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Borja de la Sen-Corcuera,1,2 Jesús Montero-Iruzubieta,3,4 Ronald M Sánchez-Ávila,1,5 Gorka Orive,1,2 Eduardo Anitua,1,2 Manuel Caro-Magdaleno,4 Jesús Merayo-Lloves5 1Biotechnology Institute (BTI), Vitoria, Spain; 2University Institute for Regenerative Medicine and Oral Implantology (UIRMI), Vitoria, Spain; 3Clínica Cartujavisión, Sevilla, Spain; 4Hospital Universitario Virgen de Macarena, Sevilla, Spain; 5Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, Oviedo, SpainCorrespondence: Ronald M Sánchez-ÁvilaInstituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Avda Dres Fernández-Vega Num 34, Oviedo E-33012 Principado de Asturias, SpainTel +34 985240141Fax +34 985233288Email ronald.sanchezavila@gmail.comPurpose: The objective was to evaluate the clinical results obtained from the use of immunosafe plasma rich in growth factors (isPRGF) in the treatment of patients with cicatrizing conjunctivitis (CC) who had not responded to the usual therapy.Patients and Methods: This is a retrospective study that included patients diagnosed with CC, in whom isPRGF was used in different phases (I: eye drops; II: eye drops and injectable; III: eye drops, injectable and surgical treatment) to achieve control of the inflammation. As a clinical follow-up of the patients, the better corrected visual acuity (BCVA), degree of inflammation (measured from 1 to 4), the severity of the CC, Schirmer I test, IOP and TBUT were analyzed. The adverse events were also evaluated.Results: Ten eyes (6 patients) were evaluated, 50% corresponded to Stevens–Johnson Syndrome and 50% to ocular mucous membrane pemphigoid. The mean age was 59.7 ± 16.5 (39– 80) years, and 50% were women. Fifty per cent of the cases were initially considered severe CC, and 10% of the cases (one eye of one patient) were considered severe CC at the end of the treatment (p = 0.046). The initial degree of inflammation was 2 in 4 eyes, 3 in two eyes, and 4 in 4 eyes, and final inflammation degree was 1 in all cases (p = 0.004). Twenty per cent of the cases achieved stability in Phase I of the treatment with immunosafe PRGF, 70% with both Phases I and II, and only one case underwent Phase III to achieve stability. The IOP improved significantly (p = 0.027) though the BCVA, TBUT and Schirmer I test showed no significant changes. The follow-up time was 23.1 ± 6.7 (13.6– 30.3) months. No adverse effects were reported.Conclusion: Treatment with PRGF technology in its injectable and topical immunosafe formulations may be a novel alternative for the treatment of patients with CC, given its complement activity modulating effect, as well as its anti-inflammatory, antifibrotic and regenerative properties.Keywords: immunosafe plasma rich in growth factors, isPRGF, Stevens–Johnson syndrome, ocular mucous membrane pemphigoid, blood derivatives

Pedro Molina-Solana,1 Francisco de Borja Domínguez-Serrano,1 Antonio Manuel Garrido-Hermosilla,1,2 Jesús Montero-Iruzubieta,1,2 Ana Fernández-Palacín,3 Enrique Rodríguez-de-la-Rúa-Franch,1,2 Manuel Caro-Magdaleno1,2 1Ophthalmology, Virgen Macarena Hospital Seville, Seville, Spain; 2Surgery Department, University of Seville, Seville, Spain; 3Preventive Medicine and Public Health Department, University of Seville, Seville, SpainCorrespondence: Manuel Caro-Magdaleno Calle Bogotá 7, Bloque 3, 1ºB, Seville 41013, SpainTel +34 609030403Email mcaro79@gmail.comPurpose: Artificial tears only provide transient relief for dry eye. To the best of our knowledge, this is the first study to objectively compare treatment with artificial tears with Keratograph 5M, which allows accurate and objective investigation of dry eye and artificial tear treatment. We aimed to evaluate whether a preservative-free combination of 0.4% hyaluronic acid and 0.2% galactoxyloglucan can improve dry eye using the new topographer, Keratograph 5M.Patients and Methods: This prospective longitudinal, single-arm interventional cohort study was performed at a tertiary referral center and involved 20 patients with dry eye (40 eyes). Preservative-free artificial tears were administered every 3 h. The participants underwent clinical and instrumental evaluations at baseline, 15, 30, 60, 90 and 120 min after instillation and 1 week and 1 month after treatment. Baseline values were considered as the controls. All patients were assessed with Keratograph 5M for non-invasive Keratograph first break-up time and non-invasive Keratograph average break-up time, conjunctival hyperemia, and tear meniscus height. Ocular surface staining with fluorescein was evaluated using the slit-lamp and fluorescein break-up time examinations, and the Ocular Surface Disease Index score was recorded for each patient.Results: The signs and symptoms improved after 1 month of preservative-free 0.4% hyaluronic acid and 0.2% galactoxyloglucan treatment. There was a significant increase in the non-invasive Keratograph first break-up time and non-invasive Keratograph average break-up time at 15, 30, 60, and 90 min, and 1 week and 1 month (P < 0.05) and a decrease in hyperemia, corneal staining, and Ocular Surface Disease Index scores after 1 week and 1 month (P < 0.05). No treatment-related adverse event was observed.Conclusion: A combination of 0.4% hyaluronic acid and 0.2% galactoxyloglucan artificial tears seems effective for treating dry eye. Keratograph 5M can objectively detect these changes during the follow-up period.Keywords: artificial tears, Keratograph, non-invasive Keratograph break-up time, Ocular Surface Disease Index, dry eye

Asunción Alfaro-Juárez,1,* Manuel Caro-Magdaleno,1,2,* Jesús Montero-Iruzubieta,1,2 Ana Fernández-Palacín,3 Ana Muñoz-Morales,1 Manuel Alberto Castilla-Martino,1 Consuelo Spínola-Muñoz,1 Enrique Rodríguez de la Rúa1,2 1U.G.C. Oftalmología, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain; 2Deparmento de Cirugía, Universidad de Sevilla, Sevilla, Spain; 3Deparmento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, Spain*These authors contributed equally to this workCorrespondence: Manuel Caro-MagdalenoU.G.C. Oftalmología, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, C/Bogota 7, Bloq.3, 1st-B, Sevilla 41013, SpainTel +34609030403Email mcaro79@gmail.comPurpose: In limbal stem cell deficiency, both the Ocular Surface Disease Index (OSDI) questionnaire and tear break-up time (BUT) are comparable between traditional methods and the Keratograph 5M. In this study, we aimed to correlate OSDI with Keratograph 5M interviewed OSDI, as well as slit-lamp tear BUT with Keratograph 5M noninvasive tear break-up time (NIKBUT) in limbal stem cell deficiency.Patients and methods: Thirty-eight limbal stem cell-deficiency patients (76 eyes) from Virgen Macarena-Rocio Hospital (Seville, Spain) underwent this diagnostic test study. All patients completed the traditional OSDI. We measured the BUT, performed a Keratograph 5M analysis of NIKBUT first (employed for the analysis) followed by the average NIKBUT, the level of dryness, and conducted the OSDI questionnaire through an interview. For each pair of tests, we analyzed the means and applied an intraclass correlation coefficient (r), creating a Bland-Altman plot for data dispersion.Results: Average values were 47.5 points (±25.8), and 47.3 points (±27.5) for traditional OSDI and Keratograph OSDI, respectively (P =0.87); the r value indicates good agreement (0.72). The Bland-Altman plot followed a linear pattern, and the results were similarly distributed. The NIKBUT mean was shorter than the BUT mean (P = 0.007); the r value indicates moderate agreement (0.574). The Bland-Altman plot formed an almost horizontal line, with almost all values between the mean and two standard deviations.Conclusion: Keratograph 5M is useful for the evaluation of the ocular surface in limbal stem cell deficiency. NIKBUT can substitute BUT based on its advantages of being noninvasive, objective, with intraobserver and interobserver repeatability and reliability. The Keratograph 5M OSDI is comparable to the traditional questionnaire.Keywords: keratograph, limbal stem cell deficiency, noninvasive keratograph tear break-up time, ocular surface desease index, tear break-up time