|
 
 |
| EDITORIAL |
|
| Year : 2017 | Volume
: 7
| Issue : 4 | Page : 177-178 |
|
Therapy for corneal diseases, layer by layer
Wei-Li Chen
Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| Date of Web Publication | 5-Dec-2017 |
Correspondence Address:
Wei-Li Chen
7, Chung-Shan South Road, Taipei
Taiwan
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/2211-5056.219939
How to cite this article:
Chen WL. Therapy for corneal diseases, layer by layer. Taiwan J Ophthalmol 2017;7:177-8 |
Cornea is a thin and transparent structure in the most anterior part of the eyeball and plays an important role in controlling vision. From the most anterior part of the cornea, the tear film, and to the most posterior part, the corneal endothelium, a defect in any layer may impair visual function. Accordingly, treatment strategy should focus on the layer of the corneal disease and treat the defect layer by layer.
In this issue, we selected several important and interesting articles about diseases in different layers of the cornea and the respective treatments.
| Treatment of Dry Eye | |  |
Topical autologous serum has long been used to treat severe dry eye syndrome.[1],[2],[3],[4] However, the pros and cons of using autologous serum in the treatment of primary and secondary Sjogren syndrome (SS) have seldom been systemically discussed. Hwang et al. reported that primary and secondary SS could react differently to treatments because of the elevated serum pro-inflammatory cytokine levels in secondary SS.[5] In this issue, Ma et al. analyzed the serum components and the therapeutic effects of topical autologous serum in treating dry eye caused by primary and secondary SS. The study emphasized the importance of using erythrocyte sedimentation rate as an indicator of disease activity and predictor of therapeutic effects.
| Treatment of Limbal Insufficiency | | |
Although cell therapy using cultivated limbal or oral mucosal epithelial cell sheets has been regarded as the standard therapeutic option for limbal insufficiency,[6],[7],[8] the various cultivating protocols are known to lead to different treatment results. Among these protocols, whether the cell products should receive air lifting has not been well explored. In this issue, Chen et al. airlifted cultivated rabbit corneal epithelial cells for different durations and concluded that airlifting could trigger cell stratification and differentiation without changing the pattern and localization of several important cytokeratin and stem cell markers. Their results suggest that a suitable duration of airlifting may be considered in the cell therapy for limbal insufficiency.
| Lamellar Keratoplasty | | |
Nowadays, lamellar keratoplasty has replaced penetrating keratoplasty in most cases of corneal transplantation.[9],[10] Deep anterior lamellar keratoplasty (DALK) has the benefit of removing the lesions in the stromal layer without disrupting the recipient's own corneal endothelium. This procedure can thus prevent corneal endothelial rejection after transplantation and increase the success rates of surgeries. Ma et al. reported on the surgical outcomes of layer-by-layer DALK in this issue and provided an interesting option for patients with previous inflammation or fibrosis.
This issue also included the study by Akbar et al. which compared the surgical outcomes for transepithelial corneal crosslinking and epithelial off crosslinking in adult population with progressive keratoconus and the report by Hou et al. on corneal endothelial cell loss in penetrating keratoplasty, endothelial keratoplasty, and DALK.
Through these articles, we aim to provide the readers with a thorough understanding of the new treatment strategies for corneal disorders.
| References | | |
| 1. | Huang CJ, Sun YC, Christopher K, Pai AS, Lu CJ, Hu FR, et al. Comparison of corneal epitheliotrophic capacities among human platelet lysates and other blood derivatives. PLoS One 2017;12:e0171008.  |
| 2. | Lee YK, Lin YC, Tsai SH, Chen WL, Chen YM. Therapeutic outcomes of combined topical autologous serum eye drops with silicone-hydrogel soft contact lenses in the treatment of corneal persistent epithelial defects: A preliminary study. Cont Lens Anterior Eye 2016;39:425-30. |
| 3. | Shen EP, Hu FR, Lo SC, Chen YM, Sun YC, Lin CT, et al. Comparison of corneal epitheliotrophic capacity among different human blood-derived preparations. Cornea 2011;30:208-14. |
| 4. | Chen YM, Hu FR, Huang JY, Shen EP, Tsai TY, Chen WL, et al. The effect of topical autologous serum on graft re-epithelialization after penetrating keratoplasty. Am J Ophthalmol 2010;150:352-900. |
| 5. | Hwang J, Chung SH, Jeon S, Kwok SK, Park SH, Kim MS, et al. Comparison of clinical efficacies of autologous serum eye drops in patients with primary and secondary Sjögren syndrome. Cornea 2014;33:663-7. |
| 6. | Nakamura T, Endo K, Cooper LJ, Fullwood NJ, Tanifuji N, Tsuzuki M, et al. The successful culture and autologous transplantation of rabbit oral mucosal epithelial cells on amniotic membrane. Invest Ophthalmol Vis Sci 2003;44:106-16. |
| 7. | Tseng SC, Chen SY, Shen YC, Chen WL, Hu FR. Critical appraisal of ex vivo expansion of human limbal epithelial stem cells. Curr Mol Med 2010;10:841-50. |
| 8. | Rama P, Ferrari G, Pellegrini G. Cultivated limbal epithelial transplantation. Curr Opin Ophthalmol 2017;28:387-9. |
| 9. | Luengo-Gimeno F, Tan DT, Mehta JS. Evolution of deep anterior lamellar keratoplasty (DALK). Ocul Surf 2011;9:98-110. |
| 10. | Den S, Kawashima M, Shimmura M, Imai Y, Satake Y, Shimazaki J, et al. How good is transplantation of corneal parts compared with penetrating keratoplasty? Cornea 2010;29 Suppl 1:S48-51. |
|
Search Pubmed for