated with secondary SCLs application combined with autologous serum use. No adverse events were noted during the entire treatment period. CONCLUSIONS: The combined use of ASEs and silicone-hydrogel SCLs can successfully treat recalcitrant PEDs. Prolonged use of ASEs after total re-epithelialization can decrease recurrence rates.

Subconjunctival Injection of Fluconazole in the Treatment of Fungal Alternaria Keratitis.

PURPOSE: We report two cases of Alternaria keratitis refractory to the conventional antifungal medical treatment successfully treated with subconjunctival fluconazole injection. METHODS: Report of two cases. RESULTS: After subconjunctival injection of fluconazole (2 mg/mL) 0.5 mL twice a day for 5 days then once a day till 14 days, two cases of Alternaria keratitis refractory to the conventional antifungal medical treatment were successfully treated. No severe local and systemic side effects were found in these two patients. CONCLUSIONS: Alternaria keratitis has a varied clinical presentation and suspicion must be maintained for unusual causes of infectious keratitis. Alternaria keratitis can be difficult to eradicate even with traditional antifungals such as amphotericin B and natamycin. Subconjunctival injection of fluconazole could be effective for Alternaria keratitis unresponsive to conventional antifungal medical treatment.

Visual results and complications after trans pars plana vitrectomy and lensectomy for lens dislocation.

BACKGROUND: The aim of this study is to determine the relationship between the cause of lens dislocation and visual outcomes with complications in patients undergoing trans pars plana vitrectomy (TPPV) and trans pars plana lensectomy (TPPL) for lens dislocation. METHODS: This retrospective study was carried out from July 1995 through November 2003. After excluding patients with previous retinal detachment or combing lens dislocation and post-TPPV/TPPL follow-up intervals of less than 6 months, 36 eyes from 36 patients who had undergone vitrectomy and lensectomy for lens subluxation or dislocation due to trauma or intraocular surgery were examined. Their presenting features and complications were recorded. The relationship between the cause of lens dislocation and visual outcome with complications was tested using Fisher's exact test. RESULTS: The cause of lens dislocation included blunt and penetrating eye trauma, and intraocular surgery. Final best-corrected visual acuity was 20/40 or better in 45% of eyes in the traumatic arm and in 31% of eyes in the iatrogenic arm. Visual acuity improved after TPPV/TPPL in 90% of the eyes in the traumatic arm and in 81% of the eyes in the iatrogenic arm. Of all of the eyes, 39% had significant complications affecting postoperative visual outcomes, including retinal detachment, cystoid macular edema, vitreous hemorrhage and glaucoma. CONCLUSIONS: There were no significant differences in visual outcomes and complications between the traumatic and iatrogenic arms of the study. Therefore, the cause of lens dislocation was not a predictor of visual outcomes. Nonetheless, posterior segment complications including retinal detachment and glaucoma were major causes of poor postoperative visual outcomes.

Acute retinal necrosis syndrome: clinical manifestations and visual outcomes.

BACKGROUND: In this paper we attempt to describe the clinical features, visual outcomes, and surgical results of patients with acute retinal necrosis (ARN) syndrome and elucidate the risk factors for a poor prognosis. We also review the methods of treatment. METHODS: This was a retrospective, noncomparative, observational study of patients diagnosed with ARN syndrome. Nine patients (11 eyes) in Chang Gung Memorial Hospital, Kaohsiung from January 1990 to December of 2002 were enrolled. Blood sera and vitreous specimens were analyzed. Necrosis locations and surgical results are described. RESULTS: Bilateral involvement occurred in 2 of our 9 patients (2/9, 22.2%). There was no specific relationship between age and level of the serum virus antibody. All of our polymerase chain reaction data for herpes simplex virus were negative. All 6 eyes of 6 patients who underwent surgery for retinal detachment had partial retinal reattachment postoperatively. Overall, anatomic success was achieved in 8 eyes (8/11, 72.7%). The percentage of eyes with ambulatory visual acuity was 36.3% (4/11), and visual acuity was preserved in 27.3% (3/11) at the last visit. CONCLUSIONS: We found that retinal necrosis which extended rapidly to the posterior pole was associated with a poor visual outcome. Eyes with less than grade II necrosis extension are good candidates for prophylactic peripheral retinal photocoagulation. Early detection and prompt treatment with acyclovir seems to improve the final visual outcome.