Efficacy of Long-term Use of 0.3% Sodium Hyaluronate Eye Drops for Traumatic Corneal Abrasion: A Randomized Controlled, Pilot Trial.

PURPOSE: Traumatic corneal abrasion (TCA) causes damage to both corneal epithelium and the underlying hemidesmosomal junctions. Delayed recovery of hemidesmosomal junctions causes symptomatic episodes. However, there is no recommended treatment for recovery of hemidesmosomal junctions, indicating that a blank period exists in TCA treatment. In this study, the efficacy of long-term use of sodium hyaluronate on recovery of hemidesmosomal junctions during the blank period in TCA healing was investigated. METHODS: In this prospective, randomized control pilot study, 60 patients with TCA were enrolled. The patients were randomized 1:1 to receive 0.3% sodium hyaluronate eye drops for 3 months (HA group) or observation alone (control group) after complete corneal epithelium recovery. The primary and secondary outcomes were the cumulative incidence of major and minor symptomatic episodes during a 12-month follow-up, respectively. RESULTS: Fifty-six subjects (29 in the HA group and 27 in the control group) completed the 12-month follow-up. The 12-month cumulative incidence rate of major symptomatic episodes was 20.7% in the HA group and 18.5% in the control group. No significant difference was found between the 2 groups (P = 0.838). The 12-month cumulative incidence rate of minor symptomatic episodes was 48.3% and 37.0% in the HA and control groups, respectively, with no significant difference (P = 0.397). CONCLUSIONS: Approximately one-fifth of patients with TCA experience major symptomatic episodes again within their 1-year follow-up. Long-term use of sodium hyaluronate in the period of recovery of hemidesmosomal junctions has no benefit to it.

Repeat Keratoplasty for Failed Therapeutic Keratoplasty for Microbial Keratitis: An Analysis of Characteristics and Risk Factors.

PURPOSE: To report the ratio of repeat-to-initial keratoplasty among patients who had underwent therapeutic keratoplasty for microbial keratitis in Southern China and to investigate the characteristics and risk factors of repeat keratoplasty. METHODS: A retrospective and inclusive review of the clinical records of patients who had received therapeutic keratoplasty for microbial keratitis, at Zhongshan Ophthalmic Center during December 2012 to January 2018, was performed. Patients who suffered coexistent endophthalmitis or underwent keratoplasty combined with other surgeries were excluded. Data on clinical characteristics of all eligible patients were collected. RESULTS: A total of 447 patients were identified. Their mean age was 48.7 ± 15.5 years, and 290 (64.9%) were male. Out of the 447 patients, 18 (4.0%) received repeat keratoplasty. Their mean age was 45.9 ± 11.3 years, and 14 (77.8%) were male. The most common indication of repeat keratoplasty (12/18) was refractory infectious keratitis. Most of the patients (15/18, 83.3%) received the second keratoplasty within 12 months after the initial keratoplasty. Factors, including age, gender, initial causative organism, presence of initial corneal perforation, ocular comorbidities, and surgical procedures were not found statistically significantly different between patients who received and not received repeat keratoplasty. CONCLUSION: The ratio of repeat-to-initial keratoplasty for therapeutic keratoplasty is low, compared to a failure rate of the initial grafts of over 50% reported in previous studies. The low ratio and the most common indication of repeat keratoplasty, refractory infectious keratitis, reflect caution for performing regrafts in such patients.