PURPOSE: To report a case of chemical injury of the cornea caused by high-dose ethanol during orbital wall fracture repair. CASE SUMMARY: A 56-year-old male presented with pain after blowout fracture repair surgery. During the surgery, 2% hexethanol solution (2% chlorhexidine and 72% ethanol mixture), which was used for disinfection of the face, flowed into the left eye. Conjunctival injection in the left limbus, a large corneal epithelial defect, and severe stromal edema were subsequently observed. The patient was treated with topical antibiotics, steroids, and autologous serum eye drops. After 1 week, the corneal epithelial defect was improved, but at the second month of therapy, recurrent corneal erosion with deterioration of the endothelial cell function occurred. Anterior stromal puncture and laser keratectomy were performed. The corneal epithelial defect and erosion improved, but the endothelial cell density was severely decreased. CONCLUSIONS: The 2% hexethanol solution is usually used for preoperative skin disinfection, but it contains a high concentration of ethanol. The surgeon should be aware that high concentrations of ethanol may result in severe corneal damage, including corneal endothelial dysfunction and limbal cell deficiency.
Anti-Bacterial Agents ; Chlorhexidine ; Cornea ; Corneal Injuries ; Corneal Surgery, Laser ; Disinfection ; Edema ; Endothelial Cells ; Ethanol ; Humans ; Male ; Middle Aged ; Ophthalmic Solutions ; Orbit ; Punctures ; Skin ; Steroids

PURPOSE: Transforming growth factor-β-induced protein (TGFBIp) is highly expressed in the cornea, and mutant TGFBIp induces corneal diseases. However, the function of TGFBIp in cornea epithelium is not fully investigated. Here, we tested the importance of TGFBIp in regulation of gene expression and corneal epithelial cell (CEC) activity. MATERIALS AND METHODS: The effect of TGFBIp on CEC activity was analyzed by cell migration, adhesion, proliferation and wound healing assay. Analysis of gene expression was examined by western blot and quantitative reverse transcription PCR. RESULTS: The results demonstrated that TGFBIp increased adhesion, migration, proliferation, and wound healing of CECs. Analysis of gene expression presented that TGFBIp-stimulated CECs exhibited increased expression of mucin family genes, such as MUC1, -4, -5AC, and -16. Furthermore, TGFBIp treatment increased the expression of MUC1, -4, -5AC, -7, and -16 in conjunctival epithelial cells. TGFBIp also increased the activity of intracellular signaling molecules ERK and AKT in CECs. Using pharmacologic inhibitors of ERK and AKT, we showed that the expression of mucin genes by TGFBIp is mediated by the activation of ERK and AKT signaling. CONCLUSION: Our findings demonstrate that the locally generated TGFBIp in the cornea may contribute to wound healing of CECs by enhancing the migration, adhesion, and proliferation of CECs. In addition, our results suggest that TGFBIp has a protective effect on ocular surfaces by inducing the expression of mucin genes in corneal and conjunctival epithelial cells. These data suggest that TGFBIp is a useful therapeutic target for patients with corneal wounds.
Blotting, Western ; Cell Movement ; Cornea ; Corneal Diseases ; Epithelial Cells* ; Epithelium ; Gene Expression ; Gene Expression Regulation ; Humans ; Mucins* ; Polymerase Chain Reaction ; Reverse Transcription ; Wound Healing* ; Wounds and Injuries*

We describe herein a case of an impending corneal perforation with a large descemetocele in a patient with previous penetrating keratoplasty (PKP) that subsequently was treated with an emergent lamellar keratoplasty using frozen preserved cornea. A 76-year-old male patient, who had a PKP, presented with a completely whitish and edematous graft accompanied by large epithelial defects. Although antibiotics and antiviral agents were tried for three days, the corneal stroma abruptly melted, except for the Descemet's membrane and endothelium. Cryopreserved corneal tissue that was kept at -80degrees C was thawed and sutured on top of the remaining Descemet's membrane and endothelium. Pathological and microbiological tests were conducted using the remaining donor and recipient corneal tissues. After tectonic corneal transplantation on top of a large descemetocele, a healthy graft and relatively clear interfaces between graft-host junctions were maintained without serious adverse reactions throughout 6 month follow-up period. Microbiological evaluations of donor tissue at the time of thawing and tissue preparation were done, and the results were all negative. Tissue that was taken intraoperatively from the recipient cornea also showed negative microbiological results. In conclusion, tectonic lamellar keratoplasty, using cryopreserved corneal tissue, only onto the remaining Descemet's membrane and endothelium in an emergent condition, was a safe and effective treatment.
Cornea/*surgery ; Corneal Perforation/pathology/physiopathology/*surgery ; Corneal Transplantation/*methods ; *Cryopreservation ; Eye Injuries, Penetrating/pathology/physiopathology/*surgery ; Female ; Humans ; Keratoplasty, Penetrating ; Male ; Middle Aged ; *Tissue Donors ; Treatment Outcome ; Visual Acuity

OBJECTIVE: To determine the efficacy of fibrin glue derived from a single human donor for sealing induced penetrating corneal wounds on cadaveric porcine eyes compared to conventional suturing.

METHODS: Forty (40) porcine eyes were randomized into two groups. In the experimental group, the corneal incisions were sealed using fibrin glue prepared from a single human donor. Eyes in the control group were sealed using two interrupted nylon 10-0 sutures. Baseline intraocular pressures were obtained and an anterior chamber maintainer connected to the Centurion Vision System was inserted through a side port. A 3 mm metal keratome was used to create a uniform, central, full-thickness straight incision in all eyes. After making the incision, the presence or absence of leakage was determined using Seidel's test. The eyes were then sealed according to the group they were randomized in. The intraocular pressure (IOP) was gradually increased using the Centurion Vision System to determine the leakage pressure of all sealed eyes in both groups.

RESULTS: The mean baseline IOP was comparable between the two groups (control group = 21.15 + 1.66 mmHg; experimental group = 21.65 + 1.81, p value = 0.299). All eyes in the control group, showed no leakage immediately after sealing the corneal wounds with sutures. One out of twenty eyes in the experimental group was positive for leakage after application of the fibrin glue (p value = 0.5). The mean leakage pressure was significantly higher for the suture group at 90.25 + 14.9 mmHg compared to the fibrin glue group at 32.30 + 7.6 mmHg (p value = <0.001).

CONCLUSION: Fibrin glue prepared from a single donor is comparable to two nylon 10-0 sutures in sealing 3 mm corneal penetrating wounds at IOP of up to 32 mmHg. For higher IOP, nylon 10-0 suture is more effective than fibrin glue in sealing the corneal penetrating wounds in cadaveric porcine eyes. 

Human ; Male ; Female ; Swine ; Fibrin Tissue Adhesive ; Intraocular Pressure ; Nylons ; Sutures ; Corneal Injuries ; Cornea ; Suture Techniques ; Anterior Chamber ; Wounds, Penetrating ; Metals

Regarding therapies for treatment of corneal wounds, ex vivo corneal culture is the most effective for minimizing expensive animal studies. Eighteen porcine enucleated eyes were soaked in 0.2% povidone iodine solution for disinfection prior to cornea excision. Subsequently, corneas were excised from whole eyes and filled with an agar/medium mixture. Corneas were transferred into culture dishes, after which culture medium was added until the limbus was covered. Cultures were then placed onto a plate rocker to mimic blinking action, followed by incubation at 37degrees C and 5% CO2. Corneas were harvested on Days 0, 3, and 7 after incubation, and optical coherence tomography (OCT) was performed on Day 7. Two eyes from each group were fixed in 2% glutaraldehyde/4% paraformaldehyde for low vacuum scanning electron microscopy (LV-SEM), and four eyes from each group were fixed in 10% neutral-buffered formalin for histological analysis. OCT results showed that central corneal thickness significantly increased by Day 7 compared to Day 0 (P<0.05). Using LV-SEM, gaps between endothelial cells were detected on Day 7 of ex vivo culture. In the histological evaluation, four to five stratified squamous cell layers, wing cells, and basal cells in the epithelium as well as flat-shaped keratocytes in the stroma were found on Day 0. By Day 7, stratified squamous cells and basal cells had decreased in number, and slightly round-shaped keratocytes were observed; however, the number of keratocytes was similar to that on Day 0. In this short-term ex vivo culture, epithelium and endothelium were sensitive to culture, whereas stroma and keratocytes were well maintained. An additional deswelling method will be needed to obtain more successful results in porcine corneal ex vivo culture.
Animals ; Blinking ; Cornea* ; Disinfection ; Endothelial Cells ; Endothelium ; Epithelium ; Formaldehyde ; Microscopy, Electron, Scanning ; Povidone-Iodine ; Tomography, Optical Coherence ; Vacuum ; Wounds and Injuries ; Wings, Animal

PURPOSE: To investigate the biologic effects of preservative-free artificial tear drops on cultured human corneal epithelial cells in vitro. METHODS: The effects of preservative-free artificial tear drops (sodium hyaluronate 0.1% (Kynex(R), Alcon, Seoul, Korea), sodium hyaluronate 0.18% (Kynex2(R), Alcon, Seoul, Korea), and sodium hyaluronate 0.3% (Hyaluni eye drops 0.3%(R), Taejoon, Seoul, Korea)) on human corneal epithelial cells were evaluated. Cellular proliferation was determined using MTT (3- (4,5-dimethylthiazol-2yl)-2,5-diphenyl-2H-tetrazolium bromide) and Ki-67 assays. Cellular migration was determined using CD44 and scratch wound assays. Cell damage was determined using the lactate dehydrogenase (LDH) assay and cellular morphologies using electronic microscopy and inverted microscopy. RESULTS: Proliferation of corneal epithelial cells, as determined by the MTT and Ki-67 assays, was not significantly different between the different eye drops (p > 0.05). The measured value of cellular migration after exposure of the sodium hyaluronate 0.3%, as determined by mean CD44 percentage and scratch wound assay, was higher than that of the sodium hyaluronate 0.1% and sodium hyaluronate 0.18%, but the CD44 value was not significantly different (p > 0.05). The LDH titer tended to increase as the concentration of sodium hyaluronate increased (p > 0.05), but influence on cytoplasm, as determined by electronic microscopy, was not different. CONCLUSIONS: Among 3 preservative-free artificial tear drops, sodium hyaluronate 0.3% demonstrated increased migration of corneal epithelial cells. As the concentration of sodium hyaluronate in eye drops increased, the corneal cytotoxicity of corneal epithelial cells also increased. However, there was no significant difference among the 3 tear drops.
Cell Proliferation ; Cornea ; Cytoplasm ; Epithelial Cells* ; Humans ; Hyaluronic Acid* ; L-Lactate Dehydrogenase ; Microscopy ; Ophthalmic Solutions ; Seoul ; Tears ; Wounds and Injuries

PURPOSE: To evaluate the success and complication rates of triple procedure, including pterygium excision, marginal amniotic membrane insertion beneath the conjunctiva, and limbal-conjunctival autograft in pterygium surgery. METHODS: We conducted a retrospective study on 45 eyes of 45 patients who underwent pterygium surgery between August 2011 and October 2012. After pterygium excision, amniotic membrane was placed beneath the conjunctiva along the margin of the exposed sclera followed by a limbal conjunctival autograft. Success rates, intraoperative and postoperative complications were evaluated. RESULTS: Forty-three eyes with primary pterygium and 2 eyes with recurrent pterygium were enrolled in the present study. The mean age of the patients was 59.87 +/- 14.30 years with a mean follow-up of 12.9 +/- 4.6 months. There were no complications during surgery. Early postoperative complications included partial wound dehiscence in 1 eye and a simple conjunctival cyst on the autografted conjunctiva in the another eye. No clinically significant recurrence (G2, G3) was noted during the observational periods. Thirty-nine (86.7%) and 6 (13.3%) eyes were graded as G0 and G1, respectively. CONCLUSIONS: Our surgical technique not only has the benefits of the limbal conjunctival autograft acting as a barrier against fibrovascular invasion of the cornea and supplying stem cells to the corneal epithelium but also has antiangiogenic effects of amniotic membrane with minimal use. In addition, this technique is a safe surgical method in primary and recurrent pterygium.
Amnion ; Autografts ; Conjunctiva ; Cornea ; Epithelium, Corneal ; Follow-Up Studies ; Humans ; Postoperative Complications ; Pterygium* ; Recurrence ; Retrospective Studies ; Sclera ; Stem Cells ; Wounds and Injuries

PURPOSE: To investigate the epidemiological and clinical characteristics of industrial ocular trauma for treatment application and prevention. METHODS: A retrospective survey of 207 eyes from 206 patients who visited Gosin University Gospel Hospital from January 1, 1998 to December 31, 2007 was performed. The age, sex, diagnosis, causes, injury site, primary ocular surgery, duration of hospitalization and treatment, and initial and final visual acuities were reviewed using the United States Eye Injury Registry (USEIR) form based on the Birmingham Eye Trauma Terminology (BETT). RESULTS: The trauma incidence was higher in males (95.65%) in their forties (50.24%). The mean patient age was 41.5 years. Separately counted lesions were presented as a proportion to total injured eyes. The most common diagnosis of industrial ocular traumas was global injuries (124.1%), orbital wall fractures (6.3%), adnexal trauma (5.3%) and optic nerve injuries (3.4%). The most common cause of ocular injuries was flying iron piece (28.67%), and the cornea was the most frequent injured site (69.1%). In 43% of the patients, surgical treatments were performed and the most common surgery was primary closure of the cornea or sclera (82.02%), followed by vitrectomy (30.33%). The average of initial and final visual acuity (log MAR) was 1.2 and 0.93, respectively. In 69.7% of all patients, the final visual acuity was improved or stabilized compared to the initial status. CONCLUSIONS: Flying objects are still the most frequent cause of industrial ocular trauma and in approximately 70% of all patients, the final visual outcome improved or stabilized compared to the initial status. These types of ocular traumas can be significantly reduced by wearing protector shields along with educational safety programs.
Cornea ; Diagnosis ; Diptera ; Eye Injuries ; Hospitalization ; Humans ; Incidence ; Iron ; Male ; Optic Nerve Injuries ; Orbit ; Retrospective Studies ; Sclera ; United States ; Visual Acuity ; Vitrectomy

This study was performed to evaluate the effects of conditioned media (CM) from human amniotic epithelial cells (HAECs) on the corneal wound healing process. Eighteen rabbits (36 eyes) were used and randomly assigned to three groups according treatment: CM from HAECs (group 1), vehicle alone (group 2), and saline (group 3). Corneal alkali injuries were induced with 1 N sodium hydroxide. Each reagent used for treatment evaluation was injected into the dorsal bulbar subconjunctiva and the area of the corneal epithelial defect was measured every other day. Two animals from each group were euthanized at a time on days 3, 7, and 15, and the cornea was removed for histological examination. The sum of the epithelial defect areas measured on day 0 to day 6 as well as day 0 to day 14 in group 1 was significantly smaller than those of other groups. Histological examination revealed that the group 1 corneas had less inflammatory cell infiltration and showed more intact epithelial features compared to the other groups. These results suggest that CM from HAECs promote corneal wound healing in rabbits.
Alkalies/*toxicity ; Amnion/*cytology ; Animals ; Cornea/*injuries ; Corneal Diseases/chemically induced/therapy/*veterinary ; Culture Media, Conditioned/*pharmacology ; Epithelial Cells/*physiology ; Humans ; Male ; *Rabbits

In order to investigate the feasibility of the modified chitosan-gelatin crosslinked membrane (MC-Gel) and chitosan-gelatin crosslinked membrane (CS-Gel) to be a potential biomaterial for corneal regeneration, we evaluated their physicochemical properties and intraocular biocompatibility in this study. White light transmission and permeability of these membranes were detected. Results showed that white light transmission of both membranes was above 90% at 500 nm, which was similar to that of human cornea. The glucose, tryptophan and NaCl permeability of MC-Gel membrane and CS-Gel membrane was better than or similar to those of human cornea. The methylthiazol tetrazolium (MTT) assay was used to assess cell viability and proliferation. Also, interlamellar corneal transplantation was carried out to evaluate ophthalmic biocompatibility of MC-Gel membrane and CS-Gel membrane. Results indicated that MC-Gel membranes could support the proliferation of HCEC and displayed good intraocular biocompatibility when implanted into rabbits. No severe inflammatory reaction occurred after transplantation and the implanted MC-Gel membrane degraded completely 16 weeks post-operation. Due to its good physicochemical properties and biocompatibility, MC-Gel membrane could be a promising candidate material for corneal regeneration.
Animals ; Biocompatible Materials ; chemistry ; Cells, Cultured ; Chitosan ; chemistry ; Cornea ; cytology ; Corneal Injuries ; Cross-Linking Reagents ; Epithelium, Corneal ; cytology ; physiology ; surgery ; Gelatin ; chemistry ; Guided Tissue Regeneration ; methods ; Humans ; Membranes, Artificial ; Rabbits ; Regeneration ; Tissue Engineering ; methods ; Tissue Scaffolds