Survey report on keratoplasty in China: A 5-year review from 2014 to 2018.

To provide the general information on corneal transplantation (CT) in China, China Cornea Society designed a questionnaire on CT from 2014 to 2018 and entrusted it to 31 committee members for implementation of the survey nationwide. This article presents the results of the survey and compares the indicators used in the survey and those in the annual statistical report released by the Eye Bank Association of America (EBAA). The number of corneal transplantations completed by the 64 hospitals from 2014 to 2018 was respectively 5377, 6394, 7595, 8270 and 8980, totally 36,616 (22,959 male and 13,657 female). The five largest hospitals by the number of corneal transplantations completed 15,994 surgeries in total, accounting for 43.68% of all the surgeries performed in the 64 hospitals. The most common indication for corneal transplantations was corneal leukoma (7683, 20.98%), followed by bacterial keratitis (4209, 11.49%), corneal dystrophies (4189, 11.44%), keratoconus (3578, 9.77%) and corneal perforation (2839, 7.75%). The main surgical techniques were penetrating keratoplasty (PK) (19,896, 54.34%), anterior lamellar keratoplasty (ALK) (13,869, 37.88%). The proportion of PK decreased from 57.97% in 2014 to 52.88% in 2018 while the proportion of ALK increased from 36.04% in 2014 to 37.92% in 2018. The geographical distribution of keratoplasties performed in China is unbalanced. PK and ALK were the main techniques of CT and corneal leukoma, bacterial keratitis and corneal dystrophies were the main indications for CT in China.

A novel mutation in C5L2 gene was associated with hyperlipidemia and retinitis pigmentosa in a Chinese family.

BACKGROUND: Previous studies indicated that hyperlipidemia was associated with retinitis pigmentosa (RP). We aimed to identify the mutations in the C5L2 gene which was reported to be associated with hyperlipidemia in a Chinese family with (RP). METHODS: The Proband from the family was screened for mutations in the C5L2 gene that was known to cause hyperlipidemia. Cosegregation analysis was performed in the available family members. Linkage analysis was performed for one missense mutation to calculate the likelihood of its pathogenicity. One hundred and fifty unrelated, healthy Chinese subjects were screened to exclude nonpathogenic polymorphisms. RESULTS: By direct sequencing method, we identified a novel mutation (Thr196Asn) in C5L2 gene. In this family, each affected family members with RP showed a heterozygous mutation in the C5L2 gene. And all the carriers with heterozygous mutation have increased serum lipid levels in this family. CONCLUSIONS: The present study has extended the mutation spectrum of C5L2, and Thr196Asn mutations in C5L2 were associated with RP and serum lipid levels.

Toxicity and pharmacokinetics of intrastromal injection of amphotericin B in a rabbit model.

PURPOSE: To investigate the ocular toxicity and pharmacokinetics of intrastromal injection of amphotericin B (AmB) in a rabbit model. METHODS: Forty albino rabbits were randomly divided into five groups (eight per group). The rabbits were anesthetized before they received the medication. Intrastromal injection of 0.1 ml balanced salt solution containing 0, 5, 10, 20 or 30 µg of AmB was performed on eyes of each group five times (once per four days), respectively. The presence of possible corneal clouding, epithelial erosion and corneal neovascularization was monitored with a slit-lamp biomicroscope. Corneal ultrasonic pachymetry was used to detect the corneal thickness of intrastromal-injected eyes. Thirty days after the last injection, the corneal transparency as well as the number and ultrastucture of corneal endothelial cells were examined. The concentrations of the AmB in the cornea and aqueous humor were evaluated at 30 min, 6 h and at 1, 3 and 7 days after the intrastromal injection of 10 µg AmB. RESULTS: Intrastromal injection of AmB at concentrations of 5 and 10 µg per 0.1 ml did not induce obvious toxicity to the cornea when compared with the controls. However, when the concentration of AmB increased to 20 µg per 0.1 ml or more, corneal edema, corneal epithelial erosion and severe neovascularization appeared. A single intrastromal injection of 10 µg AmB achieved an effective drug level in corneas which was maintained for up to 7 days. CONCLUSIONS: Intrastromal injection of AmB at a concentration of less than 10 µg per 0.1 ml is safe to the rabbit corneas. Intrastromal injection of AmB may be an adjunctive treatment for deep recalcitrant fungal keratitis.

[Effects of tobramycin dexamethasone eye ointment for blepharitis: multi-center clinical trial].

OBJECTIVE: To realize the effectiveness and security of Tobramycin and Dexamethasone Eye Ointment for blepharitis treatment. Design Case control studies. Participants 148 patients be diagnosed as blepharitis including 81 cases as research group and 67 cases as control group. METHODS: Multi-center randomized controlled clinical trial. The patients met the inclusion criteria from First Hospital Peking University, Beijing Tongren Hospital, Southwest Hospital, Ophthalmology Center Zhongshan University and Third Hospital Peking University were divided into two groups in Aug. to Dec. 2011. Tobramycin dexamethasone eye ointment was applied to eye lid in research group while patients in control group used tobramycin eye ointment. All patients were informed to apply warm compress to the lids, mechanically washing to the eyelids and artificial tears. At the beginning, the 7(th) day, the 14(th) day and the 28(th) day of treatment, observation of symptom, sign and side effect were recorded. RESULTS: Before treatment the difference of the symptom scores of burning sensation, tears, photophobia and itch of two groups has no statistically significant (t = 1.87, 0.43, -0.64, 0.93, P > 0.05), but the symptom scores have a statistically significant decrease (t = 1.99 - 6.90, P < 0.05) at the 7(th) day, 14(th) day, 28(th) day. Before treatment the difference of signs scores have no statistically significant except the term of new blood vessels (t = 2.32, P = 0.02) while all the signs scores have a statistically significant decrease at the 7(th) day, 14(th) day, 28(th) day. Side effect: the number of patients with elevated intraocular pressure of research and control group is 3 and 1 respectively and the ratio is 3.7% and 1.5%. CONCLUSIONS: The tobramycin dexamethasone eye ointment can improve signs and symptoms of blepharitis patients. Some patients have to face with the risk of elevated intraocular pressure and it's necessary to monitor the intraocular pressure.

[A primary study of L-carnitine protective effect on corneal and conjunctival epithelium of mouse dry eye model induced by hyperosmolar saline].

OBJECTIVE: To evaluate protective effects of L-carnitine on corneal and conjunctival epithelium of mouse dry eye model induced by hyperosmolar saline. METHODS: Sixty female BALB/c mice at the age of 6 - 8 weeks were randomly divided into three groups (20 in each): Hyperosmolar saline group (HO), Hyperosmolar and Isosmotic saline group (HO + IO), as well as Hyperosmolar saline and 1% L-carnitine group (HO + 1%LCA). The HO group was treated with 500 mOsmol/L sodium chloride solution; the HO + IO group with 308 mOsmol/L sodium chloride solution first and 500 mOsmol/L sodium chloride solution 30 minutes later; and the HO + 1%LCA group with 1%L-carnitine eye drop first and 500 mOsmol/L sodium chloride solution 30 minutes later. Alternately, 5 times a day for 28 days. Corneal fluorescein staining, corneal epithelial hematoxylin-eosin staining and thickness measurement, conjunctival epithelial periodic acid-schiff reagent staining and goblet cell counting were conducted on 0, 7th, 14th and 28th days, respectively. On 28th day, corneal surface was inspected by scaning electron microscopy and tear osmolarity was measured. RESULTS: In HO or HO + IO group, compared with HO + 1%LCA group, the number of goblet cells was reduced, the score of corneal fluorescein staining and corneal epithelial thickness was elevated: on 7th day, there was difference noticed in the corneal epithelial thickness [(27.7 ± 1.1), (26.5 ± 1.4), (25.1 ± 1.0) µm, P < 0.01] and the number of goblet cell [(11.9 ± 1.1), (12.1 ± 0.9), (13.3 ± 0.9), P < 0.01] in 3 groups; on 14th day, there was evident change in the corneal fluorescein staining area [(3.2 ± 0.9), (2.9 ± 0.7), (1.7 ± 0.8), χ(2) = 11.465, P < 0.01] in 3 groups. On 28th day, Increased tear osmolarity and lowered microvilli on cornea were examined in HO [(327.37 ± 4.20) mOsmol/L] or HO + IO [(324.36 ± 5.72) mOsmol/L] group compared with HO + 1%LCA [(308.29 ± 5.72) mOsmol/L] group (P < 0.01). CONCLUSION: L-carnitine had protective effect on corneal and conjunctival epithelium of mouse dry eye model induced by hyperosmolar saline, and should be studied further.

Binocular form deprivation influences the visual cortex.

α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors are considered to play a crucial role in synaptic plasticity in the developing visual cortex. In this study, we established a rat model of binocular form deprivation by suturing the rat binocular eyelids before eye-opening at postnatal day 14. During development, the decay time of excitatory postsynaptic currents mediated by α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors of normal rats became longer after eye-opening; however, the decay time did not change significantly in binocular form deprivation rats. The peak value in the normal group became gradually larger with age, but there was no significant change in the binocular form deprivation group. These findings indicate that binocular form deprivation influences the properties of excitatory postsynaptic currents mediated by α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors in the rat visual cortex around the end of the critical period, indicating that form stimulation is associated with the experience-dependent modification of neuronal synapses in the visual cortex.

A comparison of cyclosporine 0.05% ophthalmic emulsion versus vehicle in Chinese patients with moderate to severe dry eye disease: an eight-week, multicenter, randomized, double-blind, parallel-group trial.

PURPOSE: The goals of this study were to compare the efficacy and safety profile of topical cyclosporine 0.05% versus vehicle in Chinese patients with moderate to severe dry eye disease. METHODS: In this multicenter, randomized, double-blind, vehicle-controlled, parallel-group study, 233 dry eye patients were allocated to receive either cyclosporine 0.05% or vehicle twice daily for 8 weeks. Primary outcome was the difference between groups, in total score of 4 symptoms and 4 signs change from baseline at weeks 2, 4, and 8. Changes in symptoms (ocular dryness, foreign body sensation, photophobia and burning) and signs (conjunctival hyperemia, Schirmer test, tear Break-up time (BUT), and corneal punctate fluorescein staining) at weeks 2, 4, and 8 as well as frequency of administration of concomitant artificial tears, were considered as secondary outcomes. The safety profile was evaluated by examining adverse events, changes in visual acuity, and ocular tolerance. RESULTS: Greater improvements of the total score were seen in cyclosporine 0.05% group than in the vehicle group at all follow-up times (P < 0.01). Improvements in ocular dryness at week 8 (P = 0.040) and foreign body sensation during weeks 4 and 8 (P < 0.020) were significantly greater with cyclosporine. In addition, compared with the vehicle, cyclosporine significantly improved 2 objective dry eye disease signs: corneal staining at weeks 4 (P = 0.025) and 8 (P = 0.050) and the Schirmer test at week 4 (P = 0.035). However, no between-group difference approached statistical significance in photophobia, burning, BUT value, conjunctival hyperemia and frequency of administration of concomitant artificial tears at any follow-up times (P > 0.05).The cumulative frequency of adverse events did not significantly differ between the groups (P = 0.519), which were 11.21% and 8.55%, respectively. There were no patients who experienced reduced visual acuity. CONCLUSION: Cyclosporine 0.05% ophthalmic emulsion is an effective and safe treatment for Chinese patients with moderate to severe dry eye disease.

Corneal and aqueous humor concentrations of amphotericin B using three different routes of administration in a rabbit model.

BACKGROUND: Little is known about the ocular penetration following intrastromal or intracameral injection of amphotericin B (AMB), the current drug of choice in fungal keratitis. Concentrations of AMB were investigated in the cornea and aqueous humor of rabbits after using one of three different routes of administration: topical 0.25% AMB eye drops and intrastromal and intracameral injection of AMB (10 microg). METHODS: Forty-five healthy rabbits were randomly divided into 3 groups. The eyes of group A and group B received a 0.1-ml intrastromal and intracameral injection, respectively, containing 10 microg AMB. Group C received topical 0.25% AMB (corneal epithelium debrided, every 5 min for 30 min). Cornea and aqueous humor concentrations of AMB after 30 min, 6 h, 1, 3 and 7 days were analyzed by high-performance liquid chromatography. RESULTS: After a single injection, effective drug levels were achieved in corneas in group A, maintained for 7 days, exceeding the minimum inhibitory concentration at which 90% of isolates are inhibited (MIC(90)) for a wide spectrum of fungi and molds. There were significant differences (p < 0.001) compared with group B and group C. Effective drug levels were achieved in the aqueous humor in group B at 30 min after a single injection, exceeding MIC(90), but drug levels decreased abruptly within 1 day. There were significant differences (p < 0.004) compared with group A and group C, and a considerable amount of AMB was detected in corneas and aqueous in group C within 1 day. CONCLUSION: High drug levels can be reached that cover the MICs of most fungi in the rabbit cornea and aqueous humor after intrastromal and intracameral injection, respectively. Penetration of topical AMB greatly increased after epithelial abrasion.

Activation of retinal stem cells in the proliferating marginal region of RCS rats during development of retinitis pigmentosa.

Retinal stem cells (RSCs) have been demonstrated at the proliferating marginal regions from the pars plana of ciliary body to the ciliary marginal zone (CMZ) in adult lower vertebrates and mammals. Investigations in the lower vertebrates have provided some evidence that RSCs can proliferate following retinal damage; however, the evidence that this occurs in mammals is not clear. In this study, we explored RSCs proliferation potential of adult mammalian in proliferating marginal regions of Royal College of Surgeons (RCS) rats, an animal model for retinitis pigmentosa (RP). The proliferation was evaluated using BrdU labeling, and Chx-10 as markers to discern progenitor cell of CMZ in Long-Evan's and RCS rats at different postnatal day (PND) after eye opening. We found that few Chx-10 and BrdU labeled cells in the proliferating marginal regions of Long-Evan's rats, which significantly increased in RCS rats at PND30 and PND60. Consistent with this, Chx-10/Vimentin double staining cells in the center retina of RCS rats increased significantly at PND30 after eye opening. In addition, mRNA expression of Shh, Ptch1 and Smo was up-regulated in RCS rats at PND60 compared to age-matched Long-Evan's rats, which revealed Shh/ptc pathway involving in the activation of RSCs. These results suggest that RSCs in the mammalian retinal proliferating marginal regions has the potential to regenerate following degeneration.

Tear film function in type 2 diabetic patients with retinopathy.

PURPOSE: To investigate whether diabetes mellitus is correlated with tear film dysfunction. METHODS: Tear film function tests including tear film breakup time (BUT), fluorescein staining, Schirmer I test, rose Bengal staining, total tear protein detection, tear sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and TMS-4 corneal topography were performed. A dry-eye questionnaire was used. RESULTS: Compared with the control group and nonproliferative diabetic retinopathy (NPDR) group, in the proliferative diabetic retinopathy (PDR) group, the BUT and the value of the Schirmer I test were reduced significantly (p < 0.01); corneal fluorescein staining scores, the positive rate of rose Bengal staining and the surface regularity index (SRI) and surface asymmetry index (SAI) were higher (p < 0.01); concentrations of lactoferrin and tear-specific prealbumin were lower (p < 0.01, p < 0.05, respectively). In diabetic patients, the SRI and SAI were positively correlated with fluorescein staining scores (r = 0.754, 0.480, p < 0.01, respectively), and the dry-eye symptoms were significantly related to an abnormal BUT and Schirmer I test (p < 0.01, respectively). CONCLUSION: The declined tear film function is severer in the patients with PDR than in those with NPDR. Besides the traditional methods, tear SDS-PAGE and TMS corneal topographic indices contribute to the discovery of tear film dysfunction in diabetic patients.

Effect of topical FK506 used alone or combined with keratoplasty on patients with recurrent Mooren's corneal ulcer.

PURPOSE: To evaluate the efficacy of topical 0.1% FK506 used alone or combined with keratoplasty on patients with recurrent Mooren's ulcer. METHODS: This is a retrospective interventional consecutive case series. Nine patients (15 eyes) with recurrent Mooren's ulcer were treated with topical 0.1% FK506 alone or combined with keratoplasty. Two eyes with ulcers involving less than half the corneal limbus were treated with topical 0.1% FK506. Of the other 13 eyes with ulcers involving more than half the limbus, twelve were treated with excision of the ulcer and adjacent conjunctiva combined with lamellar keratoplasty. One eye with a central impending corneal perforation was treated with penetrating keratoplasty. Topical 0.1% FK506 was given post-operatively to all thirteen eyes after re-epithelia-ligation of the cornea. FK506 levels in the surgically resected cornea and conjunctiva of the operated eyes were measured using enzyme immunoassay procedures. Twelve patients (17 eyes) with recurrent Mooren's ulcer treated with lamellar keratoplasty combined with topical 0.1% dexamethasone were taken as the control. The main measure of the outcome was the recurrence of Mooren's ulcer in the patients. RESULTS: Nine patients (15 eyes) with recurrent Mooren's ulcer were all successfully treated. Vision in 5 eyes improved by two lines or better after treatment. No recurrence was observed during the follow up period of 12 to 22 months. After topical application of 0.1% FK506, concentrations of 30 to approximately 350 ng/g of FK506 were found in the cornea and conjunctiva. Seven eyes of Mooren' s ulcer in the control group recurred during the follow up period. CONCLUSION: Topical 0.1% FK506 used alone or combined with keratoplasty is a safe and effective therapy for patients with recurrent Mooren's ulcer.

Clinical analysis of 135 patients with severe eye burn / 中华烧伤杂志

<p><b>UNLABELLED</b>To investigate the clinical characteristics, prognosis, and complications of acute severe burn injury of the eyes.</p><p><b>METHODS</b>One hundred and thirty-five patients (155 eyes) with acute severe burn injury of the eyes admitted to our hospital from 1977 to 2002 were analyzed retrospectively. The recovery rate and time, causes and incidence of blindness, and complications of burn injury of different depth and causes of burns were analyzed statistically.</p><p><b>RESULTS</b>(1) The recovery time of patients with full-thickness burn of the eye ball was obviously shorter than that with IV degree eye burn, and the recovery rate of those with III degree burn was also evidently higher than that with IV degree burns (P < 0.01). Among the patients with non-repaired IV degree eye burn, the incidence of corneal perforation (6 eyes) in patients injured by acid was markedly higher than that by alkali (1 eye, P < 0.05). There were 38 III degree injured eyes with the visual acuity more than 0.05 and 51 with that less than 0.05. While there was no eye with the visual acuity more than 0.05 but 66 with that less than 0.05. Fifty-two out of 78 eyes injured by acid and alkali went blind with occoecatio ratio of 66.7%. But 65 out of 77 eyes injured by heat went blind with occoecatio ratio of 84.4%. The complication in patients with III degree eye burn was lower than that with IV degree burns. The incidence of corneal perforation and symblepharon in patients with III degree eye burn was 1.1% and 36.0%, which was obviously lower than that with IV degree eye burn (27.3% and 59.1%, P < 0.01). The highest incidence of corneal perforation and symblepharon was in those with eye burn injured by acid (29.2%, 37.5%). While the highest incidence of the symblepharon in those with thermal eye burn was 53.2%.</p><p><b>CONCLUSION</b>Among the patients with IV degree burns, those with acid, alkali and heat burns have bad prognosis, with high blindness rate. Current therapies cant improve eye function and prognosis of the patients thoroughly, which need further study in the future.</p>

[Analysis of current status of eye bank construction in Western China].

OBJECTIVE: To evaluate the current status of eye bank construction in Western China. METHODS: The numbers of eye banks, equipments of eye banks, methods of donor cornea preservation, fund for managing eye banks, technicians of eye banks, and difficulties in the construction of eye bank were surveyed by questionnaires from ophthalmology associations and eye banks in the following provinces and city: Sichuan province, Yunnan province, Guizhou province, Guangxi Zhuang autonomous region, Tibet autonomous region, Shanxi province, Gansu province, Ningxia Hui autonomous region, Qinghai province, Xinjiang Weiwuer autonomous region, Neimonggu autonomous region, and city of Chongqing before March 2003, and the numbers of eye banks and donor corneas obtained from January 1999 to March 2003 were also included in the study. RESULTS: The current situation of eye bank construction in Western China showed: (1) There were total 8 eye banks in 6 provinces among the 12 provinces and city of Western China. The mean coverage rate of eye bank in Western China was 50%. There were two eye banks in Chongqing and Shanxi separately, one eye bank in Sichuan, Yunnan, Gansu and Xinjiang respectively. (2) The fundamental equipment of each eye bank included super-clean worktable, slit-lamp microscope, refrigerator, and liquid nitrogen jar. There were 5 specular microscopes and 6 computers in the 8 eye banks of Western China. The moist chamber and medium-term corneal preserving medium were used as short term and medium-term storage methods to keep the endothelial cell survival of donor cornea. As a long term preservation of corneal donor, glycerine dehydration and deep low temperature were still used regularly. (3) financial support of eye bank was from hospital, government assigned fund, international Orbis organization and etc. (4) There were only one or two technicians in majority of the eye banks investigated in the study. (5) From January 1999 to March 2003, community education regarding to donation of eye was carried out forty-two times. During the same period, the donated cornea was added up to 156, and 126 of them were used in clinical transplantation. The difficulties in the construction of eye banks in Western China included: the amount of donated cornea was not enough; the technical exchange and cooperation between the eye banks were little; the patients could not afford the cost of transplantation surgery. CONCLUSIONS: The current situation of eye bank construction in Western China was behind that of rest areas in China, and the development of eye banks in Western China was not equal.

Microsurgical treatment of Mooren's corneal ulcer.

This study evaluated the effect of microsurgery of lamellar keratoplasty (LKP) on Mooren's corneal ulcer. The surgical effect, postoperative astigmatism, postoperative vision, postoperative ulcer recurrence, and surgical complications of 2 groups of consecutive Mooren's ulcer inpatients treated respectively by non-microsurgery of LKP and microsurgery of LKP were analyzed. There were significant differences of the effect, postoperative astigmatism, postoperative vision, postoperative ulcer recurrence, and surgical complications between the 2 groups. The effect and postoperative vision of the microsurgery-treated group were better than those of the non-microsurgery-treated group. The postoperative astigmatism, postoperative ulcer recurrence, and surgical complications of the microsurgery-treated group were less than those of the non-microsurgery-treated group. Microsurgery of LKP of Mooren's corneal ulcer can greatly improve the cure rate of the disease and postoperative vision, and reduce surgical complication and postoperative ulcer recurrence.

[A primary study on soluble protein and soluble antigen of corneal stroma in Mooren ' s ulcer patients].

OBJECTIVE: To investigate changes of soluble protein and soluble antigen of corneal stroma in Mooren's ulcer patients and autoantibody in the patients' sera against the soluble antigen. METHODS: The corneal stromal specimens taken from 15 Mooren's ulcer patients who received lamellar keratoplasty were studied. Soluble protein and soluble antigen of the corneal stroma were extracted. The soluble protein contents were measured. The soluble corneal stromal extracts were tested by using sodium dodecyl sulfate polyacrylamide gel electrophoresis technique (SDS-PAGE). The protein strips of electrophoresis were analyzed using thin layer scanning system. Peripheral vein blood of 15 patients with Mooren's ulcer was taken. Indirect enzyme linked immunosorbent assay (ELISA) was used to test the level of autoantibody in the patients' sera against the soluble antigen of the corneal stroma. RESULTS: Soluble protein contents of corneal stroma extracts were 0.435 mg/L in the patient group and 0.645 mg/L in the normal control group. SDS-PAGE results of the affected corneal stromal extracts showed that a protein about 12 000 of molecular weight appeared at 0.92 of Rf. 12 000 protein was not found in the control group. The content of 12 000 protein was 22.1% of the total soluble protein of the involved corneal stroma. The level of autoantibody in the patients' sera against the soluble antigen was much higher than that of normal control (t = 15.15,P < 0.001). CONCLUSIONS: The appearance of 12 000 protein in the soluble protein of the involved corneal stroma may have a connection with the soluble corneal stromal antigen. The level of the autoantibody in the patients' sera against the soluble antigen is significantly higher than that of the control. It represents that Mooren's ulcer patients have an autoimmune reaction to the corneal stroma.

[Effect of FK506 eye-drop combined with keratoplasty on recurrent Mooren's ulcer].

OBJECTIVE: To observe the effect of FK506 eye-drop combined with keratoplasty on recurrent Mooren's ulcer. METHODS: 9 cases (15 eyes) of recurrent Mooren's ulcer were treated with topical FK506 eye-drop combined with keratoplasty. Of the 15 eyes, two of Mooren's ulcer smaller than half circle of the limbus were treated with 0.1% FK506 eye-drop. Among the other 13 eyes of the ulcer larger than half the circle of the limbus, 12 eyes were treated with excision of conjunctiva combined with lamellar keratoplasty. One eye with a central corneal perforation was treated with penetrating keratoplasty. FK506 eye-drop 0.1% was given to the 13 operated eyes after the re-epithelialization of the cornea. The effect of FK506 on recurrent Mooren's ulcer was observed. Measurements of FK506 in surgically resected cornea and conjunctiva, and aqueous humor of the operated eyes were performed using enzyme immunoassay procedure. Twelve cases of recurrent Mooren's ulcer treated with lamellar keratoplasty combined with topical 0.1% dexamethasone eye-drop were taken as control. RESULTS: After application of 0.1% FK506 eye-drop, concentrations of 30 - 350 ng/g of FK506 were found in the cornea and conjunctiva, and no FK506 was measured in the aqueous humor. Nine cases (15 eyes) of recurrent Mooren's ulcer were all cured and no recurrence was observed during the follow-up time of 12 - 17 months. The vision of 5 eyes was improved more than 2 lines after the treatment. Seven eyes of Mooren's ulcer in the control group recurred. CONCLUSION: 0.1% FK506 eye-drop combined with keratoplasty is an effective treatment for recurrent Mooren's ulcer.

Studies on the effects of the immunosuppressant FK-506 on the high-risk corneal graft rejection.

PURPOSE: To evaluate the clinical efficacy of FK-506 on suppressing high-risk cornea transplantation rejection. METHODS: In a randomized controlled clinical trial, 56 eyes of 56 patients with high-risk keratoplasty (including total corneal transplantation TCT, total corneal transplantation with circular lamellar sclera CST, vascularization corneal transplantation and corneal retransplantation) were divided into the experimental group and the control group (each with 28 eyes). The experimental group was treated by FK-506 eyedrops (0.5 mg/ml) and TobraDex eyedrops, compared with the control group that was treated by 1% CsA eyedrops and TobraDex eyedrops. In the average 8.1-month follow-up period, the visual acuity, graft transparent duration and Rejection Index (RI) of grafts were observed. RESULTS: In the follow-up period, the graft rejection rate of the experimental and the control group was 63.6% and 95.2% respectively (chi2 = 4.72, P < 0.05) with significant difference. CONCLUSIONS: The local application of FK-506 suppressed effectively the graft rejection of corneal transplantation of the patients at high risk.