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Praveena Gupta, Malkit Singh, Jamal Saada, Edward Kraft, Kevin Merkley, Kathleen Vincent; Modified Therapeutic Agents to Reduce Corneal Edema in Ex-Vivo Porcine Eyes. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1405.
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Delicate hydration of the corneal stroma is needed to maintain good vision and corneal transparency. In Fuchs’ Endothelial Dystrophy, endothelial cells are damaged and lost causing fluid accumulation in the stroma. Medical management has been limited to 5% hypertonic saline drops or ointment, to draw water out of the edematous cornea through osmosis. Once medical treatment fails, chronic corneal edema can lead to bullae, inflammation, fibrosis, opacification, and pannus, which requires surgical management at the end stage. In this study, we induce corneal edema in ex-vivo porcine eyes and compare the effects of 5% hypertonic saline drops to modified hypertonic and hyperosmolar agents as potential therapeutics in reducing corneal edema in ex-vivo porcine eyes.
Corneal edema was induced in freshly enucleated pig eyes by immersing the whole globe in distilled water overnight. Intact porcine eye globes were then treated (n=4) in each group by one hour immersion in either:- 5% hypertonic saline drops (standard therapy), or- one of two modified hypertonic and hyperosmolar agents—o 5% saline with 0.25% polyethylene glycol, 0.25% hyaluronic acid, 20% dextran; oro 5% saline with 0.25% polyethylene glycol, 0.25% hyaluronic acid, and 50% glycerol;Central Corneal thickness was measured before and after swelling and after the treatment with modified osmolar agents using the Vevo 2100 high frequency, high resolution ultrasound imaging system (Fujifilm VisualSonics, Inc.), B-mode images were acquired using the MicroScan™ Transducers MS550D.
There was no significant difference in the 5 % saline treatment group and the modified 5 % saline combined with 20 % dextran group after one hour of treatment. However, there was a 37 % decrease in the corneal edema (p<.05) in the group that was treated with 5 % saline and 50 % glycerol. This corneal shrinkage with the combined hypertonic and hyperosmotic (50% glycerin) agent is more robust than using glycerin or the standard 5 % saline alone.
Corneal edema may be improved significantly by combining the standard hypertonic saline therapy with a hyperosmotic agent like glycerol. This may open new avenues for better management of Fuch’s dystrophy and quick vision recovery by deferring surgical interventions.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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