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Treatment of Cornea and Ocular Surface Diseases

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: closed (20 August 2022) | Viewed by 25015

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Special Issue Editor

Prof. Dr. Vincenzo Scorcia

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Guest Editor

Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
Interests: keratoconus; keratoplasty; deep anterior lamellar keratoplasty; anterior segment OCT; cataract; endothelial keratoplasty; optical coherence tomography; corneal tomography; ocular surface disease; dry eye
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Ocular surface diseases range from mild forms of keratoconjunctivitis sicca to severe conditions, such as corneal ulcer that impair cornea’s transparency. In such cases, keratoplasty may be required to restore ocular integrity and/or to rehabilitate the patient’s vision. Optimization of the ocular surface prior to surgery is essential to achieve success and includes maximizing tear function, restoring normal lid anatomy and function, and ensuring an adequate supply of limbal stem cells. These vital steps help to enhance the survival and clarity of the subsequent corneal graft.

We invite researchers to submit original research and review articles on cutting-edge treatments for the management of cornea and ocular surface diseases.

Prof. Dr. Vincenzo Scorcia
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

cornea
ocular surface disease
dry eye
corneal ulcer
keratoplasty

Published Papers (10 papers)

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Research

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16 pages, 3202 KiB

Open AccessArticle

Management and Treatment Outcomes of High-Risk Corneal Transplantations

by Karolina Urbańska, Marcin Woźniak, Piotr Więsyk, Natalia Konarska, Weronika Bartos, Mateusz Biszewski, Michał Bielak, Tomasz Chorągiewicz and Robert Rejdak

J. Clin. Med. 2022, 11(19), 5511; https://doi.org/10.3390/jcm11195511 - 20 Sep 2022

Cited by 2 | Viewed by 2029

Abstract

Corneal transplantation is the most effective treatment for corneal blindness. Standard planned keratoplasties have a high success rate. Conditions such as active inflammation at the time of surgery, the presence of ocular surface disease, previous graft disease, or neovascularization make them more susceptible to rejection. These are so-called high-risk corneal transplantations. In our study, we selected 52 patients with a higher risk of graft rejection. A total of 78 procedures were performed. The main indications for the first keratoplasty were infections (59.6%) and traumas (21.2%). Visual acuity (VA) significantly improved from 2.05 logMAR on the day of keratoplasty to 1.66 logMAR in the latest examination (p = 0.003). An analysis of the graft survival showed a 1-year survival of 54% and a 5-year survival of 19.8% of grafts. The mean observation time without complications after the first, second, and third surgery was 23, 13, and 14 months, respectively. The best results were noted among patients with infectious indications for keratoplasty (p = 0.001). Among them, those with bacterial infection had the best visual outcomes (p = 0.047). Full article

(This article belongs to the Special Issue Treatment of Cornea and Ocular Surface Diseases)

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10 pages, 999 KiB

Open AccessArticle

Therapeutic Efficacy and Safety of Intense Pulsed Light for Refractive Multiple Recurrent Chalazia

by Reiko Arita and Shima Fukuoka

J. Clin. Med. 2022, 11(18), 5338; https://doi.org/10.3390/jcm11185338 - 11 Sep 2022

Cited by 5 | Viewed by 3598

Abstract

To evaluate the efficacy and safety of intense pulsed light (IPL) combined with meibomian gland expression (MGX) for the treatment of refractory multiple and recurrent chalazia without surgery or curettage. This was a retrospective controlled study. Patients with multiple and recurrent chalazia, who had performed the conventional treatment at least 2 months without any surgery or curettage, were enrolled in this study. Twenty-nine consecutive multiple recurrent chalazia (12 patients) were assigned to receive either the combination of IPL and MGX or MGX alone as a control. Each eye underwent one to four treatment sessions with 2-week intervals. Parameters were evaluated before and 1 month after the final treatment session. Clinical assessments included symptom, size of each chalazion, lid margin abnormalities, corneal and conjunctival fluorescein staining, meibum grade, the number of Demodex mites, the Schirmer value and meiboscore. All parameters except meiboscore and the Schirmer value were significantly improved with IPL-MGX therapy, whereas only meibum grade was significantly improved with MGX alone. There were no adverse events which occurred in either group. IPL-MGX was safe and effective for multiple and recurrent chalazia without surgery or curettage by reducing the size of chalazion and improving lid margin abnormalities and meibum grade. Full article

(This article belongs to the Special Issue Treatment of Cornea and Ocular Surface Diseases)

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13 pages, 1350 KiB

Open AccessArticle

Dry Eye Parameters and Lid Geometry in Adults Born Extremely, Very, and Moderately Preterm with and without ROP: Results from the Gutenberg Prematurity Eye Study

by Achim Fieß, Clara Hufschmidt-Merizian, Sandra Gißler, Ulrike Hampel, Eva Mildenberger, Michael S. Urschitz, Fred Zepp, Bernhard Stoffelns, Norbert Pfeiffer and Alexander K. Schuster

J. Clin. Med. 2022, 11(10), 2702; https://doi.org/10.3390/jcm11102702 - 11 May 2022

Cited by 12 | Viewed by 1421

Abstract

Background/Aims: This study aimed to analyze the effects of perinatal history on tear film properties and lid geometry in adults born preterm. Methods: The Gutenberg Prematurity Eye Study (GPES) is a German prospective examination of adults born preterm and term aged 18 to 52 years with Keratograph^® 5M and Schirmer test I. Main outcome measures were first non-invasive tear film break-up time (F-NITBUT), bulbar redness (BR), Schirmer test, and nasal palpebral angle measurement. The associations with gestational age (GA), birth weight (BW), and BW percentile, retinopathy of prematurity (ROP), ROP treatment, and other perinatal factors were evaluated using regression analyses. Results: 489 eyes of 255 preterm and 277 eyes of 139 full-term individuals (aged 28.6 +/− 8.8 years, 220 females) were included. Of these, 33 participants (56 eyes) had a history of spontaneously regressed ROP and 9 participants (16 eyes) had a history of ROP treatment. After adjustment for age and sex, lower F-NITBUT (<20 s) was associated with ROP treatment (OR = 4.42; p = 0.025). Lower GA correlated with increased bulbar redness (B = −0.02; p = 0.011) and increased length of wetting in the Schirmer test (B = −0.69; p = 0.003). Furthermore, low GA was associated with narrowing of the nasal palpebral angle (B = 0.22; p = 0.011) adjusted for age and sex, but not when considering ROP in the multivariable model. Conclusion: Our analyses indicate that perinatal history affects ocular surface properties, tear production and lid geometry in adults born term and preterm. This might indicate that affected persons have a predisposition to diseases of the corneal surface such as the dry eye disease. Full article

(This article belongs to the Special Issue Treatment of Cornea and Ocular Surface Diseases)

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16 pages, 2928 KiB

Open AccessArticle

Membrane of Plasma Rich in Growth Factors in Primary Pterygium Surgery Compared to Amniotic Membrane Transplantation and Conjunctival Autograft

by Miriam Idoipe, Borja de la Sen-Corcuera, Ronald M. Sánchez-Ávila, Carmen Sánchez-Pérez, María Satué, Antonio Sánchez-Pérez, Gorka Orive, Francisco Muruzabal, Eduardo Anitua and Luis Pablo

J. Clin. Med. 2021, 10(23), 5711; https://doi.org/10.3390/jcm10235711 - 6 Dec 2021

Cited by 5 | Viewed by 2074

Abstract

This prospective and comparative study aimed to compare the use of a conjunctival autograft (CAG), plasma rich in growth factors fibrin membrane (mPRGF) or amniotic membrane transplantation (AMT) in primary pterygium surgery. Patients were assigned for surgery with CAG (group A), mPRGF (group B), or AMT (group C). Pterygium recurrence, Best Corrected Visual Acuity (BCVA), graft size (measured with anterior segment optical coherence tomography (AS-OCT)), and ocular surface symptoms (visual analogue scale (VAS) and ocular surface disease index (OSDI)) were evaluated. Thirteen eyes in group A, 26 in group B, and 10 in group C were evaluated. No changes in BCVA (p > 0.05) were found. Recurrence cases for groups A, B, and C were none, two, and two, respectively, and three cases of pyogenic granulomas in group A. The horizontal/vertical graft size was lower in group B vs group A (p < 0.05) from months 1 to 12. The improvement in VAS frequency for groups A, B, and C was: 35.5%, 86.2%, and 39.1%, respectively. The OSDI scale reduction for groups A, B, and C was: 12.7%, 39.0%, and 84.1%. The use of the three surgical techniques as a graft for primary pterygium surgery was safe and effective, showing similar results. The mPRGF graft represents an autologous novel approach for pterygium surgery. Full article

(This article belongs to the Special Issue Treatment of Cornea and Ocular Surface Diseases)

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14 pages, 1036 KiB

Open AccessArticle

Comparative Analysis of Corneal Parameters in Swept-Source Imaging between DMEK and UT-DSAEK Eyes

by Anna Machalińska, Agnieszka Kuligowska, Bogna Kowalska and Krzysztof Safranow

J. Clin. Med. 2021, 10(21), 5119; https://doi.org/10.3390/jcm10215119 - 30 Oct 2021

Cited by 6 | Viewed by 1500

Abstract

Background: The need to provide a comparative analysis of corneal parameter changes compared to their preoperative values between Descemet membrane endothelial keratoplasty (DMEK) and ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) patients. Methods: The study included 24 eyes after UT-DSAEK and 24 eyes after DMEK. Visual acuity, endothelial cell count (ECC), central corneal thickness (CCT), mean keratometry (MK), mean astigmatism (MA), astigmatism asymmetry (AA) and higher-order aberrations (HOAs) were assessed at baseline and 1, 3, 6 and 12 months after the surgery. Results: From the 3rd month post operation, ECC was higher in the DMEK eyes than in the UT-DSAEK eyes (p = 0.01). In a bivariate analysis that was adjusted for age, DMEK was associated with a smaller decrease in posterior MK at the 1-month (β = −0.49, p = 0.002), 3-month (β = −0.50, p < 0.001), 6-month (β = −0.58, p < 0.001) and 12-month (β = −0.49, p < 0.001) follow-up visits. There were no significant differences in changes in anterior or combined surface MK throughout the observation period. Accordingly, no significant differences in changes in MA, AA or HOAs compared to the baseline values were identified between the eyes after DMEK and UT-DSAEK at any follow-up time point. Conclusions: UT-DSAEK seemed to be an easier and safer technique than DMEK while maintaining similar outcomes regarding irregular astigmatism and total keratometry values. Full article

(This article belongs to the Special Issue Treatment of Cornea and Ocular Surface Diseases)

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11 pages, 268 KiB

Open AccessArticle

Topo-Pachimetric Accelerated Epi-On Cross-Linking Compared to the Dresden Protocol Using Riboflavin with Vitamin E TPGS: Results of a 2-Year Randomized Study

by Ciro Caruso, Robert Leonard Epstein, Pasquale Troiano, Francesco Napolitano, Fabio Scarinci and Ciro Costagliola

J. Clin. Med. 2021, 10(17), 3799; https://doi.org/10.3390/jcm10173799 - 25 Aug 2021

Cited by 5 | Viewed by 2013

Abstract

In the present study (clinical trial registration number: NCT05019768), we compared the clinical outcome of corneal cross-linking with either the standard Dresden (sCXL) or the accelerated custom-fast (aCFXL) ultraviolet A irradiation protocol using riboflavin–D-α-tocopheryl poly(ethylene glycol)-1000 succinate for progressive keratoconus. Fifty-four eyes of forty-one patients were randomized to either of the two CXL protocols and checked before treatment and at the 2-year follow-up. The sCXL group was subjected to CXL with 30 min of pre-soaking and 3 mW/cm² UVA irradiation for 30 min. The aCFXL group was subjected to CXL with 10 min of pre-soaking and UVA irradiation of 1.8 ± 0.9 mW/cm² for 10 min ± 1.5 min. In both groups, a solution of riboflavin–vitamin E TPGS was used. Uncorrected distance visual acuity, corrected distance visual acuity, pachymetry, Scheimpflug tomography, and corneal hysteresis were performed at baseline and after 24 months. Both groups showed a statistically significant improvement in corrected distance visual acuity, and keratometric and corneal hysteresis compared to baseline conditions; no statistically significant differences in outcomes between the two groups were observed. Improvement in refractive, topographic, and biomechanical parameters were observed after sCXL and aCFXL, making the riboflavin–VE-TPGS solution an effective option as a permeation enhancer in CXL procedures. Deeper stromal penetration of riboflavin could be complemented by photo-protection against UVA and free radicals formed during photoinduced processes. Full article

(This article belongs to the Special Issue Treatment of Cornea and Ocular Surface Diseases)

15 pages, 4119 KiB

Open AccessArticle

Establishment of a Robust and Simple Corneal Organ Culture Model to Monitor Wound Healing

by Sandra Schumann, Eva Dietrich, Charli Kruse, Salvatore Grisanti and Mahdy Ranjbar

J. Clin. Med. 2021, 10(16), 3486; https://doi.org/10.3390/jcm10163486 - 6 Aug 2021

Cited by 5 | Viewed by 2586

Abstract

The use of in vitro systems to investigate the process of corneal wound healing offers the opportunity to reduce animal pain inflicted during in vivo experimentation. This study aimed to establish an easy-to-handle ex vivo organ culture model with porcine corneas for the evaluation and modulation of epithelial wound healing. Cultured free-floating cornea disks with a punch defect were observed by stereomicroscopic photo documentation. We analysed the effects of different cell culture media and investigated the impact of different wound sizes as well as the role of the limbus. Modulation of the wound healing process was carried out with the cytostatic agent Mitomycin C. The wound area calculation revealed that after three days over 90% of the lesion was healed. As analysed with TUNEL and lactate dehydrogenase assay, the culture conditions were cell protecting and preserved the viability of the corneal tissue. Wound healing rates differ dependent on the culture medium used. Mitomycin C hampered wound healing in a concentration-dependent manner. The porcine cornea ex vivo culture ideally mimics the in vivo situation and allows investigations of cellular behaviour in the course of wound healing. The effect of substances can be studied, as we have documented for a mitosis inhibitor. This model might aid in toxicological studies as well as in the evaluation of drug efficacy and could offer a platform for therapeutic approaches based on regenerative medicine. Full article

(This article belongs to the Special Issue Treatment of Cornea and Ocular Surface Diseases)

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13 pages, 1159 KiB

Open AccessArticle

Visual Acuity and Number of Amniotic Membrane Layers as Indicators of Efficacy in Amniotic Membrane Transplantation for Corneal Ulcers: A Multicenter Study

by Javier Lacorzana, Antonio Campos, Marina Brocal-Sánchez, Juan Marín-Nieto, Oswaldo Durán-Carrasco, Esly C. Fernández-Núñez, Andrés López-Jiménez, Jose L. González-Gutiérrez, Constantinos Petsoglou and Jose L. García Serrano

J. Clin. Med. 2021, 10(15), 3234; https://doi.org/10.3390/jcm10153234 - 22 Jul 2021

Cited by 7 | Viewed by 2237

Abstract

Background: To evaluate new indicators in the efficacy of amniotic membrane transplantation (AMT) for non-healing corneal ulcers (NHCUs). Methods: Retrospective, multicenter study. In total, 223 AMTs for NHCU in 191 patients were assessed. The main outcomes studied were the success rate of AMT (complete re-epithelization), postoperative visual acuity (VA) gain, and number of AM layers transplanted. Results: The overall AMT success rate was 74.4%. In 92% of our patients VA stability or improvement. Postoperative VA was significantly higher than preoperative VA in the entire cohort (p < 0.001) and in all etiological groups of ulcers (post-bacterial, p ≤ 0.001; post-herpetic, p ≤ 0.0038; neurotrophic ulcers, p ≤ 0.014; non-rheumatic peripheral, p ≤ 0.001; and ulcers secondary to lagophthalmos and eyelid malposition or trauma, p ≤ 0.004). Most participants (56.5%) presented a preoperative VA equal to or less than counting fingers (≤0.01). Of these, 13.5% reached a postoperative VA equal to or better than legal blindness (≥0.05) after AMT. A higher success rate was observed in the monolayer than in the multilayer AMT (79.5% and 64.9%, respectively; p = 0.018). No statistically significant values were found between the number of layers transplanted and VA gain (p = 0.509). Conclusion: AMT is not only beneficial in achieving complete re-epithelialization in NHCUs but also in improving postoperative VA; these improvements are independent of etiologies of ulcers. Furthermore, the use of monolayer AMT seems to be a more appropriate option than multilayer AMT for NHCU since the multilayer AMT did not present better outcomes (success rate and VA gain) compared to monolayer AMT in the different types of ulcers studied. Full article

(This article belongs to the Special Issue Treatment of Cornea and Ocular Surface Diseases)

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Review

Jump to: Research

8 pages, 934 KiB

Open AccessReview

New Perspectives in the Pathophysiology and Treatment of Pain in Patients with Dry Eye Disease

by Giuseppe Giannaccare, Carla Ghelardini, Alessandra Mancini, Vincenzo Scorcia and Lorenzo Di Cesare Mannelli

J. Clin. Med. 2022, 11(1), 108; https://doi.org/10.3390/jcm11010108 - 25 Dec 2021

Cited by 9 | Viewed by 3370

Abstract

Ocular discomfort and eye pain are frequently reported by patients with dry eye disease (DED), and their management remains a real therapeutic challenge for the Ophthalmologist. In DED patients, injury at the level of each structure of the ocular surface can determine variable symptoms, ranging from mild ocular discomfort up to an intolerable pain evoked by innocuous stimuli. In refractory cases, the persistence of this harmful signal is able to evoke a mechanism of maladaptive plasticity of the nervous system that leads to increased pain responsiveness. Peripheral and, subsequently, central sensitization cause nociceptor hyperexcitability and persistent pain perception that can culminate in the paradoxical situation of perceiving eye pain even in the absence of ocular surface abnormalities. Effective therapeutic strategies of these cases are challenging, and new options are desirable. Recently, a theoretical novel therapeutic approach concerns enkephalins thanks to the evidence that eye pain sensations are modulated by endogenous opioid peptides (enkephalins, endorphins and dynorphins). In this regard, new topical agents open up a new theoretical scenario in the treatment of ocular discomfort and eye pain in the setting of DED, such as, for example, a multimolecular complex based on proteins and glycosaminoglycans also containing opiorphin that may assist the physiological pain-relieving mechanism of the eye. Full article

(This article belongs to the Special Issue Treatment of Cornea and Ocular Surface Diseases)

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22 pages, 15840 KiB

Open AccessReview

The Role of the Stromal Extracellular Matrix in the Development of Pterygium Pathology: An Update

by Javier Martín-López, Consuelo Pérez-Rico, Selma Benito-Martínez, Bárbara Pérez-Köhler, Julia Buján and Gemma Pascual

J. Clin. Med. 2021, 10(24), 5930; https://doi.org/10.3390/jcm10245930 - 17 Dec 2021

Cited by 4 | Viewed by 2634

Abstract

Pterygium is a benign fibrovascular lesion of the bulbar conjunctiva with frequent involvement of the corneal limbus. Its pathogenesis has been mainly attributed to sun exposure to ultraviolet-B radiation. Obtained evidence has shown that it is a complex and multifactorial process which involves multiple mechanisms such as oxidative stress, dysregulation of cell cycle checkpoints, induction of inflammatory mediators and growth factors, angiogenic stimulation, extracellular matrix (ECM) disorders, and, most likely, viruses and hereditary changes. In this review, we aim to collect all authors’ experiences and our own, with respect to the study of fibroelastic ECM of pterygium. Collagen and elastin are intrinsic indicators of physiological and pathological states. Here, we focus on an in-depth analysis of collagen (types I and III), as well as the main constituents of elastic fibers (tropoelastin (TE), fibrillins (FBNs), and fibulins (FBLNs)) and the enzymes (lysyl oxidases (LOXs)) that carry out their assembly or crosslinking. All the studies established that changes in the fibroelastic ECM occur in pterygium, based on the following facts: An increase in the synthesis and deposition of an immature form of collagen type III, which showed the process of tissue remodeling. An increase in protein levels in most of the constituents necessary for the development of elastic fibers, except FBLN4, whose biological roles are critical in the binding of the enzyme LOX, as well as FBN1 for the development of stable elastin. There was gene overexpression of TE, FBN1, FBLN5, and LOXL1, while the expression of LOX and FBLN2 and -4 remained stable. In conclusion, collagen and elastin, as well as several constituents involved in elastic fiber assembly are overexpressed in human pterygium, thus, supporting the hypothesis that there is dysregulation in the synthesis and crosslinking of the fibroelastic component, constituting an important pathogenetic mechanism for the development of the disease. Full article

(This article belongs to the Special Issue Treatment of Cornea and Ocular Surface Diseases)

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