Diamond Burr for the Treatment of an Indolent Corneal Ulcer in a Foal

Background: Indolent corneal ulcers have been described as superficial ulcers with an associated rim of loose peripheral epithelium Treatment for indolent ulcers include debridement, grid keratotomy, multiple punctate keratotomy, third eyelid flaps, application of cyanoacrylate tissue adhesives, superficial keratectomy, and a debridement with a diamond burr.Case: A 2-month-old female American Quarter Horse was referred to the Ophthalmology Veterinary Section of the Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil, presenting epiphora and blepharospasm. A local veterinarian doctor had prescribed broad spectrum topical antibiotic and anti-inflammatory drops, although there was no positive response to the treatment for the past two weeks. Ophthalmic examination reveals and moderate discomfort in the left eye, epiphora, and mild corneal edema in the area of the defect. Slit lamp biomicroscopy revealed a superficial corneal ulcer with about 6 mm. Corneal epithelium did not adhere to underlying corneal stroma. The remainder of the ophthalmic examination of the left eye was unremarkable. The diagnosis of a corneal ulcer was made based on these clinical signs and fluorescein staining of the cornea where the stain dissects under the unattached epithelial lip. A handheld battery-operated motorized diamond burr, with a 3.5 mm medium grit tip, was utilized to remove the epithelium. The medical treatment included tobramycin eye drops, and flurbiprofen sodium ophthalmic solution, being applied six times daily, after the procedure, during two weeks, and atropine sulphate 1% was applied once a day, during three days. The foal was hospitalized until healing the corneal ulcer. For two weeks, the foal was assessed daily, and, after that, follow-up visits were scheduled weekly for four months. Healing was defined as the point at which the cornea no longer retained fluorescein.Discussion: Ulcers localized to the corneal epithelium, do not heal within the expected time frame, and have been characterized by epithelial border poorly adherent corneal and being commonly referred as indolent corneal ulcers. In this case, corneal ulcers are chronic and have not responded to an appropriate therapy for 14 days. The corneal ulcer was diagnosed based on history, clinical signs and fluorescein staining of the cornea. Usually, medical treatments provide disappointing results. Surgical treatment aims to remove the loosened epithelium in order to facilitate the growth of new epithelial cells, with stronger adhesion complexes. The utilization of a diamond burr, for the treatment of an indolent corneal ulcer, has been previously reported in humans, and dogs. In the present case, the debridement with a diamond burr was chosen on account of excellent results obtained in previous studies in humans and dogs, when treating indolent corneal ulcers. In the current case, the corneal ulcer healed in ten days, while in a study comparing the outcome in 23 horses treated by debridement, grid keratotomy, or superficial keratectomy, the mean times until complete healing were 15, 16 and 23 days, respectively. In the present case, debridement with diamond burr was effective in the treatment of a recurrent corneal ulcer in a foal.

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Use of Plasma Rich in Growth Factors and ReGeneraTing Agent Matrix for the Treatment of Corneal Diseases

Vision ◽

10.3390/vision5030034 ◽

2021 ◽

Vol 5 (3) ◽

pp. 34

Author(s):

Ronald M. Sánchez-Ávila ◽

Edmar Uribe-Badillo ◽

Carlos Fernández-Vega González ◽

Francisco Muruzabal ◽

Borja de la Sen-Corcuera ◽

...

Keyword(s):

Growth Factors ◽

Corneal Ulcer ◽

Disease Index ◽

Eye Drops ◽

Analog Scale ◽

Ocular Surface Disease Index ◽

Corneal Ulcers ◽

Corrected Visual Acuity ◽

The Mean

This study aimed to investigate the use of Plasma Rich in Growth Factors (PRGF) associated with tissue ReGeneraTing Agent (RGTA) drops for the treatment of noninfectious corneal ulcers. RGTA treatment was applied (one drop every two days); however, if ulcer closure was not achieved, PRGF eye drops treatment was added (four times/day). The time taken to reach the ulcer closure, the Best Corrected Visual Acuity (BCVA), intraocular pressure (IOP), Visual Analog Scale (VAS, in terms of frequency and severity of symptoms), and Ocular Surface Disease Index (OSDI) were evaluated. Seventy-four patients (79 eyes) were included, and the mean age was 56.8 ± 17.3 years. The neurotrophic corneal ulcer was the most frequent disorder (n = 27, 34.2%), mainly for herpes virus (n = 15, 19.0%). The time of PRGF eye drops treatment associated with the RGTA matrix was 4.2 ± 2.2 (1.5–9.0) months, and the follow-up period was 44.9 ± 31.5 months. The ulcer closure was achieved in 76 eyes (96.2%). BCVA, VAS and OSDI improved from the baseline (p < 0.001), and IOP remained unchanged (p = 0.665). RGTA and PRGF in noninfectious ulcers were effective and could be a therapeutic alternative for this type of corneal disease.

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Loss of FOXC1 contributes to the corneal epithelial fate switch and pathogenesis

Signal Transduction and Targeted Therapy ◽

10.1038/s41392-020-00378-2 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Mingsen Li ◽

Liqiong Zhu ◽

Jiafeng Liu ◽

Huaxing Huang ◽

Huizhen Guo ◽

...

Keyword(s):

Epithelial Cells ◽

Corneal Epithelium ◽

Corneal Ulcer ◽

Corneal Epithelial ◽

Ocular Development ◽

Rieger Syndrome ◽

Corneal Ulcers ◽

Epithelial Homeostasis ◽

Forkhead Box ◽

Interferon Regulatory Factor 1

AbstractForkhead box C1 (FOXC1) is required for neural crest and ocular development, and mutations in FOXC1 lead to inherited Axenfeld–Rieger syndrome. Here, we find that FOXC1 and paired box 6 (PAX6) are co-expressed in the human limbus and central corneal epithelium. Deficiency of FOXC1 and alternation in epithelial features occur in patients with corneal ulcers. FOXC1 governs the fate of the corneal epithelium by directly binding to lineage-specific open promoters or enhancers marked by H3K4me2. FOXC1 depletion not only activates the keratinization pathway and reprograms corneal epithelial cells into skin-like epithelial cells, but also disrupts the collagen metabolic process and interferon signaling pathways. Loss of interferon regulatory factor 1 and PAX6 induced by FOXC1 dysfunction is linked to the corneal ulcer. Collectively, our results reveal a FOXC1-mediated regulatory network responsible for corneal epithelial homeostasis and provide a potential therapeutic target for corneal ulcer.

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Treatment of Noninfectious Corneal Disorders With Plasma Rich in Growth Factors and ReGenerating Agent Matrix

10.21203/rs.3.rs-49518/v1 ◽

2020 ◽

Author(s):

Ronald Mauricio Sanchez-Avila ◽

Edmar Uribe-Badillo ◽

Carlos Fernandez-Vega Gonzalez ◽

Francisco Muruzabal ◽

Borja De la Sen Corcuera ◽

...

Keyword(s):

Growth Factors ◽

Adverse Events ◽

Corneal Ulcer ◽

Eye Drops ◽

Ocular Surface Disease Index ◽

Corneal Ulcers ◽

Corrected Visual Acuity ◽

The Mean ◽

Mean Time

Abstract Background: To provide the efficacy and safety of Plasma Rich in Growth Factors (PRGF) associated with tissue ReGeneraTing Agent (RGTA) drops for the treatment of noninfectious corneal ulcers.Methods: This retrospective study included patients from Fernandez-Vega University Institute between 2010 and 2019, with noninfectious corneal ulcers and no response to standard treatments. RGTA treatment was firstly applied (1 drop every two days), but if ulcer closure was not achieved, PRGF eye drops treatment was added (4 times/day). The time to reach the ulcer closure; the Best Corrected Visual Acuity (BCVA), intraocular pressure (IOP), Visual Analog Scale (VAS, in frequency and severity of symptoms), and Ocular Surface Disease Index (OSDI) were evaluated. The presence of adverse events along the follow-up period was also reported. Results: Seventy-four patients (79 eyes) were included in the study, forty-six eyes (62.2%) were women, and the mean age was 56.8 ± 17.3 years. The neurotrophic corneal ulcer was the most frequent disorder found in the patients of the study (n = 27, 34.2%), mainly due to the herpes virus (n = 15, 19.0%). The mean time of PRGF eye drops treatment associated with RGTA matrix was 4.2 ± 2.2 (1.5 -9.0) months, and the follow-up period was 44.9 ± 31.5 months. The ulcer closure was achieved in 76 eyes (96.2%). BCVA, VAS and OSDI improved significantly from the baseline (p<0.001), while IOP remained unchanged (p=0.665). No adverse events were recorded. Conclusions: The use of RGTA and PRGF in noninfectious ulcers was effective and safe, and it could be a therapeutic alternative for this type of corneal diseases.

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Microbial keratitis: A five years retrospective clinical study in tertiary eye hospital of eastern region of Nepal

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v4i4.18252 ◽

2017 ◽

Vol 4 (4) ◽

pp. 118-125

Author(s):

Lila Raj Puri ◽

Gauri Shankar Shrestha

Keyword(s):

Visual Acuity ◽

Clinical Study ◽

Clinical Features ◽

Corneal Ulcer ◽

Health Concern ◽

Eye Drops ◽

Microbial Keratitis ◽

Corneal Ulcers ◽

Retrospective Clinical Study ◽

Corneal Scraping

Background: Corneal ulcer is a sight threatening disease of significant public health concern. Early diagnosis with microbiological identification of the causative organism and institution of the proper medical therapy are important for successful visual recovery.Objectives: To find out the demographic and predisposing factors associated with corneal ulcers, evaluate management of ulcers on the basis of clinical features and corneal scraping results.Methods: It was a retrospective clinical study conducted among 1897 subjects with microbial keratitis in Sagarmatha Choudhary Eye Hospital, Lahan, Nepal from January 2010 to December 2014. Assessment included detailed eye examination with slit lamp for size, depth and location of ulcer, presenting visual acuity on internally illuminated Snellen’s chart, and corneal scrapings for Gram’s stain and 10% Potassium hydroxide wet mount. A standard treatment was delivered on the basis of clinical features and corneal scraping results. Subjects were evaluated subsequently after 48 hours, one week, two weeks, three weeks and four weeks of initiation of therapy. Non-responding cases were admitted to perform re-scraping and to modify therapy.Results: Majority of subjects (71.2%) belonged to the age group of 26 to 55 years (71.2%), presented after two weeks (82.3%) and used non-prescription eye drops (71.9%) before visiting to the eye hospital. Ocular trauma (54.5%) was the most commonly reported predisposing factor. The central and paracentral ulcers comprised of 72.8% of ulcers withsize greater than 2mm in 2.7% and moderate ulcer in 71.1%. Microbiological test revealed fungal ulcers in 78.1% subjects. Presenting visual acuity better than 6/18 was reported in 7% only.Conclusion: Corneal ulcer was one of the commonly reported eye disease in Terai region of Nepal. Trauma is the commonest cause of corneal infection. Fungal corneal ulcers werecommonly noted.

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OUR EXPERIENCE OF USING AUTOLOGICAL BLOOD SERUM IN COMPLEX TREATMENT OF BACTERIAL CORNEAL ULCERS IN PATIENTS WITH DIABETES MELLITUS DEPENDING ON THESEVERETY OF DIABETIC POLYNEUROPATHY

Kharkiv Surgical School ◽

10.37699/2308-7005.3.2020.18 ◽

2020 ◽

pp. 92-98

Author(s):

O. V. Zavoloka ◽

P. A. Bezditko ◽

M. A. Karliychuk ◽

N. M. Bezega

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Corneal Ulcer ◽

Diabetic Polyneuropathy ◽

Autologous Serum ◽

Eye Drops ◽

Corneal Sensitivity ◽

Corneal Ulcers ◽

Patients With Diabetes

Summary. Diabetic keratopathy, which develops against the background of diabetic corneal neuropathyshould be taken into account when choosing tactics for the treatment of bacterial corneal ulcers in patients with diabetes mellitus. The aim of the study was to determine the effectiveness of treatment of bacterial corneal ulcers with the help of additional local use of autological serum eye drops in patients with type 1 diabetes depending on the severity of diabetic polyneuropathy (DPN). Materials and methods. The results of observation of 10 patients (10 eyes) with bacterial corneal ulcer and type 1 diabetes mellitus, in which delayed healing of corneal ulcer defect were noted and the absence of microorganisms ware confirmed by repeated bacteriological examinations of corneal smears and scrapings,were analyzed. In addition to standard therapy, all patients 2 weeks after the start of treatment were additionally prescribed eye drops with autologous serum. Patients were divided into 2 groups according to the stage of severity of DPN: the first group consisted of 5 patients with symptomatic stage, the second - 5 patients with a stage of severe complications. In addition to standard, ophthalmic examination methods included bacteriological examination, fluorescein test, OCT of the anterior segment of the eye on the device TOPCON 3D OCT-2000, non-contact examination of corneal sensitivity. Results and discussion. It was found that the threshold of corneal sensitivity in patients with bacterial corneal ulcer at the stage of severe complications of DPN was higher than that in symptomatic DPN by an average of 16.6 % during the observation. The degree of pericorneal injection and infiltration of the cornea, as well as the size and depth of the ulcerative defect of the cornea at the stage of severe complications exceeded the corresponding indicators of patients with symptomatic DPN during the observation. Normalization of conjunctival color and reepithelialization of the cornea in all patients with severe complications occurred 3 days later than in patients with symptomatic DPN. Conclusions. The course of bacterial keratitis in patients with diabetes mellitus depends on the severity of DPN: a pronounced violation of corneal innervation at the stage of severe complications of DPN, manifested by a decrease in its sensitivity, leads to prolongation of treatment, even with additional use of eye drops with autologous serum.

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The efficacy and safety of 0.5% Levofloxacin versus fortified Cefazolin and Amikacin ophthalmic solution for the treatment of suspected and culture-proven cases of infectious bacterial keratitis: a comparative study

Asian Biomedicine ◽

10.5372/1905-7415.0501.009 ◽

2011 ◽

Vol 5 (1) ◽

pp. 77-83 ◽

Cited By ~ 5

Author(s):

Ngamjit Kasetsuwan ◽

Pinnita Tanthuvanit ◽

Usanee Reinprayoon

Keyword(s):

Clinical Signs ◽

Ophthalmic Solution ◽

Eye Drops ◽

Bacterial Keratitis ◽

Efficacy And Safety ◽

Time Duration ◽

Serious Adverse Events ◽

Efficacy Analysis ◽

The Mean ◽

Mean Time

Abstract Background: Bacterial keratitis is a major devastating ocular condition that quickly deteriorates the patient’s vision. Vigorous and prompt treatment of bacterial keratitis with broad-spectrum antibiotic eye-drops is preferred. Objective: Evaluate the efficacy and safety of 0.5% Levofloxacin for the treatment of suspected and cultureproven cases of infectious bacterial keratitis in comparison to fortified Cefazolin and Amikacin ophthalmic solution. Materials and methods: Seventy-one eyes from 69 patients suspected of having infectious bacterial keratitis were enrolled in the study. The patients were randomized into two arms, 0.5% Levofloxacin eye drops (34 eyes) or fortified Cefazolin and Amikacin (37 eyes). Sixty-eight eyes were included in the efficacy analysis. During treatment, on days 2, 7, 14, and 21, the patient’s symptoms and signs were scored from grade 0-3 (absent to severe). Results: At the end of the treatment, 61 out of 71 eyes completely healed. The resolution of the keratitis was not significantly different between both groups. There were no significant differences in the mean time-duration for the ulcer to heal or for the symptoms and clinical signs to disappear between the two groups. No serious adverse events or side effects from the disease were found. The patients compliance was 80% based on the self-reported diaries. Conclusion: The efficacy and safety of 0.5% topical Levofloxacin was comparable to fortified Cefazolin and Amikacin for the treatment of mild-to-moderate bacterial keratitis. Topical Levofloxacin is far superior because of its availability and patient compliance when used as monotherapy for the treatment of infectious bacterial keratitis.

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The Effects of Rimexolone 1% in Postoperative Inflammation after Cataract Extraction. A Double-Masked Placebo-Controlled Study

European Journal of Ophthalmology ◽

10.1177/112067219800800105 ◽

1998 ◽

Vol 8 (1) ◽

pp. 16-21 ◽

Cited By ~ 18

Author(s):

A. Bron ◽

P. Denis ◽

T. C. Hoang-Xuan ◽

C. Boureau-Andrieux ◽

P. Crozafon ◽

...

Keyword(s):

Cataract Surgery ◽

Anterior Chamber ◽

Clinical Signs ◽

Ophthalmic Solution ◽

Cataract Extraction ◽

Controlled Study ◽

Eye Drops ◽

Severity Scores ◽

Lens Implantation ◽

Ocular Pressure

Aim A multicentre, randomized, placebo-controlled double-masked study was conducted to assess the efficacy and safety of Rimexolone 1% eye drops in reducing inflammation after cataract surgery and intra-ocular lens implantation. Methods Rimexolone 1% (124 patients) or placebo (58 patients) was given, four times a day for 14 days starting 22-34 hours after surgery. All patients also received tobramycin 0.3% four times a day for 7 days. The clinical signs of ocular inflammation were recorded on days 1, 3, 8, 15 and 17 or 18. Results Rimexolone 1% markedly decreased the mean inflammation severity scores, and the sum of clinical assessments of cells and flare in the anterior chamber compared with placebo at each assessment. In addition, the percentage of patients with no anterior chamber inflammation was significantly higher with Rimexolone 1% than with the placebo at each assessment. All these results were statistically significant. Intra-ocular pressure did not rise after treatment with Rimexolone 1%. Conclusions The results suggest that Rimexolone 1% ophthalmic solution is an effective and safe steroidal anti-inflammatory agent for topical use following cataract surgery and intraocular lens implantation.

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Semi-MsST-GAN: A Semi-Supervised Segmentation Method for Corneal Ulcer Segmentation in Slit-Lamp Images

Frontiers in Neuroscience ◽

10.3389/fnins.2021.793377 ◽

2022 ◽

Vol 15 ◽

Author(s):

Tingting Wang ◽

Meng Wang ◽

Weifang Zhu ◽

Lianyu Wang ◽

Zhongyue Chen ◽

...

Keyword(s):

Corneal Ulcer ◽

Ground Truth ◽

Semantic Features ◽

Slit Lamp ◽

Feature Maps ◽

Generative Adversarial Network ◽

Fluorescein Staining ◽

Corneal Ulcers ◽

Multi Scale ◽

Adversarial Network

Corneal ulcer is a common leading cause of corneal blindness. It is difficult to accurately segment corneal ulcers due to the following problems: large differences in the pathological shapes between point-flaky and flaky corneal ulcers, blurred boundary, noise interference, and the lack of sufficient slit-lamp images with ground truth. To address these problems, in this paper, we proposed a novel semi-supervised multi-scale self-transformer generative adversarial network (Semi-MsST-GAN) that can leverage unlabeled images to improve the performance of corneal ulcer segmentation in fluorescein staining of slit-lamp images. Firstly, to improve the performance of segmenting the corneal ulcer regions with complex pathological features, we proposed a novel multi-scale self-transformer network (MsSTNet) as the MsST-GAN generator, which can guide the model to aggregate the low-level weak semantic features with the high-level strong semantic information and adaptively learn the spatial correlation in feature maps. Then, to further improve the segmentation performance by leveraging unlabeled data, the semi-supervised approach based on the proposed MsST-GAN was explored to solve the problem of the lack of slit-lamp images with corresponding ground truth. The proposed Semi-MsST-GAN was comprehensively evaluated on the public SUSTech-SYSU dataset, which contains 354 labeled and 358 unlabeled fluorescein staining slit-lamp images. The results showed that, compared with other state-of-the-art methods, our proposed method achieves better performance with comparable efficiency.

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Corneal ulcers associated with FHV-1 in cats

E3S Web of Conferences ◽

10.1051/e3sconf/201913501072 ◽

2019 ◽

Vol 135 ◽

pp. 01072

Author(s):

Sergey Kartashov ◽

Evgeniya Kartashova ◽

Alexander Butenkov ◽

Anastasia Rakityanskaya ◽

Marina Petrova ◽

...

Keyword(s):

Corneal Epithelium ◽

Recovery Time ◽

Corneal Ulcer ◽

Anterior Part ◽

Combined Therapy ◽

Simultaneous Administration ◽

Corneal Ulcers ◽

Rostov Region ◽

Simultaneous Infection

Corneal ulcer is a common pathology of the anterior part of the eye in cats, of various etiologies, but clinically manifested stereotypically, by the loss of corneal epithelium with a positive fluorescein test and pain. An analysis of 184 cases of various problems of the organs of vision revealed that the incidence of this pathology in the Rostov region is more than 70%. Corneal ulcers of any etiology with simultaneous infection caused by FHV-1 respond better to therapy with systemic antiviral and anti-collagenase drugs. Combined therapy of corneal ulcers in cats with the simultaneous administration of “Famciclovir” and heterogeneous serum significantly reduces the recovery time of the corneal epithelium.

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Kynurenic Acid Accelerates Healing of Corneal Epithelium In Vitro and In Vivo

Pharmaceuticals ◽

10.3390/ph14080753 ◽

2021 ◽

Vol 14 (8) ◽

pp. 753

Author(s):

Anna Matysik-Woźniak ◽

Waldemar A. Turski ◽

Monika Turska ◽

Roman Paduch ◽

Mirosław Łańcut ◽

...

Keyword(s):

Epithelial Cell ◽

Corneal Epithelium ◽

Kynurenic Acid ◽

Pharmaceutical Products ◽

Corneal Epithelial Cell ◽

Eye Drops ◽

Conjunctival Epithelium ◽

Corneal Erosion

Kynurenic acid (KYNA) is an endogenous compound with a multidirectional effect. It possesses antiapoptotic, anti-inflammatory, and antioxidative properties that may be beneficial in the treatment of corneal injuries. Moreover, KYNA has been used successfully to improve the healing outcome of skin wounds. The aim of the present study is to evaluate the effects of KYNA on corneal and conjunctival cells in vitro and the re-epithelization of corneal erosion in rabbits in vivo. Normal human corneal epithelial cell (10.014 pRSV-T) and conjunctival epithelial cell (HC0597) lines were used. Cellular metabolism, cell viability, transwell migration, and the secretion of IL-1β, IL-6, and IL-10 were determined. In rabbits, after corneal de-epithelization, eye drops containing 0.002% and 1% KYNA were applied five times a day until full recovery. KYNA decreased metabolism but did not affect the proliferation of the corneal epithelium. It decreased both the metabolism and proliferation of conjunctival epithelium. KYNA enhanced the migration of corneal but not conjunctival epithelial cells. KYNA reduced the secretion of IL-1β and IL-6 from the corneal epithelium, leaving IL-10 secretion unaffected. The release of all studied cytokines from the conjunctival epithelium exposed to KYNA was unchanged. KYNA at higher concentration accelerated the healing of the corneal epithelium. These favorable properties of KYNA suggest that KYNA containing topical pharmaceutical products can be used in the treatment of ocular surface diseases.

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