Yan-Ming Chen

The Effect of Topical Autologous Serum on Graft Re-epithelialization After Penetrating Keratoplasty

PURPOSE To analyze factors influencing corneal graft re-epithelialization after penetrating keratoplasty (PK) and evaluate the effect of topical autologous serum in promoting graft re-epithelialization. DESIGN Prospective interventional study. METHODS We analyzed 165 eyes of 165 patients who underwent PK between January 1, 2005 and December 31, 2007. Patients were divided into 2 groups according to routine use or non-use of postoperative 20% topical autologous serum. Postoperative slit-lamp examination after fluorescein staining was performed, and graft re-epithelialization time was recorded. Recipient/donor characteristics, surgical variables, and topical use of autologous serum were analyzed for their effects on post-PK graft re-epithelialization. Statistical analysis was performed by univariate and multivariate regression analysis using the ordinal logistic fit model to assess the potential risk factors influencing graft re-epithelialization after PK. RESULTS In univariate analysis, diabetes mellitus (DM), longer death-to-storage time and death-to-surgery time of the donor, and larger recipient size significantly delayed graft re-epithelialization (P < .05). Use of autologous serum significantly expedited graft re-epithelialization (P = .004). In multiple regression analysis, only DM in the recipient (odds ratio [OR] = 5.10, P < .001), postoperative use of autologous serum (OR = 0.54, P = .046), and larger graft size (OR = 4.44, P < .001) influenced graft re-epithelialization. The beneficial and healing effect of autologous serum is particularly significant in diabetic recipients and larger grafts. CONCLUSIONS Several factors may influence graft re-epithelialization after PK. Graft re-epithelialization time was longer in diabetic recipients and larger grafts. Use of autologous serum may be a beneficial strategy in these patients with potentially delayed epithelial healing.

Subconjunctival injection of bevacizumab in the treatment of corneal neovascularization associated with lipid deposition.

Purpose: To determine the effects on corneal neovascularization (NV) and lipid deposition after subconjunctival injection of bevacizumab in patients who had NV associated with lipid keratopathy. Methods: A case interventional study enrolled 18 patients (18 eyes) with lipid keratopathy. We gave monthly subconjunctival injections of bevacizumab from 3 to 10 times during the follow-up period according to the clinical response. We evaluated the centricity, extent, and percentage of involved corneal surface (PICS) of the corneal NV; the density and PICS of the corneal lipid deposition; and best-corrected visual acuity before and after treatment. We analyzed the treatment effects using Wilcoxon and Student t tests. Results: After the treatment, the change in best-corrected visual acuity was less than 2 lines. The extent, centricity, and PICS of the corneal NV and the density and PICS of the corneal lipid deposition decreased significantly after treatment (P = 0.014/0.002/0.001 and 0.001/<0.001, respectively). No eyes had side effects. Conclusions: The effects of subconjunctival injection of bevacizumab in treating corneal NV associated with lipid deposition were significant in some patients.

The different effects of early and late bevacizumab (Avastin) injection on inhibiting corneal neovascularization and conjunctivalization in rabbit limbal insufficiency.

PURPOSE To compare the effects of early, mid, and late subconjunctival injection of bevacizumab on corneal neovascularization (NV) and conjunctivalization in a rabbit limbal insufficiency model. METHODS Limbal insufficiency was created surgically, and subconjunctival injections of 2.5 mg bevacizumab twice weekly for 1 month were started immediately (early group), 1 week (mid group), and 1 month after injury (late group). The corneal epithelial alterations, stromal opacity, centricity, extent, and PICS (percentage of involved corneal surface) of the corneal NV were evaluated. The expression of cytokeratins K3, K4, K12, K13, and MUC5 by the corneal surface cells was examined by immunohistochemistry. RESULTS Bevacizumab significantly inhibited corneal NV in the early and mid, but not the late, treatment groups at 4 weeks after treatment (PICS: P < 0.01 in the early group, P < 0.01 in the mid group, and P > 0.05 in the late group). Early and mid treatment produced significant inhibition of corneal alteration (P < 0.01 in the early group and P = 0.03 in the mid group) and stromal opacity (P < 0.01 in the early group and P = 0.02 in the mid group) at 4 months after treatment but not in the late group. The immunohistochemistry of cytokeratin on the corneal surface cells at 1 month after treatment was K3(+), K4(-), K12(+), K13(-), and MUC5(-) in the early group; K3(+), K4(+), K12(+), K13(+), and MUC5(-) in the mid group; and K3(+), K4(+), K12(-), K13(+), and MUC5(+) in the late treatment group. CONCLUSIONS Early and mid bevacizumab injection inhibited corneal NV, epithelial alteration, and stromal opacity in limbal insufficiency, but late treatment did not. Early treatment with bevacizumab seems to be clinically beneficial in the management of limbal injury such as chemical burn.

Comparison of corneal epitheliotrophic capacity among different human blood-derived preparations.

Purpose: To compare the corneal epitheliotrophic capacity of different human blood-derived preparations, including cord blood serum (CBS), peripheral blood serum (PBS), and fresh frozen plasma (FFP) on bovine corneal epithelial cells. Materials and Methods: The concentrations of epithelial growth factor, transforming growth factor β1, insulin-like growth factor 1, hyaluronic acid, fibronectin, albumin, glucose, and calcium in different human blood derivatives were evaluated using enzyme-linked immunosorbent assay or biochemical methods. Cultivated bovine corneal epithelial cells were incubated with various blood derivatives, and cell proliferation, migration, and differentiation were evaluated by colorimetric assay, Boyden chamber chemotaxis assay, wounding assay, scanning electron microscopy, and transepithelial electric resistance measurements. Wound closure was assessed using a scratch-induced directional wounding assay. Results: Of the 3 human blood derivatives evaluated, CBS had the highest concentrations of epithelial growth factor, transforming growth factor β1, and hyaluronic acid (P < 0.05). FFP had the lowest concentration of calcium and the highest concentration of glucose (P < 0.05). CBS demonstrated the highest ability to promote cellular proliferation, followed by PBS and FFP (P < 0.05). CBS was also the best in promoting cellular differentiation because scanning electron microscopy demonstrated coherent monolayers of flattened and polygonal-shaped cells with evenly distributed microvilli. Transepithelial electric resistance was noted to be the highest for cells incubated in CBS, indicating formation of well-differentiated cells with functional tight junction (P < 0.05). Cells cultivated with FFP were the least capable of promoting proliferation, migration, and differentiation. Conclusions: Different human blood derivatives may have different concentrations of epitheliotrophic factors. CBS is generally superior to PBS in promoting corneal epithelial proliferation and differentiation.

Idiopathic Sclerosing Orbital Inflammation – A Case Series Study

Aims: It was the aim of this study to perform a review of the clinical features, treatments and outcomes of patients with idiopathic sclerosing orbital inflammation (ISOI) in Taiwan. Methods: All patients with histologically confirmed ISOI from 1995 to 2007 at the National Taiwan University Hospital were included. We reviewed the medical charts to see the clinical presentation, treatment modalities, treatment efficacy and final clinical status of these patients. Results: Six male and 3 female patients ranging in age from 33 to 82 years were included. The most common symptoms were pain and blurred vision (both 77.8%). Reduced visual acuity and proptosis were the most common signs (both 89%). Five patients received oral steroid treatment with/without pulse therapy combined with tissue removal, the response to which was good in 1 patient and partially effective in the other 4 patients. One patient received oral steroids and surgery, followed by radiotherapy, with only partial response. Patients with oral prednisolone or surgery only all had poor responses. Conclusion: ISOI is rare and also difficult to diagnose and manage. Early intervention with steroids/immunosuppressants combined with surgical debulking procedures may result in control or regression of this recalcitrant disease.

Anterior corneal buttons from DSAEK donor tissue can be stored in optisol GS for later use in tectonic lamellar patch grafting.

Purpose: The aim of this study was to evaluate the feasibility of storing anterior corneal buttons split from donor Descemet stripping automated endothelial keratoplasty (DSAEK) tissue for later use in tectonic lamellar patch grafting. Methods: Donor corneas for DSAEK were split into anterior and posterior lamellae using a 350-&mgr;m depth microkeratome, and the remaining anterior corneal buttons were stored for up to 4 weeks at 4°C in Optisol GS before use in patch grafting of the cornea and sclera. Results: Optisol GS–preserved anterior lamellar patch grafts successfully restored and maintained corneoscleral integrity after the removal of limbal dermoids (5 cases), after the coverage of the exposed polypropylene suture ends of scleral fixated posterior chamber intraocular lenses (2 cases), corneoscleral melting after pterygium excision (3 cases), sterile corneal ulceration with or without perforation (5 cases), Mooren ulceration (3 cases), and pseudomonas corneal ulceration with impending perforation (1 case). It was also used as a temporary substitute while waiting for a full-thickness corneal graft in a fulminant candida infection after DSAEK (1 case). All grafts remained structurally intact at the last postoperative examination of 19.2 ± 7.6 months after the tectonic surgery. Conclusions: Anterior corneal buttons from DSAEK donor tissue may be stored in Optisol GS for later use in tectonic patch grafting. This method obviates the longer operating time required for the surgeon to manually dissect the donor cornea in the operating room and reduces the wastage of precious donor corneas in countries where there are chronic shortages of eye bank donor tissue.

Effect of oral azithromycin in the treatment of chlamydial conjunctivitis

PurposeTo assess the efficacy of oral azithromycin in the treatment of chlamydial conjunctivitis.MethodsWe performed a retrospective study in patients with clinically suspected chlamydial conjunctivitis who underwent conjunctival swab sampling for Chlamydia direct fluorescent antibody (DFA) tests between 1 January 2006 and 31 December 2006. Patients with positive DFA results were orally administered azithromycin once a week for 2 consecutive weeks. If DFA examinations still showed positive results after 4 weeks, additional azithromycin was orally administered once. The DFA tests were repeated 4 weeks later, and this was continued until the DFA tests showed negative results.ResultsAmong the 67 suspected patients, 45 (67.2%) showed positive results from the DFA tests, of whom 42 received treatment. After the first 2 weeks, only 27 patients returned to the clinic and completed the treatment. The test results of 19 (70.4%) patients became negative after the treatment with two weekly doses of oral azithromycin. Among the remaining eight patients, four (14.8%) needed an additional dose of oral azithromycin, and the other four (14.8%) required two additional doses. All 27 patients tolerated the treatment well, with an adverse event of mild gastritis in only one patient.ConclusionsTwo weekly doses of oral azithromycin were effective and well tolerated in the treatment of chlamydial conjunctivitis. However, more than one course of treatment was necessary in some patients.

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.

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.

Bilateral complicated stromal dissections during mechanical epikeratome separation of the corneal epithelium.

PURPOSE To present a case of bilateral inadvertent stromal cuts during mechanical epikeratome separation of the corneal epithelium using a Centurion SES epikeratome (Norwood EyeCare Pty Ltd). METHODS A 25-year-old woman underwent epi-LASIK surgery. Preoperative examinations showed no remarkable findings. After epithelial flap creation, a linear stromal cut near the temporal upper flap edge was found in the right eye. An irregular stromal cut involving the central cornea was found in the left eye after undergoing epi-LASIK with a new separator. Excimer laser ablation was continued in both eyes without flap reposition. RESULTS Six months postoperatively, best spectacle-corrected visual acuity was 20/20 in the right eye and 20/25 in the left eye. Corneal topographic examination revealed a regular pattern in the right eye and irregularities in the left. CONCLUSIONS Stromal dissection during mechanical separation of the corneal epithelium with a Centurion SES epikeratome is a potential complication of epi-LASIK. Visual impairment can result from such complications.