AIM:To investigate the incidence,risk factors,clinical course,and outcomes of corneal epithelial defects(CED)following vitreoretinal surgery in a prospective study setting.METHODS:This was a post-hoc analysis of all p...AIM:To investigate the incidence,risk factors,clinical course,and outcomes of corneal epithelial defects(CED)following vitreoretinal surgery in a prospective study setting.METHODS:This was a post-hoc analysis of all participants in DISCOVER intraoperative optical coherence tomography study.Subjects with CED 1 d after surgery without intraoperative corneal debridement was defined as the postoperative CED group.Subjects who underwent intraoperative debridement were defined as intraoperative debridement group.Eyes were matched 2:1 with controls(eyes without postoperative CED)for comparative assessment.The primary outcomes were the incidence of CED on postoperative day one and the incidence of required intraoperative debridement.Secondary outcomes included time to defect closure,delayed healing(>2 wk),visual acuity(VA)and presence of scarring at one year and cornea consult.RESULTS:This study included 856 eyes that underwent vitreoretinal surgery.Intraoperative corneal debridement was performed to 61(7.1%)subjects and postoperative CED developed spontaneously in 94(11.0%)subjects.Significant factors associated with postoperative CED included prolonged surgical duration(P=0.003),diabetes mellitus(P=0.04),postoperative ocular hypotension(P<0.001).Prolonged surgical duration was associated with intraoperative debridement.Delayed defect closure time(>2 wk)was associated with corneal scar formation at the end of the 1 y in all epithelial defect subjects(P<0.001).The overall rate of corneal scarring for all eyes undergoing vitrectomy was 1.8%.CONCLUSION:Prolonged duration of surgery is the strongest factor associated with both intraoperative debridement and spontaneous postoperative CED.Delayed defect closure is associated with a greater risk of corneal scarring at one year.The overall rate of corneal scarring following vitrectomy is low at<2%.展开更多
AIM: To study the influence of frontalis muscle flap suspension on ocular surface by analyzing the clinical features and inflammatory cytokines.METHODS: A prospective, observational case series. Thirty-one eyes of 25 ...AIM: To study the influence of frontalis muscle flap suspension on ocular surface by analyzing the clinical features and inflammatory cytokines.METHODS: A prospective, observational case series. Thirty-one eyes of 25 patients with severe congenital blepharoptosis who underwent frontalis muscle flap suspension surgery with at least 6 mo of follow-up were included in the study. The main outcome measures were margin reflex distance 1(MRD_1), degree of lagophthalmos, ocular surface disease index(OSDI), fluorescein staining(Fl), tear break-up time(BUT), Schirmer I test, and inflammatory cytokine assay.RESULTS: The degrees of lagophthalmos significantly increased after surgery. The OSDI scores significantly increased 1wk postoperatively and then decreased 4wk after operation. The Fl scores reflected corneal epithelial defects in sixteen patients at early stage postoperatively. The BUT and Schirmer I test values remained stable and did not show change compared to those before surgery. The inflammatory cytokines in conjunctival epithelial cells(including IL-1β, IL-6, IL-8, TNF-α, and IL-17A) significantly increased 1wk after the surgery(P<0.001), then returned to the normal level at 24wk postoperatively. The levels of inflammatory cytokine IL-1β, IL-6, IL-8, TNF-α, and IL-17A elevated significantly and were positively correlated with OSDI and Fl scores.CONCLUSION: Frontalis muscle flap suspension surgery results in lagophthalmos in early period of post-operation and relieved after months. The elevation of inflammatory cytokines level may participate in the occurrence of corneal epithelial defects at the early postoperative stage.展开更多
基金Supported by National Institutes of Health/National Eye Institute,Bethesda,Maryland,USA(K23-EY022947-01A1)。
文摘AIM:To investigate the incidence,risk factors,clinical course,and outcomes of corneal epithelial defects(CED)following vitreoretinal surgery in a prospective study setting.METHODS:This was a post-hoc analysis of all participants in DISCOVER intraoperative optical coherence tomography study.Subjects with CED 1 d after surgery without intraoperative corneal debridement was defined as the postoperative CED group.Subjects who underwent intraoperative debridement were defined as intraoperative debridement group.Eyes were matched 2:1 with controls(eyes without postoperative CED)for comparative assessment.The primary outcomes were the incidence of CED on postoperative day one and the incidence of required intraoperative debridement.Secondary outcomes included time to defect closure,delayed healing(>2 wk),visual acuity(VA)and presence of scarring at one year and cornea consult.RESULTS:This study included 856 eyes that underwent vitreoretinal surgery.Intraoperative corneal debridement was performed to 61(7.1%)subjects and postoperative CED developed spontaneously in 94(11.0%)subjects.Significant factors associated with postoperative CED included prolonged surgical duration(P=0.003),diabetes mellitus(P=0.04),postoperative ocular hypotension(P<0.001).Prolonged surgical duration was associated with intraoperative debridement.Delayed defect closure time(>2 wk)was associated with corneal scar formation at the end of the 1 y in all epithelial defect subjects(P<0.001).The overall rate of corneal scarring for all eyes undergoing vitrectomy was 1.8%.CONCLUSION:Prolonged duration of surgery is the strongest factor associated with both intraoperative debridement and spontaneous postoperative CED.Delayed defect closure is associated with a greater risk of corneal scarring at one year.The overall rate of corneal scarring following vitrectomy is low at<2%.
基金Supported by the National Natural Science Foundation of China(No.81670823)
文摘AIM: To study the influence of frontalis muscle flap suspension on ocular surface by analyzing the clinical features and inflammatory cytokines.METHODS: A prospective, observational case series. Thirty-one eyes of 25 patients with severe congenital blepharoptosis who underwent frontalis muscle flap suspension surgery with at least 6 mo of follow-up were included in the study. The main outcome measures were margin reflex distance 1(MRD_1), degree of lagophthalmos, ocular surface disease index(OSDI), fluorescein staining(Fl), tear break-up time(BUT), Schirmer I test, and inflammatory cytokine assay.RESULTS: The degrees of lagophthalmos significantly increased after surgery. The OSDI scores significantly increased 1wk postoperatively and then decreased 4wk after operation. The Fl scores reflected corneal epithelial defects in sixteen patients at early stage postoperatively. The BUT and Schirmer I test values remained stable and did not show change compared to those before surgery. The inflammatory cytokines in conjunctival epithelial cells(including IL-1β, IL-6, IL-8, TNF-α, and IL-17A) significantly increased 1wk after the surgery(P<0.001), then returned to the normal level at 24wk postoperatively. The levels of inflammatory cytokine IL-1β, IL-6, IL-8, TNF-α, and IL-17A elevated significantly and were positively correlated with OSDI and Fl scores.CONCLUSION: Frontalis muscle flap suspension surgery results in lagophthalmos in early period of post-operation and relieved after months. The elevation of inflammatory cytokines level may participate in the occurrence of corneal epithelial defects at the early postoperative stage.
