bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of epithelial corneal layer after phacoemulsification
Authors: Cerdà‐Ibáñez Marta , Peris‐Martínez Cristina 
Published: January 2024

Aims/Purpose: To verify whether changes occur in the epithelial corneal layer after phacoemulsification depending on the number of endothelial cells.Methods: This is a prospective observational study on patients who were going to have cataract removal surgery. The patients were divided into two groups in accordance with their endothelial cell count: one group with more than 1500 endothelial cells and the other with fewer than 1500 cells. We analysed the epithelial layer with the RTVue (Optovue, Fremon, USA) device. The epithelial mapping was performed before surgery, the day after the intervention, a week after the procedure, 1 and 6 months post‐surgery.Results: The epithelial layer was greater in patients who had more than 1500 endothelial cells. This difference was statistically significant at every visit except the day after surgery, when there were no differences between the groups.Conclusions: Immediate postoperative corneal oedema following phacoemulsification affects the cornea irregularly at the sublayer level. Corneal oedema secondary to the cataract removal surgery can affect the epithelial layer, but this is a transient change since a week after surgery this layer showed the same differences as before the procedure. These changes were encountered in the central cornea, without involvement of the incision sites. Patients with fewer endothelial cells showed a lower epithelial layer thickness even though there were no significant statistical differences in pachymetry between the two groups. Possibly this difference is secondary to a higher stromal thickness layer to compensate for such changes.
Feasibility of 3D bioprinting of a corneal stroma tissue equivalent using a desktop 3D printer
Authors: Diafa Aspasia , Tsouknidas Alexandros 
Published: January 2024

Aims/Purpose: The aim of this poster is to present a proof of concept for the possibility of three‐dimensional bioprinting of a corneal stroma equivalent, using a modified (open source) three‐dimensional desktop printer.Methods: We present the experimental process designed for the realization of the three‐dimensional bioprinting of a corneal stroma equivalent, utilizing a tissue‐specific deposition nozzle based on commercially available and easily printable parts. The final design considers all the required modifications of the 3D printer and the selection of the appropriate bioink.Results: We designed a prototype proprietary device to be fitted on a MendelMax 3 3D printer. The particular open‐source device works as a syringe extruder, with the syringe containing the bioink. The composition of the bioink is based on a carefully selected blend of collagen, alginate, and keratocytes. The mixture demonstrates suitable structural integrity and transparency after crosslinking.Conclusions: This proof‐of‐concept work demonstrates that, with proper modification, a standard commercial three‐dimensional printer can be modified to use bioinks and bioprint corneal stroma tissue equivalents. More research is required regarding the viability of the tissue equivalents and their clinical applications.
Ocular pathogens and antibiotic susceptibility patterns in bacterial keratitis during 2010–2019 in the county of Östergötland, Sweden, a retrospective study
Authors: Roth Jenny , Toprak Baris , Somajo Sofia , Macedo Antonio Filipe , Lagali Neil 
Published: January 2024

Aim/Purpose: The aim of this study was to identify causative bacterial species, aetiology of infection and determine antibiotic susceptibility in bacterial keratitis in the county of Östergötland, Sweden.Methods: We performed a retrospective search in the regional Electronic Health Record, period 2010–2019, for patients diagnosed with keratitis according to the codes of the International Classification of Disease.Results: One‐hundred and ninety patients with lab culture‐confirmed bacterial keratitis were included in the final analysis. Antimicrobial susceptibility tests were available for all confirmed bacterial keratitis. Laboratory tests revealed a total of 188 (84%) Gram‐positive and 36 (16%) Gram‐negative pathogens. The most frequently reported bacterial species were coagulase‐negative staphylococci (CoNS) (39%), Staphylococcus aureus (17%) and Cutibacterium acnes (10%). Pseudomonas spp. was the most frequently reported Gram‐negative bacterial species (7%). Contact lens wear and severely ill/blind eye were the top two aetiological factors associated with bacterial keratitis. Most of the isolates (157 out of 173) were reported susceptible to first line antibiotics, which are fluoroquinolones, and nearly all (145 out of 155) isolates were susceptible to chloramphenicol ‐ that is the recommended treatment in combination with fluoroquinolones. We did not detect any cases of methicillin‐resistant Staphylococcus aureus. The type of treatment and the outcome of the treatment including visual acuity were assessed in the cohort.Conclusions: Our results revealed a positive rate of bacterial keratitis of 59% for the samples sent to the laboratory. The bacterial species causing keratitis in the current study were consistent over time and the species were susceptible to the recommended antibiotics. These findings indicate patients are receiving the correct treatment.
Artificial tears, preservatives, so what?
Authors: Alnoor Umalbaninn , Ahrensberg Simone , Freiberg Josefine , Kolko Miriam , Nagstrup Anne , Heegaard Steffen 
Published: January 2024

Aims/Purpose: To investigate the cell survival of human conjunctival goblet cells (CGs) when incubated with preserved and preservative‐free (PF) artificial tears (AT) used against dry eye disease (DED). The following ATs were tested: 0.011% benzalkonium chloride (BAK)‐preserved Viskøse® Øjendråber, 0.006% BAK‐preserved Oftagel®, 0.005% BAK‐preserved Oculac®, 0.001% PolyQuad™‐preserved Systane® Ultra, 0.01% Cetrimide‐preserved Artelac®, and PF ATs: Systane® Ultra, Oculac®, Oftagel®, and Thealoz® Duo.Methods: Primary cultures of human conjunctival CGs were cultivated from donor conjunctiva. After incubation with the above‐mentioned ATs for 2 h, CG survival was analysed using a lactate dehydrogenase assay and calculated to a negative control.Results: AT preserved with 0.011% BAK reduced GC survival by 28% compared to negative control (p = 0.001). The remaining ATs did not significantly alter the cell survival.Conclusions: BAK‐preserved ATs cause GC death in a concentration‐dependent manner. Reduction of the GC density may contribute to development of DED. PF‐ATs and PolyQuad‐ and Cetrimide‐preserved ATs may thus be a better choice for treating DED than BAK preserved ATs, as the latter may add to the ocular surface disease.
Preparation and outcome of swollen versus dextran deswollen grafts in descemet membrane endothelial keratoplasty (DMEK)
Authors: Zwingelberg Sarah 
Published: January 2024

Aims/Purpose: To evaluate the influence of organ culture medium containing dextran on graft characteristics during preparation as well as the outcome of subsequent Descemet Membrane Endothelial Keratoplasty (DMEK).Methods: 31 corneoscleral rims of the Eye Bank of the University Hospital of Cologne with a donor age between 52 and 74 years were examined between 2018 and 2022 for their intraoperative preparation conditions and the outcome after performing 31 DMEKs. For this purpose, corneoscleral rims were randomized into two organ‐cultured groups, one immersed in culture medium with dextran (group A, n = 16) and the other in medium without dextran (group B, n = 15). The intraoperative graft preparation conditions were noted by using a standardized scoresheet, including splitting and stripping behaviour, central and peripheral attachment as well as graft fragility. The post‐operative outcome parameters were defined as Best Spectacle‐Corrected Visual Acuity (BSCVA), central and peripheral corneal thickness (CCT and PCT), endothelial cell count (ECC) and re‐bubbling rate.Results: In both groups, all 31 DM‐endothelium grafts were usable for DMEK. There was no significant difference in the intraoperative preparation conditions of swollen versus dextran deswollen DM‐endothelium grafts in respect to stripping (p = 0.722) and to Descemet membrane splitting behaviour (p = 0.013). The fragility of the grafts showed no significant difference (p = 0.433), as well as the peripheral scars indicating a pseudophakic donor (p = 1.000) and the tendency for central tearing (p = 0.484) during preparation. No significant difference in the outcome 12 months after DMEK in conditions of swollen versus dextran deswollen DM‐endothelium grafts regrading CCT (p = 0.189), re‐bubbling (p = 0.704), PCT (p = 0.063), could be observed. BSCVA was significantly better in group B 12 months after DMEK with p = 0.032 (group A 0.08 ± 0.38: group B 0.03 ± 0.13).Conclusions: This pilot study does not show relevant and significant differences between swollen versus dextran deswollen grafts in DMEK transplantation. Future prospective studies with higher patient numbers are needed. Our study suggests also non‐deswollen donors as suitable for DMEK surgery.
Long‐term results and persistence of topical cyclosporine a 0.1% treatment in patients with dry eye disease in a tertiary eye centre
Authors: Aghayeva Fidan , Assaf Abdelrahman , Lanzl Ines 
Published: January 2024

Aims/Purpose: This study aims to assess clinical effectiveness, outcome and safety of long‐term topical Cyclosporine A 0.1% Cationic Emulsion (CsA 0.1% CE; Ikervis®) treatment in patients with dry eye disease.Methods: Retrospective chart review of 55 patients (110 eyes) with dry eye disease and severe keratitis treated with Ikervis® since 2016 for at least 12 months without interruption was performed. Study outcomes were median change from baseline in corneal fluorescein staining (CFS, Oxford Grade Scale) score, clinical outcome, treatment discontinuation reason, ocular symptom severity and adverse events (AEs) during long follow‐up.Results: The mean age of patients was 65.96 ± 1.9 years, 81.8% women and 18.2% men. The mean follow‐up was 33.8 ± 19.1 (12–80) months. 43.6% eyes had grade III of CFS at baseline and 4.5% had grade I of CFS at the last follow up. The median CFS score reduced from 2 (1–3) at baseline to 0 (0–1) at the last follow up and this reduction was statistically significant (p < 0.001) from the fourth week. Clinical outcome was defined as active/worsening in 1.8%, stabilization in 14.5%, improvement in 69.1% and resolution in 14.5% of the cases. 65.5% of the patients have continued the treatment without interruption during the whole follow‐up, the treatment discontinuation in 35.5% of the cases were due to improvement (14.5%), AEs (5.5%), patient decision (5.5%), treatment failure (3.6%), other reason (5.5%). Ocular symptom severity was significantly reduced from baseline during the follow up (p < 0.001). In 27.3% cases treatment‐related AEs were reported, most of them (64.7%) were mild.Conclusions: This study shows a long‐term clinical effectiveness and persistence of the topical CsA 0.1% CE treatment in patients with dry eye disease. The significantly reduction of the dry eye symptoms severity from the fourth week of the initiated Ikervis® treatment sustains for a long follow up, and thus definitely improves the quality of life of patients.Reference1. Geerling G, Hamada S, Trocmé S, Ræder S, Chen X, Fassari C, Lanzl I; PERSPECTIVE study group. Real‐World Effectiveness, Tolerability and Safety of Cyclosporine A 0.1% Cationic Emulsion in Severe Keratitis and Dry Eye Treatment. Ophthalmol Ther 2022; 11(3): 1101–1117. doi: 10.1007/s40123‐022‐00487‐x.
Higher occurrence of ocular surface disease symptoms in patients with atopic dermatitis—Data in the FOREVER study
Authors: Hansen Pernille May , Rovelt Jens , Tolstrup Jette , Thyssen Jacob P. , Heegaard Steffen , Kolko Miriam 
Published: January 2024

Aims/Purpose: Atopic Dermatitis (AD) is a common inflammatory skin disease that often begins in early childhood and may continue into adulthood. AD severity, and comorbid bronchial asthma and rhinitis have been associated with increased prevalence of Ocular Surface Diseases (OSD) in AD patients (1). OSD is common in the general population and symptoms from the ocular surface do not always lead to examination and diagnosis by healthcare professionals. The purpose of this study was to investigate the occurrence of self‐reported symptoms from the ocular surface in AD patients compared to the population without AD.Methods: A questionnaire study was conducted as a part of project FOREVER (Finding Ophthalmic Risk and Evaluating the Value of Eye exams and their predictive Reliability) to examine the relationship between eye and overall health in Danish citizens. Symptoms related to the ocular surface included tearing, blurred vision, red, itching, burning, gritty, and dry eyes. Logistic regression models were used to investigate associations between AD and the occurrence of symptoms related to the ocular surface.Results: 36874 people had completed the FOREVER questionnaire. 797, 3305 and 32 772 participants answered that they have current AD, previously had AD, and never had AD, respectively. 69% (550/797) and 67% (2201/3305) in the group with current AD and previous AD experienced one or more ocular surface symptoms compared to 60% (19 517/32 772) in the non‐AD group. The odds ratio of AD and ocular surface symptoms was 1.27 [1.09–1.48] (p < 0.01) and 1.17 [1.08–1.26] (p < 0.001) for current and previous AD when adjusting for age, sex, smoking status, and atopic comorbidities; bronchial asthma and rhinitis.Conclusions: Our study found that participants with AD from the FOREVER cohort reported a higher occurrence of OSD symptoms compared to participants who have never suffered from AD. This suggest that AD patients are at higher risk of developing OSD symptoms.Reference1. Rønnstad ATM, Hansen PM, Halling AS, et al. Factors associated with ocular surface disease and severity in adults with atopic dermatitis: a nationwide survey. J Eur Acad Dermatol Venereol. 2022;36(4):592–601.
Investigation of apoptotic and inflammatory markers in hypoxia induced human cornea epithelial cells co‐cultured with limbal mesenchymal stem cells
Authors: Canbulat Zehra , Aydemir Ayse Dilara , Hasanreisoğlu Murat 
Published: January 2024

Aims/Purpose: Here we aim to investigate the effect of hypoxic conditions (5% O2) on human cornea epithelial cells (HCECs) and also by creating a system in which limbal mesenchymal stem cells (LMSCs) are co‐cultured with HCECs, the effect of LMSC is examined on this subject via paracrine mechanism.Methods: HCECs are either mono‐cultured or co‐cultured with LMSC under hypoxic and normoxic (%21 O2) conditions. HCECs of after 6, 24, and 48 h of incubation were harvested for comprehension of changes in RNA and protein expression levels. Bcl2, Bax, Erk1/2 protein levels are checked through western blot analysis, whereas expression levels of cytokines, which are IL‐6, IL‐8, IL‐10 and TGF‐β1, are investigated via RT‐qPCR.Results: Both anti‐inflammatory and pro‐inflammatory cytokine gene expression levels in co‐cultured model increased upon hypoxia and normoxia conditions compared to cytokines in mono cultured HCECs. In addition to the increase in cytokine levels in the co‐culture condition, this increase is less in the hypoxia exposed co‐culture in comparison to the normoxic co‐culture model. Furthermore, anti‐ and pro‐apoptotic protein expression levels have significantly changed upon co‐cultured both in normoxia and hypoxia conditions.Conclusions: In conclusion, it is observed that hypoxia with co‐cultured model decreased inflammation and acted as crucial role in cell death mechanism. These results were further confirmed with apoptotic protein ratio in hypoxic co‐cultured cells. The underlying mechanism will be examined in future experiments.
An attempt to evaluate the anterior surface homeostasis in patients with diabetic retinopathy
Authors: Kuligowska Agnieszka , Pius‐Sadowska Ewa , Machaliński Bogusław , Machalińska Anna 
Published: January 2024

Aims/Purpose: The aim of our study was to verify the presence of dry eye disease (DED) in diabetic patients. We also tried to determine the relationship between diabetic neuropathy and the presence of ocular surface disease.Methods: 52 type 2 diabetic patients and 52 non‐diabetic, sex and age‐matched controls were included in the study. All participants completed the OSDI questionnaire and undergone the eye surface examination with IDRA analyser including interferometry, tear meniscus height, non‐invasive tear break‐up time (NIBUT), evaluation of blepharitis, blinking pattern, pupillometry and meibography. Corneal sensation in the centre of the cornea and its 4 quadrants was analysed with the Cochet–Bonnet aesthesiometer (CBE). Corneal confocal microscopy images of sub‐basal plexus were evaluated using ACCMetrics. The concentrations of the neurotrophic factors: beta‐NGF, BDNF, NT‐4 as well as inflammatory mediators (TNF‐α, VEGF, IL‐2, ‐1β, ‐4, ‐5, ‐6, ‐8, ‐10, ‐12, GM‐CSF, IFN‐γ) were measured in the tear film using Luminex 200 analytic platform.Results: The OSDI was significantly higher in diabetic patients compared to the controls (mean: 29.08 vs. 11.67 points; p < 0.001). The groups did not differ in the results of the Schirmer test, interferometry, NIBUT and meibography values. Moreover, we did not find the elevation in the concentrations of the ocular surface inflammation indicators in tears of diabetics as compared to controls. There was a significant difference in tear meniscus between groups. Diabetics achieved significantly worse results than the control group in terms of corneal sensation, innervation parameters (average nerve length = 6.70 vs 11.54 mm/mm2; p < 0.001, average density = 9.26 vs. 19.19/mm2; p < 0.001), scotopic pupillometry and blinking interval. Tear film BDNF concentrations were lower in diabetic eyes as compared to controls (mean 1.85 vs. 2.29 pg/mg; p = <0.001).Conclusions: The lack of proinflammatory response in diabetic eyes and no differences between groups in the terms of objective clinical features may suggest that there is no cause‐and‐effect relationship between diabetes and DED. Corneal innervation disorders, clinically noticeable as decreased corneal sensation, result in a number of complications, that have a direct impact on the subjective feelings of the patient.
Comparative analysis of corneal parameters between DMEK and UT‐DSAEK eyes in 3‐year follow‐up
Authors: Machalińska Anna , Kuligowska Agnieszka , Kuśmierz‐Wojtasik Monika 
Published: January 2024

Aims/Purpose: The aim of the study was to provide a comparative analysis of corneal parameter changes compared to their preoperative values between Descemet membrane endothelial keratoplasty (DMEK) and ultrathin Descemet stripping automated endothelial keratoplasty (UT‐DSAEK) patients.Methods: The study included 27 eyes after UT‐DSAEK and 34 eyes after DMEK. Best corrected visual acuity (BCVA), endothelial cell count (ECC), central corneal thickness (CCT), mean keratometry (MK), mean astigmatism (MA), astigmatism asymmetry (AA) and higher order aberrations (HOAs) were assessed at baseline and 1, 3, 6, 12, 24 and 36 months after the surgery.Results: Patients after DMEK had significantly better BCVA than patients after UT‐DSAEK (mean 0.9 vs. 0.6 at 24th month, respectively, p = 0.002 and 0.9 vs. 0.7 at 36th month of follow‐up, respectively, p = 0.001). From the 3rd month post operation, ECC was higher in the DMEK eyes than in the UT‐DSAEK eyes (p = 0.01). However, the groups did not differ in this parameter at 24th and 36th month of observation. In a bivariate analysis that was adjusted for age, DMEK was associated with a smaller decrease in posterior MK at the 1‐month (β = −0.49, p = 0.002), 3‐month (β = −0.50, p < 0.001), 6‐month (β = −0.58, p < 0.001) and 12‐month (β = −0.49, p < 0.001) follow‐up visits. Significant differences in MK, AA and HOA values of the posterior surface of the cornea at 12th, 24th and 36th month of observation and MA of the posterior surface of the cornea at 24th month of observation were found as well, with no differences in the total values of these parameters. Accordingly, no significant differences in changes in MA, AA or HOAs compared to the baseline values were identified between the eyes after DMEK and UT‐DSAEK at any follow‐up time point.Conclusions: UT‐DSAEK seem to be an easier and safer technique than DMEK while maintaining similar outcomes regarding irregular astigmatism and total keratometry values. Nevertheless, DMEK produces significantly better BCVA outcomes.
Change in posterior astigmatism with degree of decentring graft in patients with descemet stripping automated endothelial keratoplasty
Authors: Park Jae Hyun , Kim Hyun‐Seung 
Published: January 2024

Aims/Purpose: Aligning the center of grafts in patients with Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) is difficult but important process. We investigated how the graft centring affected posterior astigmatism in patients.Methods: This study analysed 63 patients (63 eyes) who received DSAEK. Postoperative posterior astigmatism of patients was measured using pentacam, and the decentring of the graft was measured by using the distance between the patient's optic centre and the centre of the graft. Correlation analysis was performed on the relationship between graft decentring and posterior astigmatism. In addition, the spherical aberration of the cornea before and after surgery was analysed and investigated.Results: The average posterior astigmatism of the patients before surgery was 1.70 ± 2.25, and the average posterior astigmatism was 0.66D ± 0.43, confirming a decrease in posterior astigmatism after surgery (p < 0.05). The mean decentring of graft was 0.45 ± 0.33 mm. Preoperative spherical aberration was 0.192 ± 0.53 and postoperative spherical aberration was 0.044 ± 0.37, and these differences were not statistically significant (p > 0.05). Analysis of the relationship between graft decentring and postoperative posterior astigmatism showed no statistically significant correlation (p > 0.05).Conclusions: In this study, no significant correlation was found between centring of the graft and posterior astigmatism after surgery. However, centring of the graft in DSAEK plays an important role in graft survival and postoperative prognosis, surgeons should pay attention to centring well during surgery.
Anti‐inflammatory effect of mulberry anthocyanins on experimental dry eye
Authors: Lee Ji Young , Kwon Jin Woo 
Published: January 2024

Aims/Purpose: To investigate the anti‐inflammatory effects of mulberry anthocyanin on dry eye.Methods: HME‐DDS (Hot‐Melt Extrusion‐Drug Delivery System) was used to maximize the content of anthocyanin in mulberry. Experimental dry eye (EDE) was induced by topical 0.2% BAK (benzalkonium chloride) eye drops instilled twice a day for 1 week. The animals were randomly divided into those treated with and without the mulberry HME‐DDS products (10 g/kg/day). Ocular surface staining using fluorescein and Schirmer's test were performed. After 2 weeks of treatments, the animals were sacrificed, and tissues were harvested, and immunohistochemistry was performed to detect inflammatory response to compare with the control group.Results: After mulberry HME‐DDS treatments, the corneal staining score was significantly decreased compared to the untreated group (3.33 ± 0.83, 7.63 ± 1.00; p = 0.004). In addition, mulberry HME‐DDS treated group showed a significant increase in tear production compared with the untreated group (8.83 ± 2.29, 6.18 ± 2.44; p = 0.014). The mulberry HME‐DDS products decreased the expression of IL‐1, IL‐6 and IL‐17 in the cornea and lacrimal gland.Conclusions: Mulberry with HME‐DDS technology improved ocular surface findings and tear production. In addition, the mulberry HME‐DDS product reduced the expression of inflammatory cytokines in the cornea and lacrimal gland, and it was speculated that anthocyanins containing mulberry could improve clinical manifestations by suppressing inflammation.