Effect of autologous platelet-rich plasma on persistent corneal epithelial defect after infectious keratitis.

PURPOSE: Platelet-rich plasma (PRP) harbors high concentrations of growth factors related to the promotion of wound healing. We evaluated the efficacy of PRP eyedrops in the treatment of persistent epithelial defects (PEDs). METHODS: Autologous PRP and autologous serum (AS) were prepared from whole blood. The concentrations of transforming growth factor (TGF)-ß1, TGF-ß2, epidermal growth factor (EGF), vitamin A and fibronectin in the PRP and AS were analyzed and compared. The corneal epithelial healing efficacy of PRP was compared with that of AS in patients with PED induced by post-infectious inflammation. RESULTS: The concentrations of TGF-ß1, TGF-ß2, EGF, vitamin A and fibronectin in the PRP and AS were not statistically different. However, the concentrations of EGF in the PRP were significantly greater than in the AS. AS was used in 17 and PRP in 11 eyes of 28 patients. The healing rates of the corneal epithelia of the PRP-treated eyes were significantly higher than those treated with AS. CONCLUSIONS: The PRP was effective in the treatment of PEDs. This may be attributable to its high concentration of platelet-contained growth factors, most notably EGF. PRP could be an effective, novel treatment option for chronic ocular surface disease.

Chronic hepatitis C virus infection is not associated with Mooren's ulcer.

AIM: To investigate the association between chronic hepatitis C virus (HCV) infection and Mooren's ulcer. METHODS: Eight patients from different parts of China who were diagnosed with Mooren's ulcer at the Zhongshan Ophthalmic Center, Guangzhou (China) were screened for chronic HCV infection. Mooren's ulcer was diagnosed by the typical ulcer morphology, detailed case history, physical examination, and comprehensive laboratory tests. All patients had serological screening for HCV infection. RESULTS: Six male and two female patients were enrolled in the study. Their ages ranged from 31 to 65 years (mean 43.6+/-13.7). None of them was reported to have any clinical evidence of chronic HCV infection before enrolment and all were negative for HCV serology. CONCLUSION: There was no association between chronic HCV infection and Mooren's ulcer in this limited case series study.

NGF topical application in patients with corneal ulcer does not generate circulating NGF antibodies.

Nerve growth factor (NGF) is the prototype of the neurotrophin family and promotes the survival of specific populations of neurons, stimulates their morphological differentiation and regulates neuronal gene expression. Since its discovery, NGF attracted clinicians for its potential application in the treatment of neurological disorders. Recent studies demonstrated murine NGF eye drops may be successfully used to treat neurotrophic keratopathy. Neurotrophic keratopathy is a degenerative corneal disease caused by an impairment of the trigeminal nerve, which leads to corneal epithelial defect, ulcer, and perforation. NGF topical application induced complete ulcer healing and a recovery of the corneal sensitivity. The intent of this study is to address the question if murine NGF topical treatment stimulates the production of circulating anti-NGF antibodies. We evaluated patients with neurotrophic keratopathy who underwent topical therapy with NGF eye drops for possible ocular or systemic adverse effects in the course of 16-72 months follow up. None of the patients suffered any adverse reaction, except for mild and transient conjunctival hyperaemia and photophobia. Moreover, none of the treated patients developed circulating antibodies to NGF.

[Peripheral ulcerative keratitis and a form of limited wegener's granulomatosis]. / Kératite périphérique ulcérative et forme limitée de la granulomatose de Wegener.

A man aged 68 years presents superior limbal infiltrates at his left eye two weeks before a marginal ulcer which quickly perforates. He has no systemic complaint. Clinical, biological, radiologic and histological evaluations disclose superior airways and lungs implications, an inflammatory syndrome, high ANCA (antineutrophiles cytoplamic antibodies) titer and vasculitis. There is no sign of renal involvement. A limited form of Wegener's granulomatosis is diagnosed. The outcome is favorable with a partial penetrating keratoplasty and systemic corticosteroid therapy in association with immunosuppressive drugs. This so called limited form of Wegener's granulomatosis is sight threatening when eye is the initial presentation. The early diagnostic and treatment will be performed by the help of ANCA in cases with subclinical systemic manifestations.

Serum zinc in corneal ulcer--a preliminary report.

In recent times zinc is emerging as a nutrient of clinical importance and had been found to be low in serum in various disease conditions. In the current study 11 control cases and 22 corneal ulcer cases were taken. Their serum zinc level was measured by atomic absorption spectrophotometer. Serum zinc level in recalcitrant corneal ulcer cases was found to be below normal.

Cyclosporin therapy in Mooren's ulcer.

Mooren's ulcer is a rare disease of presumed autoimmune aetiology. Some cases run a chronic severe course and fail to respond to local and systemic therapy. We report here such a case with bilateral Mooren's ulcer that failed to respond to local therapy with topical corticosteroids, silver nitrate, and conjunctival resection, as well as systemic immunosuppression with corticosteroids, cyclophosphamide, and azathioprine. Systemic cyclosporin (10 mg/kg/day) resulted in resolution of the corneal ulceration within two weeks of beginning treatment, and the patient has remained in remission after 15 months of therapy. Cyclosporin side effects included hirsutism, hypertension, increased blood levels of urea and creatinine, and abnormalities in liver function tests. All these resolved on reducing the dosage of cyclosporin. The results in this case suggest that cyclosporin is an effective agent in patients with severe sight threatening Mooren's ulcer.

A controlled study on the effect of injected water-miscible retinyl palmitate on plasma concentrations of retinol and retinol-binding protein in children with measles in northern Nigeria.

Post-measles corneal ulceration resembling keratomalacia is frequently seen in young children in northern Nigeria. The concentration of retinol in plasma has been found to be depressed more by measles than by malnutrition. In order to determine whether this could be due to a specific influence of measles on the uptake, storage and release of retinol by the liver or its subsequent transport in the plasma, retinyl ester was administered parenterally to assess its effect on the concentration of circulating holo retinol-binding protein. A water-miscible preparation of retinyl palmitate was administered by intramuscular injection to well- and malnourished children with and without acute measles. In all cases, the concentration of both retinol and retinol-binding protein rose appreciably with 24 h of administration of the vitamin preparation. Thus the failure of post-measles corneal lesions to respond to orally or parenterally administered vitamin A would not appear to be due to the inability of such vitamin A to increase the level of circulating retinal in the plasma of children with measles.

Post-measles corneal ulceration in children in northern Nigeria: the role of vitamin A, malnutrition and measles.

This work was prompted by the observation that corneal ulceration was apparently more common in young children in the guinea savannah area of northern Nigeria than in children in the tropical rainforest areas of southern Nigeria, where the intake of vitamin A, as the provitamin in red palm oil, is higher. Since corneal ulceration was usually seen in association with measles, a study was carried out to clarify the relationship between nutritional status, measles infection and vitamin A status in young children. The concentration of total retinol was measured in the plasma of well-nourished and malnourished children under three years of age, with or without a clinical record of recent measles. One hundred and twenty children were studied of whom 17 had corneal lesions. Malnutrition and measles were both found to depress the plasma concentrations of retinol and albumin. Measles depressed retinol levels (-20 to -30%) more than did malnutrition (-4 to -12%) while malnutrition had a greater depressing effect on albumin concentration (-23 to -30%) than did measles (-11 to -23%). The results support the hypothesis that corneal ulceration found in association with measles in northern Nigeria, although clinically similar to xerophthalmia, is not simply mediated through an effect of measles on the concentrations of vitamin A in plasma.

Low leucocyte ascorbic acid levels and corneal ulceration.

The leucocyte ascorbic acid levels were determined in six patients with infected corneal ulcers. These levels were significantly lower than in a control group matched for age and sex. The potential role of Corynebacteria as pathogens is discussed.

Ascorbate therapy in impaired neutrophil and monocyte chemotaxis. With atopy, hyperimmunoglobulinemia E, and recurrent infection.

A Candida albicans corneal ulcer developed in a 24-year-old man with a history of eczema, asthma, and multiple bacterial infections since childhood. The infection responded well to oral flucytosine (12 g/day for 15 days) and topical amphotericin B. Positive laboratory findings included eosinophilla, hyperimmunoglobulinemia E, and impaired neutrophil and monocyte spontaneous migration and chemotactic responses. Ascorbic acid corrected the monocyte defect in vitro and in vivo, but had no effect on neutrophil function.