Purpose: To analyze the changes in corneal innervation by means of in vivo corneal confocal microscopy (IVCM) in patients diagnosed with Evaporative (EDE) and Aqueous Deficient Dry Eye (ADDE) and treated with a standard treatment for Dry Eye Disease (DED) in combination with Plasma Rich in Growth Factors (PRGF). Methods: Eighty-three patients diagnosed with DED were enrolled in this study and included in the EDE or ADDE subtype. The primary variables analyzed were the length, density and number of nerve branches, and the secondary variables were those related to the quantity and stability of the tear film and the subjective response of the patients measured with psychometric questionnaires. Results: The combined treatment therapy with PRGF outperforms the standard treatment therapy in terms of subbasal nerve plexus regeneration, significantly increasing length, number of branches and nerve density, as well as significantly improving the stability of the tear film (p < 0.05 for all of them), and the most significant changes were located in the ADDE subtype. Conclusions: the corneal reinnervation process responds in a different way depending on the treatment prescribed and the subtype of dry eye disease. In vivo confocal microscopy is presented as a powerful technique in the diagnosis and management of neurosensory abnormalities in DED.

Background and Objectives: Dry eye disease (DED) is a common and very symptomatic pathology that affects normal daily activity. The aim of the study was to evaluate the efficacy of plasma rich in growth factors (PRGF) added to one routine treatment protocol for DED (artificial tears substitutes, lid hygiene, and anti-inflammatory therapy). Materials and Methods: Patients were divided into two groups of treatment: standard treatment group (n = 43 eyes) and PRGF group (n = 59). Patients’ symptomatology (inferred from OSDI and SANDE questionnaires), ocular inflammation, tear stability, and ocular surface damage were analyzed at baseline and after 3 months of treatment. Results: OSDI test scores were significantly lower in both groups (p < 0.001). SANDE frequency test scores also improved statistically, with differences between groups (p = 0.0089 SANDE frequency and p < 0.0119 SANDE severity). There was a greater reduction in ocular redness (ocular inflammation) in the PRGF group (p < 0.0001) and fluorescein tear break-up time was significantly improved in the PRGF group (p = 0.0006). No significant changes were found in terms of ocular surface damage. No adverse events were obtained in either group. Conclusions: The addition of PRGF to the standard treatment of DED, according to the results obtained, proved to be safe and produced an improvement in ocular symptomatology and signs of inflammation, particularly in moderate and severe cases, when compared to standard treatment.

Background: The mechanism that could increase intraocular pressure (IOP) during scleral lens (SL) wear is not fully understood, although it may be related to compression of the landing zone on structures involved in aqueous humor drainage. Methods: Thirty healthy subjects were fitted with two SLs of different sizes (L1 = 15.8 mm, L2 = 16.8 mm) for 2 h in the right eye and left eye as a control. Central corneal thickness (CCT), parameters of iridocorneal angle (ICA), Schlemm’s canal (SC), and optic nerve head were measured before and after wearing both SLs. IOP was measured with a Perkins applanation tonometer before and after lens removal and with a transpalpebral tonometer before, during (0 h, 1 h, and 2 h), and after lens wear. Results: CCT increased after wearing L1 (8.10 ± 4.21 µm; p < 0.01) and L2 (9.17 ± 4.41 µm; p < 0.01). After L1 removal, the ICA parameters decreased significantly (p < 0.05). With L2 removal, nasal and temporal SC area and length were reduced (p < 0.05). An increased IOP with transpalpebral tonometry was observed at 2 h of wearing L1 (2.55 ± 2.04 mmHg; p < 0.01) and L2 (2.53 ± 2.22 mmHg; p < 0.01), as well as an increased IOP with Perkins applanation tonometry after wearing L1 (0.43 ± 1.07 mmHg; p = 0.02). Conclusions: In the short term, SL resulted in a slight increase in IOP in addition to small changes in ICA and SC parameters, although it did not seem to be clinically relevant in healthy subjects.

Congenital aniridia is a rare bilateral ocular malformation characterized by the partial or complete absence of the iris and is frequently associated with various anomalies, including keratopathy, cataract, glaucoma, and foveal and optic nerve hypoplasia. Additionally, nearly 50% of individuals with congenital aniridia experience symptoms of ocular dryness. Traditional treatment encompasses artificial tears and autologous serum. This study aimed to assess the effectiveness and safety of using platelet rich in growth factors (PRGF) plasma in patients with congenital aniridia and ocular dryness symptoms. Methods: The included patients underwent two cycles of a 3-month PRGF treatment. At 6 months, symptomatology was evaluated using the OSDI and SANDE questionnaires, and ocular surface parameters were analyzed. Results: The OSDI and SANDE values for frequency and severity demonstrated statistically significant improvements (p < 0.05). Ocular redness, corneal damage (corneal staining), and tear volume (Schirmer test) also exhibited statistically significant improvements (p < 0.05). No significant changes were observed in visual acuity or in the grade of meibomian gland loss. Conclusion: The use of PRGF in patients with congenital aniridia and ocular dryness symptoms led to significant improvements in symptomatology, ocular redness, and ocular damage. No adverse effects were observed during the use of PRGF.

Isotretinoin is a vitamin A derivative used as a first-line treatment for moderate to severe acne. One of its most frequent side effects is dry eye disease (DED), in which tear film instability and neurosensory abnormalities play an etiologic role. The purpose of this research was to analyze changes in corneal innervation and its association with tear film integrity in patients treated with oral isotretinoin. Twenty-eight patients treated with oral isotretinoin and the same number of age and sex distribution-matched healthy volunteers were included in this observational case‒control study. They were examined by in vivo corneal confocal microscopy (IVCM) to quantify the corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), and corneal nerve fractal dimension (CNFrD) in addition to the presence of dendritiform cells, microneuromas, and visibility of axonal beadings. Tear film analysis was also performed, as was the perception of discomfort related to ocular surface disease. The results of the comparative analysis of the isotretinoin group vs. the control group (mean [standard error]) were as follows: CNFD 18.57 [1.67] vs. 24. 57 [1.55] fibers per mm2 (p = 0.01); CNBD 19.05 [2.43] vs. 30.62 [3.53] branches per mm2 (p = 0.02); CNFL 13.90 [1.01] vs. 14.64 [0.66] mm per mm2 (p = 0.54); CNFrD 1.46 [0.005] vs. 1.49 [0.006] (p = 0.01); Schirmer test 5.7 [1.1] vs. 10.3 [0.5] millimeters (p < 0.001). The break-up time (BUT) was 5.70 [0.6] vs. 11.2 [0.2] seconds (p < 0.001). A linear regression equation model was developed for BUT (R2 = 0.48; 1-β = 0.98; p = 0.01) and CNFrD (R2 = 0.58; 1-β = 0.99; p = 0.002). Oral isotretinoin treatment promotes a vicious cycle of ocular surface disease that leads to damage to the subbasal nerve plexus. This damage increases with treatment time and impacts basal tear production.

Purpose: To evaluate the short-term influence of scleral lenses (SL) with different diameters on intraocular pressure (IOP) and corneal biomechanics. A secondary objective was to investigate the relationship between fluid reservoir (FR) thickness and IOP and biomechanical parameters. Methods: Thirty healthy subjects were randomly fitted with L1 (diameter of 15.80 mm) and L2 (diameter of 16.80 mm) on the right eye and worn for 2 hr. On IOP and corneal biomechanical parameters were measured with the CORVIS ST before and after SL removal. Fluid reservoir thickness at 0 and 2 hr of wear was measured using anterior segment optical coherence tomography. Results: Biomechanical parameters decreased after removal of L1 (−1.04±1.47 mm Hg) (P<0.01) and L2 (−0.80±1.74 mm Hg) (P=0.02). The biomechanical parameters A1T (−0.11±0.18 ms) (P=0.01) and SP-A1 (−4.29±9.97 mm Hg/mm) (P=0.02) decreased after L1 removal, whereas a decrease in highest concavity time (−0.21±0.50 m/s) (P=0.03) and an increase in highest concavity radius (+0.17±0.43 mm) (P=0.04) were observed after L2 removal. A significant, negative, and moderate correlation was found between highest concavity deformation amplitude and FR thickness with L1 (r=−0.42, P=0.02). Conclusions: The small changes in corneal biomechanical parameters and IOP values induced by short-term SL wear have no significant clinical impact and were not influenced by the diameter of the SL.