Ocular surface diseases and corneal refractive surgery

Modern corneal refractive surgery provides high efficiency, safety, predictability and stability of the different ametropia kinds correction’s clinically-functional results. However, in overwhelming percentage of cases, having spent some time after surgery patients complain about discomfort, eyes dryness, burning, feel gritty, redness, blurred and vision instability. Complaints mentioned above are caused by the appearance of transitory dry eye syndrome. Main etiology and pathogenesis factors of this disease are presented in this review. The results of dry eye syndrome classical diagnosis methods have been analyzed, as well as modern techniques, characterized by high specificity and sensitivity, which allow to increase the dry eye’s diagnostics accuracy. The study of the dry syndrome after corneal refractive surgery is devoted to a huge number of works of domestic and foreign authors. However, at present time there is no unique algorithm for assessing the damage of the ocular surface before and after corneal refractive surgery, which would include a set of high-precision and specific techniques for quickly and reliably evaluate the severity of dry eye syndrome, allowing to develop preventive measures and pathogenetically oriented treatment and, thereby, accelerate rehabilitation of patients after surgery. Research continuation is needed in this direction.

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Ocular surface treatment in dry eye patients before corneal refractive surgery

Clinical ophthalmology ◽

10.32364/2311-7729-2020-20-4-180-186 ◽

2020 ◽

Vol 20 (4) ◽

pp. 180-186

Author(s):

O.A. Klokova ◽

◽

R.O. Damashauskas ◽

M.S. Geidenrich ◽

◽

...

Keyword(s):

Surface Treatment ◽

Dry Eye ◽

Ocular Surface ◽

Refractive Surgery ◽

Patient Survey ◽

Dry Eye Disease ◽

Eye Disease ◽

Eye Surgery ◽

Punctal Plugs ◽

Corneal Refractive Surgery

Aim: to analyze the prevalence of dry eye disease (DED) among adult patients with ametropias and the efficacy of its complex treatment when preparing the ocular surface for corneal refractive surgery.Patients and Methods: 1,762 patients with ametropias were examined. In addition to all of the standard eye checks, vital conjunctival and corneal staining, Scheimpflug corneal topography, and anterior segment OCT as well as patient survey were performed. Standard preservative-free tear substitutes with or without a short course of steroids, lubricants, 0.05% anionic cyclosporine emulsion (twice daily), and long-term punctal plugs were prescribed for DED.Results: mild DED was diagnosed in 1,021 patients (57.9%). Of them, corneal lesion was reported in 362 patients (35.4%) and asymptomatic DED in 250 patients (25.5%). Corneal topographic indices of one or both eyes were abnormal (as a result of DED) in 147 patients (14.4%). Significant (p≤0.05) increase in corneal epithelial thickness of one or both eyes was reported in 564 patients (55.2%). Ocular surface treatment in DED patients allowed for uncomplicated corneal refractive procedures while target refraction was achieved in 1,006 patients (98.5%). Conclusion: a complex diagnostic approach to DED involving specific tests, patient survey, corneal topography, and OCT provides the diagnosis of both manifest and latent DED. Combined treatment for conjunctival and corneal xerosis that includes tear substitutes, topical cyclosporine, and punctal plugs, improves ocular surface health in DED thus enlarging the list of indications and the safety of laser eye surgery in these patients.Keywords: dry eye disease, laser eye surgery, corneal refractive procedures, anionic cyclosporine emulsion, punctal plugs, corneal epithelium.For citation: Klokova O.A., Damashauskas R.O., Geidenrich M.S. Ocular surface treatment in dry eye patients before corneal refractive surgery. Russian Journal of Clinical Ophthalmology. 2020;20(4):180–186. DOI: 10.32364/2311-7729-2020-20-4-180-186.

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Faculty Opinions recommendation of Topical cyclosporine a treatment in corneal refractive surgery and patients with dry eye.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718546233.793499173 ◽

2014 ◽

Author(s):

Karl Stonecipher

Keyword(s):

Dry Eye ◽

Cyclosporine A ◽

Refractive Surgery ◽

Corneal Refractive Surgery

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Use of Acellular Umbilical Cord-Derived Tissues in Corneal and Ocular Surface Diseases

Medicines ◽

10.3390/medicines8020012 ◽

2021 ◽

Vol 8 (2) ◽

pp. 12

Author(s):

Arianna A. Tovar ◽

Ian A. White ◽

Alfonso L. Sabater

Keyword(s):

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Ocular Surface ◽

Cellular Proliferation ◽

Mononuclear Cells ◽

Autologous Serum ◽

High Concentration ◽

Ocular Surface Diseases ◽

Natural Healing

Blood derived products have become a valuable source of tissue for the treatment of ocular surface diseases that are refractory to conventional treatments. These can be obtained from autologous or allogeneic sources (patient’s own blood or from healthy adult donors/umbilical cord blood, respectively). Allogeneic cord blood demonstrates practical advantages over alternatives and these advantages will be discussed herein. Umbilical cord blood (UCB) can be divided, generally speaking, into two distinct products: first, mononuclear cells, which can be used in regenerative ophthalmology, and second, the plasma/serum (an acellular fraction), which may be used in the form of eyedrops administered directly to the damaged ocular surface. The rationale for using umbilical cord serum (UCS) to treat ocular surface diseases such as severe dry eye syndrome (DES), persistent epithelial defects (PED), recurrent epithelial erosions, ocular chemical burns, graft versus host disease (GVHD), among others, is the considerably high concentration of growth factors and cytokines, mimicking the natural healing properties of human tears. Allogeneic serum also offers the opportunity for therapeutic treatment to patients who, due to poor heath, cannot provide autologous serum. The mechanism of action involves the stimulation of endogenous cellular proliferation, differentiation and maturation, which is highly efficient in promoting and enhancing corneal epithelial healing where other therapies have previously failed.

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Effect of corneal refractive surgery on accommodative and binocular dysfunctions among civilian pilots in Southwest China

BMC Ophthalmology ◽

10.1186/s12886-021-01855-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ye Wu ◽

Zhen Zhang ◽

Meng Liao ◽

Qi Li ◽

Xue Lin Tang ◽

...

Keyword(s):

Binocular Vision ◽

Refractive Surgery ◽

Visual Symptom ◽

Chi Square ◽

Visual Symptoms ◽

Significant Difference ◽

Symptom Scores ◽

Chi Square Test ◽

Corneal Refractive Surgery ◽

Normal Binocular Vision

Abstract Background To analyze whether corneal refractive surgery (CRS) is associated with the distribution of different accommodative dysfunctions (ADs) and binocular dysfunctions (BDs) in civilian pilots. A further aim was to analyze the percentages and visual symptoms associated with ADs and/or BDs in this population. Methods One hundred and eight civilian pilots who underwent CRS from January 2001 to July 2012 (age: 30.33 ± 4.60 years) were enrolled, the mean preoperative SE was − 1.51 ± 1.15 D (range: − 1.00- − 5.00 D). Ninety-nine emmetropic civilian pilots (age: 29.64 ± 3.77 years) who were age- and sex-matched to the CRS group were also enrolled. Refractive status, accommodative and binocular tests of each subject were performed. Visually related symptoms were quantified using the 19-item College of Optometrists in Vision Development Quality of Life (COVD-QOL) questionnaire. The 19 items were summed to obtain visual symptom scores that might indicate visual dysfunctions. The chi-square test was used to analyze differences in percentages of ADs and/or BDs between the CRS and emmetropic groups. The Mann-Whitney U test was used to compare visual symptom scores between pilots with ADs and/or BDs and pilots with normal binocular vision. Results No significant difference was observed between the CRS and emmetropic groups in the overall prevalence of ADs and BDs (15.7% and 15.2% in the CRS and emmetropic groups, respectively; P = 0.185). ADs were present in 4.63% and 3.03% of the CRS and emmetropic group, respectively. BDs were observed in 11.1% and 12.1% of the CRS and emmetropic group, respectively, yielding no significant differences between the groups in the prevalence of ADs or BDs (AD: P = 0.094; BD: P = 0.105). Pilots with ADs and/or BDs had significantly more visual symptoms than pilots with normal binocular vision (p < 0.001). Conclusions CRS for civilian pilots with low-moderate myopia might not impact binocular functions. ADs and/or BDs commonly occur in both emmetropia pilots and pilots who undergo CRS, and pilots with ADs and/or BDs are associated with increased symptoms. This study confirms the importance of a full assessment of binocular visual functions in detecting and remedying these dysfunctions in this specific population.

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Amniotic membrane extract eye drops for ocular surface diseases: use and clinical outcome in real-world practice

International Ophthalmology ◽

10.1007/s10792-021-01856-4 ◽

2021 ◽

Author(s):

Noelia Sabater-Cruz ◽

◽

Marc Figueras-Roca ◽

Miriam Ferrán-Fuertes ◽

Elba Agustí ◽

...

Keyword(s):

Clinical Outcome ◽

Amniotic Membrane ◽

Real World ◽

Ocular Surface ◽

Eye Drops ◽

Ocular Surface Diseases ◽

Membrane Extract

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Constitutive Laws for Biomechanical Modeling of Refractive Surgery

Journal of Biomechanical Engineering ◽

10.1115/1.2796033 ◽

1996 ◽

Vol 118 (4) ◽

pp. 473-481 ◽

Cited By ~ 122

Author(s):

Michael R. Bryant ◽

Peter J. McDonnell

Keyword(s):

Finite Element ◽

Material Properties ◽

Refractive Surgery ◽

Fiber Optic ◽

Transverse Isotropy ◽

Constitutive Laws ◽

Finite Element Models ◽

Corneal Refractive Surgery ◽

Best Fit ◽

Membrane Inflation

Membrane inflation tests were performed on fresh, intact human corneas using a fiber optic displacement probe to measure the apical displacements. Finite element models of each test were used to identify the material properties for four different constitutive laws commonly used to model corneal refractive surgery. Finite element models of radial keratotomy using the different best-fit constitutive laws were then compared. The results suggest that the nonlinearity in the response of the cornea is material rather than geometric, and that material nonlinearity is important for modeling refractive surgery. It was also found that linear transverse isotropy is incapable of representing the anisotropy that has been experimentally measured by others, and that a hyperelastic law is not suitable for modeling the stiffening response of the cornea.

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