An effective method for culturing functional human corneal endothelial cells using a xenogeneic free culture medium.

Endothelial dysfunction is a leading cause of corneal blindness in developed countries and the only available treatment is the endothelial transplantation. However, the limited availability of suitable donors remains a significant challenge, driving the exploration of alternative regenerative therapies. Advanced Therapy Medicinal Products show promise but must adhere to strict regulations that prohibit the use of animal-derived substances. This study investigates a novel culture methodology using Plasma Rich in Growth Factors (PRGF) as the only source of growth factors for primary cultures of human corneal endothelial cells (CECs). CECs were obtained from discarded corneas or endothelial rings and cultured in two different media: one supplemented with xenogeneic factors and other xenogeneic-free, using PRGF. Comprehensive characterization through immunofluorescence, morphological analyses, trans-endothelial electrical resistance measurements, RNA-seq, and qPCR was conducted on the two groups. Results demonstrate that CECs cultured in the xenogeneic-free medium exhibit comparable gene expression, morphology, and functionality to those cultured in the xenogeneic medium. Notably, PRGF-expanded CECs share 46.9% of the gene expression profile with native endothelium and express all studied endothelial markers. In conclusion, PRGF provides an effective source of xenogeneic-free growth factors for the culture of CECs from discarded corneal tissue. Further studies will be necessary to demonstrate the applicability of these cultures to cell therapies that make clinical translation possible.

Aclaramiento corneal espontáneo tras desprendimiento del injerto en DMEK / Spontaneous corneal clearance after graft detachment in DMEK

El desprendimiento de la membrana de Descemet es una complicación potencial tras la queratoplastia endotelial de la membrana de Descemet (DMEK, acrónimo en inglés de Descemet membrane endothelial keratoplasty). En este artículo presentamos un caso clínico de una cirugía DMEK en un caso complicado, que presentó un desprendimiento casi completo del injerto y posteriormente una opacificación de este y la formación de una seudocámara anterior. En noviembre del 2020, se realizó una cirugía DMEK a un paciente de 64 años debido a una descompensación endotelial. Tres meses después del DMEK, se observó el injerto desprendido y parcialmente adherido, fibrótico en la cámara anterior y formando una seudocámara anterior. Sin embargo, la córnea se mantuvo totalmente transparente con un recuento endotelial de aproximadamente 1.204 células/mm2 y la agudeza visual con corrección fue 20/25. Tres meses más tarde, se objetivó una opacificación significativa del injerto despegado y la agudeza visual disminuyó a 20/63. Procedimos a la extracción del injerto sin realizar una segunda DMEK. Diez meses más tarde, la córnea permaneció transparente con un recuento endotelial de 510 células/mm2 y la agudeza visual con corrección fue 20/25 (AU)

Descemet Membrane detachment is a potential complication after Descemet Membrane Endothelial Keratoplasty (DMEK). Here, we present a unique case of a DMEK surgery in a complicated eye that suffered a nearly complete DMEK graft detachment and later a graft opacification with a pseudo-anterior chamber. In Mid-November 2020, a planned DMEK was performed in a 64-year-old male patient due to corneal decompensation. Four months after DMEK, a fibrotic DMEK graft was seen across the anterior chamber with a pseudo-anterior chamber; however, the recipient cornea showed complete clearance with an endothelial cell count of about 1204 cells/mm2 and a best-corrected visual acuity of 20/25. Three months later, we observed a significant opacification of the detached graft, and the best-corrected distance visual acuity decreased to 20/63. We proceeded with the graft removal without performing a second DMEK. Ten months after graft removal, the cornea remained clear with an endothelial cell count of about 510 cells/mm2, and the best-corrected visual acuity was 20/25 (AU)

Spontaneous corneal clearance after graft detachment in DMEK.

Descemet Membrane detachment is a potential complication after Descemet Membrane Endothelial Keratoplasty (DMEK). Here, we present a unique case of a DMEK surgery in a complicated eye that suffered a nearly complete DMEK graft detachment and later a graft opacification with a pseudo-anterior chamber. In Mid-November 2020, a planned DMEK was performed in a 64-year-old male patient due to corneal decompensation. Four months after DMEK, a fibrotic DMEK graft was seen across the anterior chamber with a pseudo-anterior chamber; however, the recipient cornea showed complete clearance with an endothelial cell count of about 1204 cells/mm2 and a best-corrected visual acuity of 20/25. Three months later, we observed a significant opacification of the detached graft, and the best-corrected distance visual acuity decreased to 20/63. We proceeded with the graft removal without performing a second DMEK. Ten months after graft removal, the cornea remained clear with an endothelial cell count of about 510 cells/mm2, and the best-corrected visual acuity was 20/25.

Estado de la cirugía refractiva con lente intraocular fáquica de cámara posterior Visian ICL en España / State of refractive surgery with Visian ICL posterior chamber phakic lens in Spain

Objetivos Analizar la situación actual de la cirugía refractiva con implante de lente fáquica Visian ICL en España, señalando los rangos medios de potencias implantadas, los resultados visuales y refractivos obtenidos y los índices de seguridad y eficacia. Método Se trata de un estudio de población, transversal, descriptivo, analítico, retrospectivo, multicéntrico, en el que cada coautor recopiló los datos de, al menos, los 10 últimos pacientes (hasta un máximo de 30) con implante de lente fáquica Visian ICL. Se eligió aleatoriamente un ojo de cada sujeto para incluirlo en el estudio, y se analizaron las variables: edad, género, agudezas visuales sin corrección y con corrección pre y posquirúrgica, refracción preoperatoria y residual, queratometrías, recuento endotelial, profundidad de cámara anterior desde endotelio, paquimetría corneal central, presión intraocular, distancia blanco-blanco, lente implantada (potencia y talla) y equivalente esférico (SEQ) esperado y obtenido posquirúrgico al mes de la cirugía. Resultados Se obtuvo una muestra de 140 ojos de 140 pacientes con una edad media de 31,35±7,28 años. El SEQ preoperatorio medio fue de −6,33±3,69, la agudeza visual con corrección media de 0,96±0,16, la profundidad de cámara anterior desde endotelio de 3,30±0,29mm, distancia blanco-blanco 12,02±0,40mm, paquimetría corneal central 535,03±37,68μm, recuento endotelial 2.684,37±313,74céls/mm2 y presión intraocular 14,84±2,59mmHg. El 66,4% de las lentes implantadas fueron ICL esféricas y el 33,6% tóricas, con una potencia media de −7,81±4,09D y un cilindro medio de 2,27±1,23D. El 5,7% fueron hipermetrópicas. El 45,69% de las lentes implantadas eran de la talla 13,2mm, siendo el 37,93, 12,93 y 3,45% restante de las tallas 12,6, 12,1 y 13,7mm, respectivamente. Al mes de la cirugía se obtuvo un SEQ residual de −0,01±0,31D. Los índices de eficacia y seguridad fueron de 1,06±0,18 y 1,10±0,19, respectivamente... (AU)

Objectives To analyse the state of refractive surgery with Visian ICL phakic lens implantation in Spain, indicating the mean ranges of implanted powers, visual and refractive outcomes obtained and safety and efficacy indices. Method This is a population-based, cross-sectional, descriptive, analytical, retrospective, multicentre study in which each co-author collected data from at least the last 10 patients (up to a maximum of 30) with Visian ICL phakic lens implantation. One eye from each subject was randomly selected for study inclusion, and the variables analysed were: age, gender, visual acuities with and without correction pre and post-surgery, preoperative and residual refraction, keratometry, endothelial cellular density, anterior chamber depth from endothelium, central corneal pachymetry, intraocular pressure, white-white, implanted lens (power and size), expected and achieved spherical equivalent (SEQ) post-surgery at one month after surgery. Results A sample of 140 eyes was obtained from 140 patients with a mean age of 31.35±7.28 years. Mean preoperative SEQ was −6.33±3.69D, mean visual acuities with correction was 0.96±0.16, anterior chamber depth was 3.30±0.29mm, white-white 12.02±0.40mm, central corneal pachymetry 535.03±37.68μm, endothelial cellular density 2684.37±313.74cels/mm2 and intraocular pressure 14.84±2.59mmHg. A percentage of 66.4 of the implanted lenses were spherical ICLs and 33.6% toric, with a mean power of −7.81±4.09D and a mean cylinder of 2.27±1.23D. A percentage of 5.7 of the implanted lenses were hypermetropic. The mean SEQ target selected was +0.04±0.27D. A percentage of 45.69 of the implanted lenses were of size 13.2mm, with the remaining 37.93, 12.93 and 3.45% being of sizes 12.6, 12.1 and 13.7mm, respectively. At one month after surgery a residual SEQ of −0.01±0.31D was obtained. The efficacy and safety indices were 1.06±0.18 and 1.10±0.19...(AU)

State of refractive surgery with Visian ICL posterior chamber phakic lens in Spain.

OBJECTIVES: To analyse the state of refractive surgery with Visian ICL phakic lens implantation in Spain, indicating the mean ranges of implanted powers, visual and refractive outcomes obtained and safety and efficacy indices. METHOD: This is a population-based, cross-sectional, descriptive, analytical, retrospective, multicentre study in which each co-author collected data from at least the last 10 patients (up to a maximum of 30) with Visian ICL phakic lens implantation. One eye from each subject was randomly selected for study inclusion, and the variables analysed were: age, gender, visual acuities with and without correction pre and post-surgery, preoperative and residualrefraction, keratometry, endothelial cellular density, anterior chamber depth from endothelium, central corneal pachymetry, intraocular pressure, white-white, implanted lens (power and size), expected and achieved spherical equivalent (SEQ) post-surgery at one month after surgery. RESULTS: A sample of 140 eyes was obtained from 140 patients with a mean age of 31.35 ± 7.28 years. Mean preoperative SEQ was -6.33 ± 3.69D, mean CDVA was 0.96 ± 0.16, ACD was 3.30 ± 0.29 mm, WTW 12.02 ± 0.40 mm, CCT 535.03 ± 37.68 µm, ECD 2684.37 ± 313.74 cels/mm2 and IOP 14.84 ± 2.59 mmHg. 66.4% of the implanted lenses were spherical ICLs and 33.6% toric, with a mean power of -7.81 ± 4.09D and a mean cylinder of 2.27 ± 1.23D. 5.7% of the implanted lenses were hypermetropic. The mean SEQ target selected was +0.04 ± 0.27D. 48.92% of the implanted lenses were of size 13.2 mm, with the remaining 36.69, 10.79 and 3.60% being of sizes 12.6, 12.1 and 13.7 mm, respectively. At one month after surgery a residual SEQ of -0.01 ± 0.31D was obtained. The efficacy and safety indices were 1.06 ± 0.18 and 1.10 ± 0.19, respectively. The mean central vault was 508.80 ± 201.04 µm. The accuracy between the calculated SEQ and the obtained SEQ was 99.3% for spherical lenses and 88.2% for Cyl correction. The mean ECD at 1 month after surgery was 2805.53±273.30céls/mm2, which was a difference from preoperative of 0.11% (p = 0.922), similarly, the mean IOP was 13.98 ± 2.57 mmHg, which was a difference of -0.92 ± 2.80 mmHg. CONCLUSIONS: ICL phakic lens surgery is an effective, safe and predictable procedure. There were no significant changes in endothelial cell count or intraocular pressure measurement one month after surgery.

Long-Term Follow-up of Intrastromal Corneal Ring Segments (210-Degree Arc Length) in Central Keratoconus With High Corneal Asphericity.

PURPOSE: To assess the long-term outcomes of implanting intrastromal corneal ring segments (ICRSs) to correct central keratoconus with a high corneal asphericity value. METHODS: Forty-three eyes with central keratoconus with a corneal asphericity value ≥-1.00 were evaluated before and after implanting an inferior 210-degree arc-length Ferrara-type AFR5 ICRS (AJL Ophthalmic, Spain). Logarithm of the minimum angle of resolution uncorrected (UDVA) and best-corrected (CDVA) distance visual acuity, corneal asphericity, root mean square for coma-like aberrations [computed for the Zernike terms Z (3, 1) and Z (3, -1)], and residual refractive errors analyzed using vector analysis were recorded before and at all follow-up visits. The postoperative follow-up duration was 3 years in all cases. RESULTS: Mean UDVA (logarithm of the minimum angle of resolution scale) rose from 1.18 ± 0.59 to a postoperative 0.53 ± 0.39 after ICRS implantation (P < 0.0001). Mean CDVA varied in turn from 0.36 ± 0.18 to 0.17 ± 0.10 (P < 0.0001). CDVA remained unchanged or improved in all eyes after surgery. Both UDVA and CDVA were stable over the postoperative period (P > 0.05). The spherical equivalent declined steeply after ICRS implantation (P < 0.0001). Both spherical equivalent and refractive cylinder were stable over the postoperative period. The corneal asphericity and root mean square values for coma-like aberrations exhibited statistically significant decreases 6 months after ICRS implantation (P < 0.0001) and were also stable over postoperative follow-up (P > 0.05). CONCLUSIONS: These results suggest that implanting a single, inferior, 210-degree arc-length Ferrara-type ICRS is a safe, effective, and stable procedure for treating patients with central hyperprolate keratoconus.

Surgical Options for the Refractive Correction of Keratoconus: Myth or Reality.

Keratoconus provides a decrease of quality of life to the patients who suffer from it. The treatment used as well as the method to correct the refractive error of these patients may influence on the impact of the disease on their quality of life. The purpose of this review is to describe the evidence about the conservative surgical treatment for keratoconus aiming to therapeutic and refractive effect. The visual rehabilitation for keratoconic corneas requires addressing three concerns: halting the ectatic process, improving corneal shape, and minimizing the residual refractive error. Cross-linking can halt the disease progression, intrastromal corneal ring segments can improve the corneal shape and hence the visual quality and reduce the refractive error, PRK can correct mild-moderate refractive error, and intraocular lenses can correct from low to high refractive error associated with keratoconus. Any of these surgical options can be performed alone or combined with the other techniques depending on what the case requires. Although it could be considered that the surgical option for the refracto-therapeutic treatment of the keratoconus is a reality, controlled, randomized studies with larger cohorts and longer follow-up periods are needed to determine which refractive procedure and/or sequence are most suitable for each case.

Estudio de la relación entre miopía y personalidad / Study of the relationship between myopia and personality

Objetivo: Estudiar la correlación entre el error refractivo miópico y determinados rasgos de personalidad. Igualmente, se pretende determinar si existe correlación entre el grado de miopía y una mayor frecuencia de trastornos de la personalidad. Métodos: Estudio transversal observacional multicéntrico. La muestra la formaron 82 sujetos (26 hombres, 56 mujeres) mayores de 18 años con miopía (defecto esférico ≤ −0,5 D); 30 eran miopes magnos (<−6 D). Datos recogidos: edad y sexo, nivel de formación, resultado en el inventario de personalidad Neo PI-R, autorrefractometría, enfermedad miópica, tratamiento oftalmológico. Resultados: No se encontró correlación (rho de Spearman) estadísticamente significativa entre el defecto esférico y los rasgos de personalidad estudiados en el total de la muestra: neuroticismo (−0,057; p = 0,610), extraversión (−0,020; p = 0,857), apertura (−0,032; p = 0,774), amabilidad (−0,060; p = 0,592), responsabilidad (−0,034; p = 0,765). Al agruparlos por subgrupos de alta y baja significación (t-test), se halló una tendencia al aumento del defecto miópico con la extraversión, que resultó significativa (p = 0,002). Al comparar miopes magnos y el resto, se vio que existían diferencias significativas entre ambos grupos en cuanto a la enfermedad asociada (p < 0,001), el tratamiento recibido (p < 0,001) y el nivel de estudios ((p = 0,013), no así en las variables de personalidad: neuroticismo (p = 0,852), extraversión (p = 0,199), apertura (p = 0,560), amabilidad (p = 0,584), responsabilidad (p = 0,722). Conclusiones: Se encontró baja correlación entre miopía y personalidad. El grado de miopía no resultó diferente entre los grupos con diversos niveles de estudios. Los sujetos con enfermedad oftalmológica más grave asociada a la miopía presentaban puntuaciones más altas en neuroticismo, sin asociación significativa

OBJECTIVE: To study the correlation between the myopic refractive error and certain personality traits, and to determine whether there is a correlation between the degree of myopia and an increased frequency in personality disorders. METHODS: Cross-sectional observational multicenter study conducted on 82 subjects (26 men, 56 women) age over 18 years with myopia (spherical defect ≤ −0.5 D), with 30 subjects having high myopia (<−6 D). Data collected: age and gender, academic level, result in the Neo PI-R personality test, autorefractometry, myopic pathology, and ophthalmological treatment. RESULTS: Correlation (Spearman's) between the magnitude of the spherical defect and the 5 personality traits studied in the total sample was not statistically significant: neuroticism (−0.057; P=.610), extroversion (−0.020; P=.857), openness (−0.032; P=.774), kindness (−0.060; P=.592), and responsibility (−0.034;P=.765). By dividing them into subgroups of low and high significance (t-test), a significant (P=.002) upward trend of the myopic defect with increasing scores on extraversion was found. When comparing high myopic subjects to the non-high myopic ones, there were significant differences between the 2 groups in terms of the associated pathology (P=.001), received treatment (P=.001) and the level of studies (P=.013). There were no differences in the variables of personality: neuroticism (P=.852), extroversion (P=.199), openness (P=.560), kindness (P=.584), and responsibility (P=.722). CONCLUSIONS: A low correlation was found between myopia and personality. There was no difference in the degree of myopia between the groups with different education levels. Subjects with more severe ocular pathology associated with myopia had higher scores in neuroticism, without finding any significant association

Study of the relationship between myopia and personality.

OBJECTIVE: To study the correlation between the myopic refractive error and certain personality traits, and to determine whether there is a correlation between the degree of myopia and an increased frequency in personality disorders. METHODS: Cross-sectional observational multicenter study conducted on 82 subjects (26 men, 56 women) age over 18 years with myopia (spherical defect ≤ -0.5 D), with 30 subjects having high myopia (<-6 D). DATA COLLECTED: age and gender, academic level, result in the Neo PI-R personality test, autorefractometry, myopic pathology, and ophthalmological treatment. RESULTS: Correlation (Spearman's) between the magnitude of the spherical defect and the 5 personality traits studied in the total sample was not statistically significant: neuroticism (-0.057; P=.610), extroversion (-0.020; P=.857), openness (-0.032; P=.774), kindness (-0.060; P=.592), and responsibility (-0.034; P=.765). By dividing them into subgroups of low and high significance (t-test), a significant (P=.002) upward trend of the myopic defect with increasing scores on extraversion was found. When comparing high myopic subjects to the non-high myopic ones, there were significant differences between the 2 groups in terms of the associated pathology (P=.001), received treatment (P=.001) and the level of studies (P=.013). There were no differences in the variables of personality: neuroticism (P=.852), extroversion (P=.199), openness (P=.560), kindness (P=.584), and responsibility (P=.722). CONCLUSIONS: A low correlation was found between myopia and personality. There was no difference in the degree of myopia between the groups with different education levels. Subjects with more severe ocular pathology associated with myopia had higher scores in neuroticism, without finding any significant association.

Crecimiento de novo de un hemangioma capilar conjuntival / De novo growth of a capillary hemangioma of the conjunctiva

CASO CLÍNICO: Mujer de 22 años, diagnosticada previamente de quiste de inclusión conjuntival en el sector nasal del ojo izquierdo y tratada mediante dos drenajes incisionales, que acude a nuestra consulta con hiposfagma universal acompañado de intenso dolor. Tras realizar una biopsia escisional, fue diagnosticada de hemangioma capilar conjuntival. DISCUSIÓN: El hemangioma capilar conjuntival es una lesión mayoritariamente benigna, asintomática y congénita, siendo rara pero posible su evolución o su aparición de novo en edades adultas

CLINICAL CASE: A 22-year-old woman patient, diagnosed with an inclusion cyst of the conjunctiva in the nasal sector of the left eye, who after 2 shot/needle injections in the lesion came to our clinic with a dense subconjunctival hemorrhage in four quadrants and with severe pain. After excision biopsy, a capillary hemangioma of the conjunctiva was diagnosed. DISCUSSION: Conjunctival capillary hemangioma is mainly a benign lesion, asymptomatic and mostly congenital in origin, its progression or de novo growth is rare in adulthood

[De novo growth of a capillary hemangioma of the conjunctiva]. / Crecimiento de novo de un hemangioma capilar conjuntival.

CLINICAL CASE: A 22-year-old woman patient, diagnosed with an inclusion cyst of the conjunctiva in the nasal sector of the left eye, who after 2 shot/needle injections in the lesion came to our clinic with a dense subconjunctival hemorrhage in four quadrants and with severe pain. After excision biopsy, a capillary hemangioma of the conjunctiva was diagnosed. DISCUSSION: Conjunctival capillary hemangioma is mainly a benign lesion, asymptomatic and mostly congenital in origin, its progression or de novo growth is rare in adulthood.

Comparison of visual and refractive results of Toric Implantable Collamer Lens with bioptics for myopic astigmatism.

PURPOSE: To compare visual and refractive results of Toric Implantable Collamer Lens (TICL) and bioptics (ICL plus excimer corneal surgery) to treat myopic astigmatism. METHODS: Eighty-one eyes underwent TICL implantation and 83 eyes were treated with bioptics (corneal ablation was performed between 1.5 and 6 months after ICL implantation). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction, adverse events, safety, and efficacy were evaluated 12 months postoperatively. RESULTS: At 12 months postoperatively, the mean spherical equivalent was -0.15 ± 0.36 diopters (D) in the TICL group and -0.08 ± 0.26 D in the bioptics group (p = 0.099). Sixty-six (81.5 %) and 78 (94.0 %) eyes were within ±0.50 D for TICL and bioptics groups, respectively. The mean Snellen UDVA was not statistically different between both procedures (p = 0.909); 53 (65.4 %) and 54 (65.1 %) eyes achieved at least 20/25 or better in TICL and bioptics groups, respectively. No eye had lost more than two lines of CDVA, and 32.1 % of eyes (26/81) in the TICL group and 57.8 % of eyes (48/83) in the bioptics group had better postoperative UDVA than preoperative CDVA (p < 0.001). Safety was not statistically different between groups (p = 0.464) while efficacy was significantly higher in the bioptics group (p = 0.000). Two eyes with a TICL were treated to correct TICL decentration. CONCLUSIONS: Bioptics showed slightly better outcomes in some clinical measures such as uncorrected visual acuity, efficacy, and refractive predictability. TICL implantation shows reliable results similar to bioptics. A single procedure with TICL implantation might be preferred, eliminating the inherent risks of laser treatments and the risks of a second surgical procedure.