Clinical effectiveness of topical cyclosporine a 0.05% after laser epithelial keratomileusis.

PURPOSE: To evaluate the effect of topical cyclosporine A 0.05% after laser epithelial keratomileusis (LASEK). METHODS: This retrospective nonrandomized comparative analysis was performed in 40 patients (80 eyes) with myopia who underwent flap-off LASEK. Twenty patients (group A) were treated with topical cyclosporine A 0.05% in combination with conventional treatment, and 20 patients (group B) received conventional treatment only. In each group, 10 patients had preoperative dry eye. Uncorrected visual acuity, refractive error, corneal haze grade, symptom score, and ocular surface parameters were measured in both groups before LASEK and at 1, 2, 4, and 8 weeks postoperatively. RESULTS: There were no significant differences between the groups in postoperative uncorrected visual acuity, spherical equivalent, corneal haze grade, Schirmer test values, and keratoepitheliopathy scores. Group A had lower symptom scores (0.80 ± 0.52 vs.1.35 ± 0.49; P < 0.01) and higher tear film break-up time (BUT) (8.05 ± 1.39 vs. 6.55 ± 1.39 seconds; P < 0.01) compared with group B at 4 weeks after LASEK. In addition, in preoperative dry eye patients, symptom scores and tear film BUT returned to preoperative level at 4 weeks postoperatively in group A, whereas they returned to preoperative level at 8 weeks in group B. CONCLUSIONS: Treatment with topical cyclosporine A 0.05% can improve ocular discomfort and increase tear film BUT during the early postoperative period, especially in patients with preoperative dry eye.

Expression of CCR5 and its ligands CCL3, -4, and -5 in the tear film and ocular surface of patients with dry eye disease.

PURPOSE: To evaluate the expression of CCR5 and its ligands CCL3, CCL4, and CCL5 in the tear film and ocular surface and their correlation with disease severity in patients with dry eye disease. MATERIALS AND METHODS: The concentrations of CCL3, CCL4, and CCL5 were measured using enzyme-linked immunosorbent assay in tear samples obtained from forty-three patients with dry eye (17 SS and 26 non-SS patients) and 20 control subjects. The correlation between chemokine levels and tear film and ocular surface parameters was analyzed. Expression of the chemokines and their receptor in the conjunctiva was evaluated using immunohistochemistry. Flow cytometry was performed to detect CCR4+CD4+, CCR5+CD4+, and CCR6+CD4+ cells in the conjunctiva. RESULTS: The concentrations of CCL3, CCL4, and CCL5 were 25.3 ± 24.2, 4.65 ± 3.21, and 93.12 ± 26.31 pg/mL in control subjects, 92.33 ± 13.23, 263.13 ± 116.13, and 253.64 ± 46.29 pg/mL in patients with non-SS, and 215.56 ± 36.1, 697.85 ± 185.65, and 456.12 ± 92.82 pg/mL in patients with SS. The concentrations showed a significant increase in tears of SS patients compared with those of non-SS patients and control subjects (p < 0.05). CCL5 levels showed significant correlation with tear film break-up time, basal tear secretion, tear clearance rate, keratoepitheliopathy score, and goblet cell density (p < 0.01). Staining for the chemokines and their receptor increased in dry eye patients, especially in those with SS patients. Flow cytometry demonstrated increased numbers of CCR5+CD4+, and CCR6+CD4+ cells in dry eye patients in contrast to CCR4+CD4+ cells. CONCLUSIONS: Expression of CCR5 and its ligands CCL3, CCL4, and CCL5 increase in the tear film and ocular surface of patients with dry eye syndrome, especially in those with SS. CCL5 levels correlate significantly with various tear film and ocular surface parameters.

Usefulness of double vital staining with 1% fluorescein and 1% lissamine green in patients with dry eye syndrome.

PURPOSE: To determine the relative staining characteristics of the nasal and temporal conjunctiva as compared with other measures of dry eye and evaluate the qualitative clinical impression of the utility of the double vital staining with fluorescein and lissamine green. METHODS: Ocular surface staining was performed with a mixture of 1% fluorescein and 1% lissamine green in 50 patients with dry eye (12 patients with Sjögren syndrome and 38 patients with non-Sjögren syndrome). Ocular surface disease index (OSDI), tear breakup time (BUT), and Schirmer test were evaluated. Digital photographs were taken after vital staining on the ocular surface, and the grade of staining in various areas was assessed. Correlation among the degrees of staining, OSDI, and ocular surface parameters was analyzed. RESULTS: The nasal conjunctiva evidenced greater staining compared with the temporal conjunctiva and cornea (P = 0.04). Staining of the nasal conjunctiva showed significant correlation with OSDI (P < 0.01) and BUT (P = 0.03). Staining of the temporal conjunctiva correlated significantly with OSDI (P = 0.01), and staining of the cornea correlated with BUT (P = 0.02). CONCLUSIONS: Double vital staining with 1% fluorescein and 1% lissamine green correlates with symptoms and some ocular surface parameters in patients with dry eye and helps to identify ocular surface changes easily. It may be a useful method for the diagnosis of dry eye and the assessment of the therapeutic effect in patients with dry eye syndrome.

Photodynamic therapy with verteporfin combined with subconjunctival injection of bevacizumab for corneal neovascularization.

PURPOSE: To investigate the efficacy of combined photodynamic therapy with verteporfin and subconjunctival injection of bevacizumab for the treatment of patients with corneal neovascularization. METHODS: Twelve eyes of 12 patients with stable corneal neovascularization who were refractory to conventional treatment were treated with photodynamic therapy with verteporfin (6 mg/m) and subconjunctival injection of bevacizumab (2.5 mg/0.1 mL). Anterior segment photography was performed before and after treatment. Best-corrected visual acuity, cumulative length of corneal blood vessels, and area of corneal neovascularization were measured. RESULTS: From 1 week to 1 month after treatment, all eyes showed a notable decrease in corneal neovascularization and evidence of vascular thrombosis. At the 6-month and 1-year follow-ups, complete vascular occlusion was achieved in 8 eyes (66.7%) and partial occlusion was achieved in 3 eyes (25.0%). One eye (8.3%) showed revascularization after temporary occlusion. No ocular complications or systemic events developed. CONCLUSIONS: Photodynamic therapy with verteporfin combined with subconjunctival injection of bevacizumab seems to be effective for the treatment of corneal neovascularization.

Corneal perforation with preseptal cellulitis in a patient with acute lymphocytic leukemia.

We report a case of corneal perforation with preseptal cellulitis in a patient with acute lymphocytic leukemia (ALL). A 17-yr-old female patient who was undergoing combination chemotherapy for ALL was referred due to upper lid swelling and pain in the right eye for 2 days. Visual acuity in the right eye was 20/20. Initial examination showed no abnormal findings, other than swelling of the right upper eyelid. Computed tomography showed a finding of preseptal cellulitis. Microbiologic study of bloody and purulent discharge revealed Serratia marcescens. Corneal melting and perforation with iris prolapse were detected in the right eye on the 16th day. Emergent tectonic keratoplasty was performed. Seven months after surgery, visual acuity in the right eye was 20/300, and the corneal graft was stable.

Combined ethylenediaminetetraacetic acid chelation, phototherapeutic keratectomy and amniotic membrane transplantation for treatment of band keratopathy.

PURPOSE: The objective of this study is to evaluate the therapeutic efficacy of ethylenediaminetetraacetic acid (EDTA) chelation and excimer laser phototherapeutic keratectomy (PTK) combined with amniotic membrane transplantation (AMT) for the treatment of band keratopathy (BK). METHODS: Eleven eyes in ten patients with BK received combined PTK (ablation zone of central 7.0-7.5 mm, depth of 50 microm), EDTA chelation (0.05 M, 3 minutes), and amniotic membrane transplantation using fibrin glue. Preand postoperative best corrected visual acuities, symptom changes, reepithelialization time, cosmesis, recurrence, and complications were analyzed. RESULTS: Visual acuity improved in three eyes (27.3%) and did not change in eight eyes (72.7%). Symptoms improved in all patients, and the mean reepithelialization time was 10.6+/-5.3 days. The cosmetic results were good in eight eyes (72.7%) and were fair in three eyes (27.3%). During the mean follow-up period of 11.4+/-6.1 months (range, 6 to 23 months), no postoperative complications or recurrences were observed. CONCLUSIONS: The combination of EDTA chelation, PTK, and AMT is safe and effective for the treatment of band keratopathy.

Effect of myopia on the thickness of the retinal nerve fiber layer measured by Cirrus HD optical coherence tomography.

PURPOSE: To evaluate the effect of myopia on the peripapillary retinal nerve fiber layer (RNFL) thickness measured by Cirrus HD optical coherence tomography (OCT). METHODS: Comprehensive ophthalmic examinations were performed, including measurement of visual acuity, refraction, and axial length on 269 subjects (age, 19-26 years) with no ophthalmic abnormality. Further, 200 x 200-cube optic disc scans of the subjects' eyes were obtained with Cirrus HD OCT. The RNFL thickness at 256 points of the RNFL thickness profile and the average RNFL thickness were recorded. The correlations between these values and the axial length and spherical equivalent (SE) of refractive errors were then analyzed by simple linear regression, before and after adjustment of the ocular magnification. RESULTS: Before ocular magnification adjustment, the uncorrected average RNFL thickness decreased as the axial length increased and as the SE decreased. However, after the adjustment, the corrected average RNFL thickness exhibited no correlation with the spherical equivalent and a weak positive correlation with the axial length. Myopia also affected the RNFL thickness distribution. As the axial length increased and the spherical equivalent decreased, the thickness of the temporal peripapillary RNFL increased and that of the superior, superior nasal, inferior, and inferior nasal peripapillary RNFL decreased. CONCLUSIONS: The axial length affected the average RNFL thickness, and myopia affected the RNFL thickness distribution. High myopes are likely to exhibit different RNFL distribution patterns. Since ocular magnification significantly affects the RNFL measurement in such patients, it should be considered in diagnosing glaucoma.

Analysis of peripapillary retinal nerve fiber distribution in normal young adults.

PURPOSE. To determine the anatomic variations in the peripapillary retinal nerve fiber layer (RNFL) thickness distribution and the relationship between these anatomic variations and other ocular variables. METHODS. A complete ophthalmic examination, including measurement of visual acuity, refraction, and axial length, was performed on 269 subjects with no ophthalmic abnormalities. Further, fundus photographs and optic disc cube scans of the subjects' eyes were obtained with a fundus camera and spectral domain OCT (Cirrus HD-OCT; Carl Zeiss Meditec, Inc., Dubin, CA), respectively. The distance between the foveola and the center of the optic nerve head was measured. The correlations of the angles of the peaks in the RNFL thickness profile with the axial length, spherical equivalent of refractive error (SE), and distance between the foveola and optic disc center were analyzed by simple linear regression. RESULTS. Considerable interindividual variations were found in the angles of the peaks in the RNFL thickness profile. Further, the angles in the eyes in each individual showed significant differences. The angles of the superior and inferior first peak correlated significantly with the SE, axial length, and distance between the foveola and optic disc center. CONCLUSIONS. Subjects with increased distance between the foveola and optic disc center are likely to have a temporal shift in peak RNFL thickness. RNFL profiles with horizontally deviated peak RNFL thickness differ considerably from the normative data provided with the HD-OCT system. The variations in RNFL thickness profiles should be taken into account.

Recurrent herpes simplex keratitis after verteporfin photodynamic therapy for corneal neovascularization.

PURPOSE: To report a case of recurrent herpes simplex keratitis after verteporfin photodynamic therapy for corneal neovascularization. METHODS: A 69-year-old man who had lipid keratopathy with corneal neovascularization secondary to herpes simplex keratitis in the right eye and who was treated with topical steroid received photodynamic therapy with verteporfin. Six neovascular areas in the cornea were treated consecutively to occlude new vessels and reduce the risk of allograft rejection after subsequent keratoplasty. RESULTS: Three days after verteporfin photodynamic therapy, there was evidence of vascular occlusion. However, a herpetic epithelial ulcer was detected in the cornea. Ten days after treatment, the lesion progressed to a geographic ulcer. After topical and systemic acyclovir treatment, the lesion healed. Five months after treatment, penetrating keratoplasty and postoperative antiviral prophylaxis were performed. During a follow-up period of 12 months, the graft remained clear with visual acuity of 20/40. CONCLUSION: Herpes simplex keratitis can recur after verteporfin photodynamic therapy for corneal neovascularization.

Remarkably enhanced stability and function of core/shell nanoparticles composed of a lecithin core and a pluronic shell layer by photo-crosslinking the shell layer: in vitro and in vivo study.

A core/shell nanoparticle system with a lecithin core and a pluronic shell has been previously reported, and it was shown to act as an effective sustained release system for positively charged proteins. Here, to provide improved stability of the core/shell nanoparticle system in a physiological environment, we prepared the core/shell nanoparticle system with a photo-crosslinked shell layer by using a lecithin liposome as the core and pluronic F 127 diacrylate (DA-PF 127) as the shell layer. The DA-PF 127 was then photo-polymerized. Compared with a purely physical system, chemical crosslinking of the shell layer resulted not only in significantly increased structural stability of the core/shell nanoparticles in both an organic co-solvent and in serum but also several remarkably enhanced functioning as a protein delivery system. First, the chemically crosslinked systems were resuspended in aqueous solution after lyophilization without using a cryo-protectant. Second, target proteins were efficiently loaded into the nanoparticles by simple co-incubation in aqueous solution at a low temperature (4 degrees C) and the dried powder form of the protein-loaded nanoparticles was obtained. The loading capacity of the system was increased by more than 10 times compared with that of a purely physical system. Most importantly, the chemically crosslinked system showed more sustained release of the loaded proteins, and the release rate was not noticeably affected by the presence of serum proteins, whereas sustained release of loaded vascular endothelial growth factor (VEGF) in a purely physical system was greatly reduced by serum proteins. In an in vivo corneal angiogenesis assay the chemically crosslinked system loaded with VEGF resulted in more efficient new blood vessel formation than the physical system.

Expression of CXCL9, -10, -11, and CXCR3 in the tear film and ocular surface of patients with dry eye syndrome.

PURPOSE: To investigate the expression of CXCL9, -10, -11, and CXCR3 in the tear film and ocular surface of patients with dry eye syndrome. METHODS: Thirty-three patients with dry eye (16 with and 17 without Sjögren's syndrome) and 15 control subjects were recruited. The concentrations of CXCL9, -10, and -11 in tears were measured with enzyme-linked immunosorbent assays. The correlation between chemokine levels and tear film and ocular surface parameters was analyzed. The expression of CXCL9, -10, -11, and CXCR3 in the conjunctiva was evaluated by using immunohistochemistry. Flow cytometry was performed to count CXCR3(+) cells and CXCR3(+)CD4(+) cells in the conjunctiva. RESULTS: The concentrations of CXCL9, -10, and -11 were 1,148 +/- 1,088, 24,338 +/- 8,706, and 853 +/- 334 pg/mL, in the patients with dry eye, and 272 +/- 269 (P = 0.01), 18,149 +/- 5,266 (P = 0.02), and 486 +/- 175 (P < 0.01) pg/mL in the control subjects, respectively. The concentrations significantly increased in tears of the patients with Sjögren's syndrome compared with those of the patients with non-Sjögren's dry eye (P < 0.05). CXCL10 levels correlated significantly with basal tear secretion, and CXCL11 levels correlated significantly with basal tear secretion, tear clearance rate, keratoepitheliopathy score, and goblet cell density (P < 0.05). Staining for CXCL9, -10, -11, and CXCR3 increased in patients with dry eye, especially in the patients with Sjögren's syndrome. Flow cytometry demonstrated an increased number of CXCR3(+) and CXCR3(+)CD4(+) cells in all the patients with dry eye. CONCLUSIONS: Expression of CXCL9, -10, -11, and CXCR3 increased in the tear film and ocular surface of patients with dry eye syndrome, especially in those with Sjögren's syndrome. CXCL11 levels correlated significantly with various tear film and ocular surface parameters. (ClinicalTrials.gov number, NCT00991679.).

Prognosis of paraquat-induced ocular surface injury: therapeutic effect of amniotic membrane transplantation.

PURPOSE: To investigate the prognosis of paraquat-induced ocular surface injury and the therapeutic efficacy of amniotic membrane transplantation for the treatment of ocular surface damage. METHODS: Twenty patients (26 eyes) with ocular surface injury caused by paraquat were studied. Twelve patients (14 eyes) underwent amniotic membrane transplantation combined with medical treatment (group A), and 8 patients (12 eyes) received medical treatment only (group B). Visual acuity, time to epithelial defect closure, stromal haze, and complications were analyzed. RESULTS: The grade of the ocular surface injury was mild in 19 eyes (73.1%). Visual acuity improved in 20 eyes (76.9%). The epithelial defect healed completely in 25 eyes (96.2%), with a mean healing time of 16.04 +/- 6.22 days. At the final visit, 80.8% of cases had no stromal haze. The mean time to epithelial defect closure was 13.43 +/- 3.55 days in group A and 19.18 +/- 7.25 days in group B (P = 0.03). Complications included punctal stenosis (2 eyes) and pannus (1 eye) in group A and conjunctivalization (1 eye) and symblepharon (1 eye) in group B. CONCLUSIONS: Paraquat-induced ocular surface injury had a relatively good prognosis. Amniotic membrane transplantation was helpful in shortening the time to closure of the epithelial defect.

Therapeutic effect of intracameral amphotericin B injection in the treatment of fungal keratitis.

PURPOSE: To study the therapeutic efficacy of intracameral amphotericin B (ICAMB) injection in the treatment of fungal keratitis. METHODS: Fourteen patients with fungal keratitis received ICAMB, 10 microg/0.1 mL (group A), and 17 patients received conventional treatment only (group B). Visual acuity, time to hypopyon disappearance, time to epithelial defect closure, time to final improvement, and final outcome were analyzed and compared between the 2 groups. The concentration of amphotericin B in the aqueous humor after injection was measured using high-performance liquid chromatography. RESULTS: The mean final visual acuity (log MAR) was 1.6 +/- 1.1 in group A and 1.3 +/- 1.4 in group B (P = 0.24). The mean time to disappearance of hypopyon, epithelial defect closure, and final improvement was 9.4 +/- 9.4, 19.8 +/- 10.4, and 26.6 +/- 9.2 days in group A and 26.7 +/- 21.3 (P = 0.03), 32.6 +/- 22.8 (P = 0.08), and 52.8 +/- 38.2 days (P = 0.04) in group B, respectively. At the last follow-up, treatment success was achieved in 92.9% of group A and 82.4% of group B (P = 0.38). The mean concentration of intracameral amphotericin B was 601.6 +/- 51.3 ng/mL at 6 hours, 98.8 +/- 43.1 ng/mL at 1 day, 57.0 +/- 11.6 ng/mL at 3 days, and 52.3 +/- 8.3 ng/mL at 7 days after injection. CONCLUSIONS: ICAMB seems to be effective in reducing time to disappearance of hypopyon and final improvement in the treatment of fungal keratitis.

Photodynamic therapy with verteporfin for corneal neovascularization.

PURPOSE: To investigate the efficacy of photodynamic therapy with verteporfin for the treatment of patients with corneal neovascularization. DESIGN: Prospective interventional case series. METHODS: Eighteen eyes of 18 patients with stable corneal neovascularization who were refractory to conventional treatment were treated with photodynamic therapy with verteporfin (6 mg/m(2)). Five patients were treated following penetrating keratoplasty (PK), and two patients were treated before PK. Anterior segment photography was performed before and after treatment. Best-corrected visual acuity (BCVA) and area of corneal neovascularization were measured. RESULTS: At the one-year follow-up, 14 eyes (77.8%) showed a decrease in corneal neovascularization, and nine eyes (50.0%) showed complete vascular occlusion. In five patients who had corneal allograft, complete or partial occlusion was achieved in all eyes. Two patients who underwent subsequent keratoplasty did not manifest allograft rejection or revascularization. Seventeen eyes (94.4%) had stable or improved vision. The mean area of corneal neovascularization significantly decreased from 25.5 +/- 14.2 mm(2) to 14.9 +/- 14.6 mm(2) (P < .01), respectively. No significant complications associated with photodynamic therapy were observed except mild stromal haze in one eye. CONCLUSION: Photodynamic therapy with verteporfin may be effective for the treatment of corneal neovascularization.

Comparison of autologous serum and umbilical cord serum eye drops for dry eye syndrome.

PURPOSE: To compare the therapeutic effect between autologous serum and umbilical cord serum eye drops in the treatment of severe dry eye syndrome. DESIGN: Prospective case-control study. METHODS: Ninety-two eyes of 48 patients with severe dry eye syndrome (34 eyes of 17 patients with Sjögren syndrome and 58 eyes of 31 patients with non-Sjögren syndrome) were treated with either 20% autologous serum (41 eyes of 21 patients) or umbilical cord serum eye drops (51 eyes of 27 patients). Symptom scoring, corneal sensitivity test, tear film break-up time (BUT), Schirmer test, tear clearance rate (TCR), corneal fluorescein staining, and conjunctival impression cytologic analysis were performed before and one month and two months after treatment. RESULTS: Both autologous serum and umbilical serum treatments led to improvement in the symptom score, tear film BUT, keratoepitheliopathy score, and impression cytologic findings. Symptom and keratoepitheliopathy scores were lower at one month (P = .03 and P = .12) and two months (P = .04 and .02) for those treated with umbilical cord serum compared with those treated with autologous serum. In Sjögren syndrome patients, goblet cell density was higher at two months of umbilical cord serum treatment compared with autologous serum treatment (P = .04). CONCLUSIONS: Umbilical cord serum eye drops were more effective in decreasing symptoms and keratoepitheliopathy in severe dry eye syndrome and increasing goblet cell density in Sjögren syndrome compared with autologous serum eye drops.

Application of umbilical cord serum eyedrops for the treatment of neurotrophic keratitis.

PURPOSE: To investigate the efficacy of umbilical cord serum eyedrops for the treatment of neurotrophic keratitis. DESIGN: Prospective noncomparative case series. PARTICIPANTS: Twenty-eight eyes of 28 patients with neurotrophic keratitis who were refractory to conventional treatment. METHODS: The patients with neurotrophic keraitis were treated with 20% umbilical cord serum eyedrops 6 to 10 times a day. Ophthalmic examinations including best-corrected visual acuity (VA) measurement, corneal sensitivity test, corneal fluorescein staining, and anterior segment photography were performed before and after the treatment. Concentrations of substance P, insulinlike growth factor 1 (IGF-1), and nerve growth factor (NGF) in umbilical cord serum, normal peripheral blood serum, and tears were measured. MAIN OUTCOME MEASURES: Epithelial healing time; changes of VA and corneal sensitivity after treatment; and levels of substance P, IGF-1, and NGF in umbilical cord serum, normal peripheral blood serum, and tears. RESULTS: The epithelial defect healed completely in all eyes, with a mean healing time of 4.4+/-4.0 weeks. The epithelial defect healed within 2 weeks in 8 eyes (28.6%), between 2 and 4 weeks in 14 eyes (50.0%), and after 4 weeks in 6 eyes (21.4%). After treatment, VA improved by >2 lines in 17 eyes (60.7%). Mean pretreatment corneal sensitivity was 21.1+/-10.5 mm, and mean posttreatment corneal sensitivity was 24.3+/-11.7 mm (P<0.01). Mean concentrations of substance P, IGF-1, and NGF were 245.3+/-53.9 pg/ml, 239.0+/-77.1 ng/ml, and 729.7+/-72.0 pg/ml in umbilical cord serum; 169.5+/-81.0 pg/ml, 375.5+/-51.3 ng/ml, and 401.7+/-98.1 pg/ml in peripheral blood serum; and 69.8+/-24.9 pg/ml, 75.7+/-50.5 ng/ml, and 107.5+/-70.9 pg/ml in tears, respectively. CONCLUSIONS: Umbilical cord serum contains many neurotrophic factors, and umbilical cord serum eyedrops appeared to be effective for the treatment of neurotrophic keratitis.

Application of umbilical cord serum eyedrops for the treatment of dry eye syndrome.

PURPOSE: To investigate the efficacy of umbilical cord serum eyedrops for the treatment of severe dry eye syndrome. METHODS: Fifty-five eyes of 31 patients with severe dry eye syndrome were treated with umbilical cord serum eyedrops. Symptom scoring, tear film break-up time (BUT), Schirmer test, corneal sensitivity test, and corneal fluorescein staining were performed before and 1 and 2 months after treatment, and conjunctival impression cytology was performed before and 2 months after treatment. The concentrations of epidermal growth factor (EGF), vitamin A, and transforming growth factor-beta (TGF-beta) in umbilical cord serum and normal peripheral blood serum were measured. RESULTS: Two months after treatment, significant improvement was observed in symptom score (from 3.07 +/- 0.54 to 0.96 +/- 0. 58), BUT (from 3.96 +/- 1.56 to 5.45 +/- 2.54 seconds), and keratoepitheliopathy score (from 4.87 +/- 3.22 to 1.71 +/- 1.84) (P < 0.01). There was no statistically significant change in Schirmer and corneal sensitivity tests. In impression cytology, the grade of squamous metaplasia (from 2.35 +/- 0.72 to 1.44 +/- 0.69) and goblet cell density (from 80.91 +/- 31.53 to 154.68 +/- 43.06 cell/mm) improved significantly (P < 0.01). The mean concentrations of EGF, TGF-beta, and vitamin A were 0.48 +/- 0.09, 57.14 +/- 18.98, and 230.85 +/- 13.39 ng/mL in umbilical cord serum and 0.14 +/- 0.03, 31.30 +/- 12.86, and 372.34 +/- 22.32 ng/mL in peripheral blood serum, respectively. CONCLUSION: Umbilical cord serum contains essential tear components, and umbilical cord serum eyedrops are effective and safe for the treatment of severe dry eye syndrome.

Experimental inhibition of corneal neovascularization by photodynamic therapy with verteporfin.

PURPOSE: To investigate the anti-angiogenic effects of photodynamic therapy with verteporfin in a rabbit model of corneal neovascularization. METHODS: One week after suturing, the localization of verteporfin in the neovascularized cornea was examined through fluorescent microscopy 1 hr after administration. Rabbits were treated with one or two times of photodynamic therapy with verteporfin at 1-week intervals. Analysis of corneal neovascularization was performed by biomicroscopic and histological examinations. RESULTS: Fluorescent microscopy showed green fluorescence in the vascular walls and interstitial tissue of the corneal stroma. The mean percentages of neovascularized corneal area at 3 days, 1 week, and 2 weeks after one time of photodynamic therapy were 90.3% +/- 3.5%, 71.6% +/- 6.2%, and 43.6% +/- 15.1% in treated eyes and 96.4% +/- 1.9% (p = 0.10), 88.6% +/- 4.6% (p = 0.01), and 76.8% +/- 4.4% (p < 0.01) in control eyes, respectively. The mean percentages 3 days, 1 week, and 2 weeks after two times of photodynamic therapy were also significantly lower in treated eyes compared with control eyes. In quantitative histological examination at 1 and 2 weeks after therapy, treated eyes showed significantly less neovascular area and number of vessels than control eyes. CONCLUSIONS: Photodynamic therapy with verteporfin is a safe and useful procedure to reduce experimental corneal neovascularization and can be used to inhibit angiogenesis in the cornea.