Complications in Retinal Surgery: A Review of Corneal Changes Following Vitreoretinal Procedures

Sepulveda-Beltran, Paula A.; Levine, Harry; Chang, Victoria; Gibbons, Allister; Martínez, J.

doi:10.1097/iio.0000000000000423

Cited by 5 publications

(7 citation statements)

References 74 publications

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“…Moreover, unlike LSCD, LESC function in DK may be secondarily exacerbated as a consequence of compromised corneal sensitivity and innervation due to co-existing retinal conditions in patients with diabetes [120]. Notably, persistent epithelial defects such as neurotrophic keratopathy can develop after shaving or ablating the epithelium prior to retinal laser photocoagulation [121] or potentially due to thermal burns following laser refractive surgery [122] after which they may not fully regenerate [123]. Therefore, investigating such anomalies on a hyperglycemic background may shed new light into the pathobiology of LESCs within the diabetic cornea.…”

Section: Insights Into the Distinguishing Features Of Lescs In Dk And...mentioning

confidence: 99%

Limbal Epithelial Stem Cells in the Diabetic Cornea

Nureen,

Di Girolamo

2023

Cells

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Continuous replenishment of the corneal epithelium is pivotal for maintaining optical transparency and achieving optimal visual perception. This dynamic process is driven by limbal epithelial stem cells (LESCs) located at the junction between the cornea and conjunctiva, which is otherwise known as the limbus. In patients afflicted with diabetes, hyperglycemia-induced impairments in corneal epithelial regeneration results in persistent epithelial and other defects on the ocular surface, termed diabetic keratopathy (DK), which progressively diminish vision and quality of life. Reports of delayed corneal wound healing and the reduced expression of putative stem cell markers in diabetic relative to healthy eyes suggest that the pathogenesis of DK may be associated with the abnormal activity of LESCs. However, the precise role of these cells in diabetic corneal disease is poorly understood and yet to be comprehensively explored. Herein, we review existing literature highlighting aberrant LESC activity in diabetes, focusing on factors that influence their form and function, and emerging therapies to correct these defects. The consequences of malfunctioning or depleted LESC stocks in DK and limbal stem cell deficiency (LSCD) are also discussed. These insights could be exploited to identify novel targets for improving the management of ocular surface complications that manifest in patients with diabetes.

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Section: Insights Into the Distinguishing Features Of Lescs In Dk And...mentioning

confidence: 99%

Limbal Epithelial Stem Cells in the Diabetic Cornea

Nureen,

Di Girolamo

2023

Cells

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“…This difference between the two groups was not statistically significant (Table 2). DISCUSSION Reasons for the development of corneal edema during vitrectomy are multiple [6][7][8][9] . Despite the current advances in…”

Section: Resultsmentioning

confidence: 99%

“…I n addition to retinal-related complications [1][2][3][4][5] vitreoretinal surgery can also cause corneal complications [6] , including persistent corneal epithelial defects [7][8][9] , diabetic keratopathy [10][11][12][13] , etc., which are caused by prolonged duration of surgery and intraoperative epithelial debridement. It is well known that corneal edema often occurs during vitreoretinal surgery.…”

Section: Introductionmentioning

confidence: 99%

Silicone oil as a corneal lubricant to reduce corneal edema and improve visualization during vitrectomy

Che,

Zhou,

Zhu

2024

Int J Ophthalmol

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AIM: To evaluate the efficacy and safety of silicone oil (SO) as a corneal lubricant to improve visualization during vitrectomy. METHODS: Patients who underwent vitreoretinal surgery were divided into two groups. Group 1 was operated on with initial SO (Oxane 5700) as a corneal lubricant. Group 2 was operated on with initial lactated ringer's solution (LRS) and then replaced with SO as required. Fundus clarity was scored during the surgery. Fluorescein staining was performed to determine the damage to corneal epithelium. RESULTS: Totally 114 eyes of 114 patients were included. Single SO use maintained a clear cornea and provided excellent visualization of surgical image. In group 1, the fundus clarity was grade 3 in 41/45 eyes and grade 2 in 4/45 eyes. In group 2, corneal edema frequently occurred after initial LRS use. The fundus clarity was grade 3 in 19/69 eyes, 2 in 37/69 eyes and 1 in 13/69 eyes (P&#x003C;0.05). SO was applied in 29 eyes of initial LRS use with subsequent corneal edema, which eliminated the corneal edema in 26 eyes. Corneal fluorescein staining score in group 1 was 0 in 28 eyes, 1 in 11 eyes and 2 in 6 eyes, and 40, 20 and 9, respectively, in group 2 (all P&#x003E;0.05). CONCLUSION: The use of SO as a corneal lubricant is effective and safe for preserving and improving corneal clarity and providing clear surgical field during vitrectomy.

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“…The intricate interplay between neuronal and epithelial changes post-corneal refractive surgeries is crucial in understanding the development of DES [ 69 ]. Studies consistently underscore the profound impact of surgical procedures on both the sensory nerves and the corneal epithelium, illuminating the multifaceted pathogenesis of this postoperative complication [ 70 ]. The surgical process, particularly during stromal ablation, inadvertently severs sub-basal nerves, causing a substantial decline in corneal sensation [ 16 , 71 ].…”

Section: Reviewmentioning

confidence: 99%

Post-refractive Surgery Dry Eye: A Systematic Review Exploring Pathophysiology, Risk Factors, and Novel Management Strategies

Dossari

2024

Cureus

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Dry eye disease frequently manifests following corneal refractive procedures, significantly impacting patients' quality of life. This review systematically synthesizes current evidence on the pathophysiological mechanisms, risk factors, and therapeutic interventions for post-refractive surgery dry eye. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of literature published until August 2023 was conducted, focusing on post-refractive surgery dry eye. Eighteen relevant studies were identified through screening and eligibility assessment. A qualitative synthesis of outcomes was performed using narrative and thematic analysis methods. Surgically induced neurotrophic deficiency, stemming from nerve transection, triggers a cascade of events including apoptosis, inflammation, and lacrimal dysfunction, ultimately leading to tear film instability. Risk factors such as female gender, thyroid eye disease, meibomian gland dysfunction, higher ablation depths, and the use of LASIK over surface ablation exacerbate the condition. While conventional treatments like artificial tears provide temporary relief, emerging interventions such as nerve growth factors, matrix metalloproteinase inhibitors, serum eye drops, and specialized contact lenses show promise in promoting nerve regeneration and epithelial healing. Strategies such as customized ablation profiles, smaller optical zones, and nervesparing techniques like small incision lenticule extraction demonstrate potential advantages. A multifaceted therapeutic approach targeting neuroprotection, anti-inflammatory mechanisms, and tear film stabilization is imperative for effectively managing post-refractive surgery dry eye. Future research should focus on evaluating prognostic biomarkers, exploring precision medicine approaches, and investigating neuroprotective adjuvants to further enhance treatment outcomes.

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Complications in Retinal Surgery: A Review of Corneal Changes Following Vitreoretinal Procedures

Abstract: The corneal sensation is provided by the ophthalmic branch of the trigeminal nerve, predominantly via the long ciliary nerves. 14 The long 66 ' Sepulveda-Beltran et al

Cited by 5 publications

References 74 publications

Limbal Epithelial Stem Cells in the Diabetic Cornea

Limbal Epithelial Stem Cells in the Diabetic Cornea

Silicone oil as a corneal lubricant to reduce corneal edema and improve visualization during vitrectomy

Post-refractive Surgery Dry Eye: A Systematic Review Exploring Pathophysiology, Risk Factors, and Novel Management Strategies

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