ESTIMATION OF THE EFFICIENCY MESENCHYMAL STEM CELL SECRETOME USING IN POST-OPERATIVE CORNEAL SEQUESTRUM THERAPY CLINICAL TREATMENT RESULTS

This article summarizes our clinical treatment results for various stages of corneal sequestrum in 24 cats using mesenchymal stem cell secretome (cytokines / growth factors). Our results show that the regenerative drug used in the study had a positive effect on the quality and speed of the corneal regeneration and effectively reduced inflammation during the post-operative period, which contributed to the lack of any rejection of donor cornea.

Accelerated cross-linking technique using a protective corneal donor flap in the treatment of progressive keratoconus on «thin» corneas

Purpose. To develop a method of accelerated ultraviolet crosslinking with an initial corneal thickness equal to or less than 400 microns using a protective donor corneal flap. Definition of safety and effectiveness of this method in the treatment of progressive keratoconus. Material and methods. 20 patients (20 eyes) with a diagnosis of progressive keratoconus 2–3 stages were included in the study. The accelerated crosslinking was carried out with an IROC-VX-2000 device (Switzerland). A protective donor corneal flap was cut out by using a Femto LDV Z8 femtosecond laser (Ziemer, Switzerland). The thickness of the protective flap of the donor cornea was determined as the difference between 450 μm and the obtained value of the patient's pachymetry in 30 minutes of saturation with Dextralink in μm. Results. Indicators of uncorrected visual acuity and corrected visual acuity returned to the level of preoperative values and did not tend to decrease until the end of the observation period for 6 months. The average keratometry indices gradually decreased: after 3 months – 50.3 ± 1.5 μm, after 6 months – 48.9 ± 1.8 μm, by 12 months – 46.7 ± 2.1 μm. A decrease in elevation indicators of the anterior and posterior surfaces was marked on elevation maps throughout the observation period. Conclusion. The proposed ultraviolet crosslinking technique using a protective donor corneal flap in patients with corneal thickness 400 μm or less is reproducible. This technique proves its effectiveness and safety and allows to stabilize the condition in patients with progressive keratoconus with adequate visual function. This makes this technique necessary, taking into account the lack of adequate cross-linking technology with a thin cornea. Keywords: progressive keratoconus, thin cornea, ultraviolet crosslinking, protective donor corneal flap.

Temporary Kerato-Prosthesis to Resolve Traumatic Loss of a Healed Corneal Button

The aim of this study is to report a rare case of traumatic complete loss of a donor corneal button successfully resolved by a 24-h implantation of a temporary kerato-prosthesis. A healthy 30-year-old man with a history of prior penetrating keratoplasty (PKP) presented with an open globe following accidental contusive trauma with a ball, while he was playing football. At slit-lamp evaluation, complete dehiscence of the wound at the graft-host junction and complete corneal button loss was evident. The patient was immediately taken to the operating room, but a donor cornea was not available; therefore, a vitreo-retinal temporary kerato-prosthesis was implanted to close the eyeball until a new donor cornea was available. In case of complete dehiscence of the donor-host junction after PKP with corneal button loss, it is possible to use a temporary kerato-prosthesis to stabilize the eye and contain the intraocular structures. We recommend the availability of temporary vitreo-retinal kerato-prosthesis in the operating theatres of Corneal Surgical Units.

Production and Clinical Application of Keratobioimplants in Ukraine. Advances, Modern Challenges and Development Prospects

The article presents information on the current state of keratobioimplants production and clinical use in Ukraine. Thanks to the cooperation of the State Enterprise Bioimplant of the Ministry of Health of Ukraine with 13 ophthalmological institutions, keratobioimplants have been successfully used to treat corneal diseases since 2014. Over 7 years the enterprise has manufactured and provided for treatment 1799 keratobioimplants from the donor cornea of the human eye for various types of keratoplasty.The donors were analyzed by age, infection level, optimal timing of keratolimbal discs retrieval as well as morphometric parameters of endothelial cells.Long-term clinical outcomes demonstrate high quality of engraftment and steady increase in visual acuity in patients after penetrating keratoplasty. In 99.4% of the patients undergoing curative keratoplasty, the inflammatory process was stopped, the destruction of the cornea was stopped, and the eyes were preserved for further surgical ophthalmological interventions.

The Main Aspects of Corneal Transplantation in Ukraine and in the World: Demand Analysis, Keratoplasty Types and Future Development

The article presents information about the history and current state of corneal transplantation in Ukraine. Currently, no more than 400 keratoplasties per year are performed in Ukraine. However, the need for corneal transplantation in our country is much higher. The authors show that it is extremely important to eliminate the deficit of the donor cornea for keratoplasty and increase the number of corneal transplantations in Ukraine. It is necessary to expand the number of bases for donor corneal removal and include keratoplasty in the list of medical services funded by the National Health Service of Ukraine.For the development of corneal transplantation in Ukraine using the tissues of the deceased donor, it is necessary to solve a number of important tasks: to create positive attitude in society to donation after death, starting from school (to develop conscious informed and free consent for donation), to ensure that the population is informed about the essence of the right to be a donor of their organs or tissues after death and the mechanisms for recording their consent (or disagreement); to create conditions for documenting the consent of individuals to the opportunity to be a donor of their organs or tissues after death; to introduce a state program for the development of corneal transplantation in Ukraine with its proper funding.

Suturing large therapeutic corneal grafts based on donor size: A simplified technique for the novice corneal surgeon

Purpose: We describe a simple technique for achieving radial and equally spaced sutures by novice corneal surgeon in cases of large penetrating keratoplasties. Method: A simple mathematical equation was derived for precise calculation of spacing between interrupted sutures in large grafts ( n = 50). The ubiquitous and easily available Castroviejo calipers were used to mark the donor cornea according to the derived formula. Interrupted sutures were passed over the pre-marked points and tied. Radiality was assessed in the post-operative period. Results: A total of 50 eyes undergoing therapeutic keratoplasty with graft size between 9 and 12 mm were enrolled. Equally spaced and radially aligned sutures were achieved in all cases postoperatively with watertight apposition of the graft host junction using our simple technique. Conclusion: The Castroviejo caliper can be effectively used for equidistant spacing of interrupted sutures in large therapeutic grafts by a novice surgeon thereby simplifying the procedure and reducing the surgical time.