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To compare the outcomes of removing bandage contact lens (BCL) on days 3 and 5 after photorefractive keratectomy (PRK). One hundred patients who underwent PRK (a total of 200 eyes) were enrolled in the present study. The subjects were assigned to two groups. Group 1 consisted of the right eyes of subjects and bandage contact lenses removal were on the 3rd day; Group 2 consisted of the fellow eyes of same subjects and removed bandage contact lenses on the 5th day after PRK. Then, data obtained from both groups were compared. To evaluate complications, the subjects underwent a slit-lamp examination in all visits. Filamentary keratitis was observed in one eye in both groups. The frequency of haze was higher in group 1; however, it was not significant between the two groups. Using mixed model analysis, significant differences were observed in the rate of complications as well as pain and eye discomfort scores between the groups (P

This prospective randomized study evaluated the efficacy and safety of intense pulsed light (IPL) and meibomian gland expression (MGX) as polytherapy for Sjögren’s Syndrome-related dry eye (SS-DE). The study enrolled 55 participants with SS-DE, 27 for the treatment group and 28 for the control group. The treatment group underwent three IPL-MGX treatments, three weeks apart. A randomly-selected eye from each patient was assessed at baseline and on weeks 9, 12, and 15 for Snellen best-corrected visual acuity (BCVA), intraocular pressure, Ocular Surface Disease Index (OSDI) score, conjunctival congestion, tear meniscus height, non-invasive tear breakup time (NBUT), Schirmer’s I test (SIT), corneal fluorescein staining (CFS), meibomian gland (MG) dropout, eyelid margin abnormality, MGX and meibum quality. OSDI, NBUT, CFS, MGX, and meibum quality were significantly improved in both groups, particularly in the treatment group. The eyelid margin abnormality improved significantly in the treatment but not in the control group on weeks 12 and 15. Snellen BCVA, conjunctival congestion, and SIT improved significantly in the treatment group, but the two groups were statistically similar. Our results indicated that three IPL-MGX sessions could significantly improve the subjective and objective characteristics of SS-DE, representing a promising treatment strategy.

Purpose: To determine the safety and efficacy of 0. 3% Acetylcysteine eyedrops for the resolution of symptoms and signs of filamentary keratitis. Study design:A Randomised Clinical Trial (RCT). Place & Duration of study:This study was conducted at a tertiary care centre for a period of two and a half years, from April 2016toOctober 2018. Method:This was a prospective,interventionalstudy in which 52 consecutive cases (104 eyes) with mild to severe filamentary keratitis (classification criteria given below), between the ages of 9-72 years(mean 49±8.6) were included. Cases with an active ocular surface infection, uveitis, recent ocular surgery (< one month) and pregnant / lactating patients were excluded.All cases were prescribed lubricants, anti-inflammatory therapy (Tacrolimus skin cream 0.03%) and tetracycline eye ointment for the MGD. The alternate cases were divided into two equal groups of 26 cases; Group A received acetylcysteine eyedrops 0.3%, four times daily, Group B cases received placebo eyedrops (distilled water in a bottle).Clinical symptoms (OSDI),corneal filaments, corneal fluorescein staining,Tear Film BUT and Schirmer’s test were recorded at the beginning of study,and everytwo weeks,for the next 12 weeks. Results: Primary Outcome Measure was a reduction of symptoms (OSDI score) and absence of filament formation after treatment with 0.3% Acetylcysteine eyedrops. The patients were followed-up for a mean duration 12 ± 2weeks. There was a marked subjective as well as objective improvement in all cases within 2-4 weeks of therapy with Acetylcysteine 0.3% eyedrops as compared to the placebo group. Conclusion:Acetylcysteine 0.3% eyedrops efficiently dissolve filaments and offer quick resolution of symptoms even in severe cases of filamentary keratitis.

Purpose Pilot study to evaluate the safety and efficacy of oral guaifenesin in reducing the signs and symptoms of filamentary keratitis. Methods Prospective, uncontrolled open-label pilot study. Twelve patients with non-Sjogren dry eye disease (DED) and secondary filamentary keratitis received treatment with oral guaifenesin 600 mg twice a day (total dose of 1.2 g/day) for 4 weeks. Adverse events, change in the number of corneal filaments, corneal fluorescein staining (CFS; NEI grading system), and symptoms (Ocular Surface Disease Index) were assessed. Results Before starting oral guaifenesin, all patients were on topical medical therapy for their condition. At baseline, the mean number of filaments was 5.8 ± 2.9, CFS score 7.3 ± 3.2, and OSDI score 55.6 ± 25. After 4 weeks of treatment, the number of filaments was 2.1 ± 2.2 (p = 0.04 vs. baseline), CFS score 6.5 ± 3.1 (p = 0.5), and OSDI score 46.1 ± 30.9 (p = 0.2). One patient discontinued the medication due to gastrointestinal side effects. Conclusions Oral guaifenesin was safe and generally well tolerated, and demonstrated modest efficacy in reducing the severity of filamentary keratitis. These results should be considered preliminary; however, placebo-controlled investigations would be justified to evaluate the therapeutic efficacy of oral guaifenesin as a mucolytic in treatment of filamentary keratitis.

This study aims at improving the understanding of the subjective symptoms and signs of two different clinical categories of ocular graft-versus-host disease. After reviewing and screening 193 posthematopoietic stem cell transplantation (HSCT) patients of Peking University Third Hospital, we enrolled 148 (21 acute ocular GVHD, 127 chronic ocular GVHD). Patients’ subjective symptoms, ocular parameters, and typical ocular signs were collected and evaluated at the same visit. Classic acute ocular GVHD patients had variable levels of conjunctival involvement but few had keratopathy; increased mucus secretion (21 of 21, 100.0%), red eye (19 of 21, 90.5%), and lacrimation (11 of 21, 52.4%) were the characteristic symptoms. The classic chronic ocular group had severe eye dryness and further corneal lesions, including filamentary keratitis, corneal ulcer, and corneal vascularization. Eye dryness (115 of 127, 90.6%), increased fibrous secretion (53 of 127, 41.7%), photophobia (50 of 127, 39.4%), and alacrimia (45 of 127, 35.4%) were the most common symptoms. Although 44.1% (56 of 127) of these patients had a history of acute ocular GVHD episodes, most were overlooked, so they did not receive stepwise evaluation and treatment. Management of ocular GVHD is very challenging and requires cooperation among disciplines.

Purpose To report a case of filamentary keratitis occurring in the cornea hidden under the eyelids by squint surgery. Methods A 69-year-old female patient with a history of amblyopia was referred for intractable filamentary keratitis in the left eye. The strabismus angle was 35Δ hypertrophic, and ocular motility was within the normal range. Slit-lamp examination of her left eye revealed filamentary keratitis in more than one-third of the upper cornea behind the upper eyelid. Her right eye was diagnosed as supranuclear double elevator palsy. We performed strabismus surgery on her right eye, including inferior rectus muscle recession (5 mm) in combination with superior rectus muscle resection (5 mm) under local anesthesia. Following surgery, the left eye squint angle was improved. The filamentary keratitis of the left eye disappeared, and there was no recurrence over the following 5 years. Conclusion The squint surgery of paralyzed right eye decreased the strabismus angle, subsequently resulting in the disappearance of the filamentary keratitis in the left eye via the resolution of the relative blepharoptosis. Although the squint operation performed was not for the purpose of improving binocular function, we want to conclude that it can treat the filamentary keratitis behind the eyelid.

Purpose To compare the outcomes of bandage contact lens (BCL) removal on the fourth versus seventh post-operative day following photorefractive keratectomy (PRK). Methods This study recruited eyes of patients who underwent PRK surgery. The patients were randomly assigned to 2 groups. In Group 1 BCL was removed on the 4th postoperative day, while in Group 2, BCL was removed on the 7th postoperative day. After BCL removal, patients were asked to express their pain score and eye discomfort. At one and three months follow-up examinations, visual acuity scale was assessed. Slit-lamp examination was performed in all visits to evaluate complications. Results 260 eyes of 130 patients underwent PRK. The age and sex ratio were not significantly different between the two groups. One month after the surgery, the logMAR uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were significantly lower in Group 2 (P value = 0.016, 0.001 respectively), however, the UDVA and CDVA were not significantly different after 3 months (P > 0.05). In Group 1, filamentary keratitis (FK) was observed in 10 (7.6%) eyes, 6 (4.61%) eyes were diagnosed with recurrent corneal erosion (RCE) and corneal haze was detected in 3 (2.3%) eyes. However, in Group 2, RCE was observed in 4 (2.3%) and FK was noted in 4 (3.07%) eyes. No haze was seen in Group 2. The difference in rate of complications was statistically significant (14.6% and 6.1% in Groups 1 and 2, respectively, P = 0.02). Pain and eye discomfort scores were not significantly different (P > 0.05). There was no major complications including infectious keratitis in either groups. Conclusion Following PRK surgery, BCL removal on the seventh postoperative day yields faster visual rehabilitation and lower rate of postoperative complications with no increase in eye pain, discomfort or infection.

Significance This case report details a unique case of filamentary keratitis after penetrating keratoplasty managed with a scleral contact lens. The positive effect on vision and comfort are reported, and the challenges related to hypoxia are discussed. Purpose The purpose of this study was to report the outcome of scleral lens use in the treatment of filamentary keratitis post-penetrating keratoplasty. Case report A patient who underwent penetrating keratoplasty twice in both eyes for keratoconus presented with filamentary keratitis in the left eye. The prosthetic replacement of the ocular surface ecosystem scleral lens trial was performed for improving vision and comfort. After 6 hours of wearing prosthetic replacement of the ocular surface ecosystem device, the left eye showed complete resolution of filaments with an improved visual acuity and better comfort in both eyes. Corneal swelling indicating hypoxia was noticed in both eyes with scleral lenses and was managed accordingly. Conclusions Scleral lenses are a viable treatment option for patients with corneal filamentary keratitis after penetrating keratoplasty for achieving better vision and improved comfort. However, the risk of hypoxia cannot be undermined, which necessitates careful evaluation, follow-up, and management for safe lens wear.

The TFOS DEWS II Pathophysiology Subcommittee reviewed the mechanisms involved in the initiation and perpetuation of dry eye disease. Its central mechanism is evaporative water loss leading to hyperosmolar tissue damage. Research in human disease and in animal models has shown that this, either directly or by inducing inflammation, causes a loss of both epithelial and goblet cells. The consequent decrease in surface wettability leads to early tear film breakup and amplifies hyperosmolarity via a Vicious Circle. Pain in dry eye is caused by tear hyperosmolarity, loss of lubrication, inflammatory mediators and neurosensory factors, while visual symptoms arise from tear and ocular surface irregularity. Increased friction targets damage to the lids and ocular surface, resulting in characteristic punctate epithelial keratitis, superior limbic keratoconjunctivitis, filamentary keratitis, lid parallel conjunctival folds, and lid wiper epitheliopathy. Hybrid dry eye disease, with features of both aqueous deficiency and increased evaporation, is common and efforts should be made to determine the relative contribution of each form to the total picture. To this end, practical methods are needed to measure tear evaporation in the clinic, and similarly, methods are needed to measure osmolarity at the tissue level across the ocular surface, to better determine the severity of dry eye. Areas for future research include the role of genetic mechanisms in non-Sjogren syndrome dry eye, the targeting of the terminal duct in meibomian gland disease and the influence of gaze dynamics and the closed eye state on tear stability and ocular surface inflammation.

Eriyebilen sütür materyalleri, örneğin poliglaktin 910 (vikril), 45 gün kadar sürebilen hafif şiddetli yabancı cisim reaksiyonuna neden olabilirler. Bu sütürlere bağlı ancak sütür alınması ile iyileşebilen şiddetli yabancı cisim reaksiyonu ise çok nadiren görülebilir. Bu olgu sunumunda biz şaşılık cerrahisi sonrası vikril sütüre bağlı her iki gözünde şiddetli yabancı cisim reaksiyonu ve sol gözünde flamenter keratit gelişen bir olgunun sunumunu amaçladık. (Turk J Ophthalmol 2014; 44: 252-5) Absorbable suture materials, such as polyglactin 910 (vicryl) sutures, can cause a mild foreign body reaction in the eyes that can last up to 45 days. However, these absorbable suture ties can infrequently cause a severe foreign body reaction that can only heal by removal of the sutures. In this report, we present a case of severe conjunctival foreign body reaction in both eyes of a patient and filamentary keratitis in the patient’s left eye caused by the vicryl suture ties after surgery for esotropia. (Turk J Ophthalmol 2014; 44: 252-5)

Filamentary keratitis (FK) is a chronic and recurrent disorder of the cornea. FK is reportedly associated with various kinds of ocular surface diseases or conditions. Until now, there have been lacks of studies based on quantitative sample analysis concerning FK incidence regularity and inducement characteristics at different ages. This was a retrospective study of 147 patients (162 eyes) with FK who had been continuously and completely recorded from August 2012 to August 2015 at the Second Affiliated Hospital of Zhejiang University in Hangzhou, east of China. Our results suggest that the causative factors of FK varied at different ages and the distribution of filaments on the corneal surface was also diverse with different inducements. By exploring the frequency and clinical features of FK, we believe that the findings from our research will be clinically significant and aid in the early prevention and treatment guidance of the disease.

Purpose To report a rare case of filamentary keratitis associated with stiff person syndrome. Methods Case report. Results A 26-year-old woman with several autoimmune conditions was referred because of filamentary keratitis. Conservative management using lubrication, mucolytics, and bandage contact lenses failed to adequately relieve symptoms. Despite the addition of oral prednisone, cyclosporine, and azathioprine, the patient's condition persisted with numerous filaments and severe dry eye. One month later, the patient had an episode of sudden muscle cramps in her back, for which she was hospitalized. Investigations revealed a diagnosis of stiff person syndrome, positive for glutamic acid decarboxylase autoantibodies. Plasmapheresis and high-dose intravenous steroids were provided as initial therapy. On follow-up, her filamentary keratitis resolved and at the last visit, her ocular symptoms had completely resolved. Conclusions Filamentary keratitis is a chronic, recurrent condition that can be challenging to treat. Effective management requires careful consideration of possible predisposing causes, especially in refractory cases.

This study aims to investigate the efficacy of lacrimal plugs combined with deproteinized calf blood extract eye gel on the treatment of dry-eye-associated filamentary keratitis. Lacrimal plugs were inserted into both the upper and lower puncta of 15 patients (28 eyes). Deproteinized calf blood cxtract eye gel was applied in two patients who were not cured after this operation. All patients were asked to complete three questionnaires 1 day before the surgery and at 1 week and 1 month after the surgery. Ophthalmologic examinations were carried out and repeated at 1 day and at 1 week and 1 month after plug insertion, which include fluorescein staining, tear break-up time (BUT), Schirmer test I (STI), corneal confocal microscope (HRT-III), and impression cytology (IC). Symptoms were relieved in all patients 1 month after the application of lacrimal plugs. Deproteinized calf blood extract eye gel was applied to two patients whose symptoms remained after lacrimal plug implantation for 1 week. At 3 weeks later, the symptoms disappeared and cornea fluorescein stain was hardly identified. The lacrimal river in all patients became broader after the surgery, 11 of whom reached 0.3 mm. Cornea filamentary disappeared in all patients. The average of BUT and ST were increased to 7.50 ± 1.897 s (p

Epidemic keratoconjunctivitis caused by different serotypes of human adenoviruses is an explosive and highly contagious ocular surface infection. This is the case of a young ophthalmologist who presented a filamentary keratitis complicating an adenoviral keratoconjunctivitis. Filamentary keratitis is a chronic and debilitating disorder related to dry eye syndrome. Patients with filamentary keratitis report ocular discomfort ranging from mild foreign-body sensation to severe ocular pain. Filaments are composed of mucin, and degenerating and regenerating epithelial cells of the cornea. Current management of filamentary keratitis involves treating the underlying dry eye (non preserved lubricants, topical steroidal agents, and punctal plugs) and mechanical removal of filaments.

Absorbable suture materials, such as polyglactin 910 (vicryl) sutures, can cause a mild foreign body reaction in the eyes that can last up to 45 days. However, these absorbable suture ties can infrequently cause a severe foreign body reaction that can only heal by removal of the sutures. In this report, we present a case of severe conjunctival foreign body reaction in both eyes of a patient and flamentary keratitis in the patient's left eye caused by the vicryl suture ties after surgery for esotropia.

Objective To evaluate the efficacy of onabotulinumtoxinA injection for the treatment of refractory filamentary keratitis. Methods A retrospective review of treatment response of 33 eyes of 17 patients with filamentary keratitis resistant to conventional medical therapy who were treated with onabotulinumtoxinA injection was performed. Ocular surface findings, symptom improvement, and the number and location of filaments before and after the injections were recorded. All eyelids were injected subcutaneously with onabotulinumtoxinA (10 U/0.1 mL). All treatments were performed in accordance with an individualized treatment plan using precise localizing treatment maps, with adjustments to dosage based on treatment response. Results Objective and subjective improvement was noted after the initial onabotulinumtoxinA injection in all patients. Filaments completely resolved after the onabotulinumtoxinA injection in 29 eyes (88%). In 20 of these eyes, filaments and punctate fluorescein staining resolved, whereas in 9 eyes, filaments resolved but punctate fluorescein staining persisted. Three eyes (9%) had partial improvement: 2 residual microfilaments were noted in one eye and 1 in the other eye. In 1 eye, filaments resolved after initial and subsequent injections but recurred within 8 weeks of each injection. Although 14 treated eyes (42%) showed sustained improvement after 1 onabotulinumtoxinA injection, additional injections were necessary in 19 eyes (58%) during the follow-up period because of the recurrence of symptoms and filaments on the cornea. Conclusions OnabotulinumtoxinA injection should be considered an effective option for treating refractory filamentary keratitis. Because of the likelihood of recurrence, serial onabotulinumtoxinA injections may be necessary in some cases.

Purpose To report the early success of the use of topical cyclosporine A 0.5% drops to treat Theodore's superior limbic keratoconjunctivitis (SLK). Design A retrospective noncomparative case series. Participants Five patients diagnosed with SLK. Intervention All five patients were treated with topical cyclosporine A 0.5% drops as primary or adjunctive therapy after treatment failure in some of prednisolone acetate 1% drops and topical silver nitrate 0.5% application. Topical cyclosporine A 0.5% drops were used four times a day in both eyes. Main outcome measures Resolution of symptoms (foreign body sensation and irritation) and signs (rose bengal staining, tarsal papillary reaction, and injection). Results All five patients had long-term (6 months to 3 years) improvement of irritation and foreign body sensation, as well as improvement of injection and filamentary keratitis. Aside from burning on instillation, there were no complications related to this therapy. Conclusions Topical cyclosporine A 0.5% is helpful as primary or adjunctive therapy for SLK. It may also be used as a maintenance drug to prevent recurrence. Further study may delineate the specific role and treatment parameters for the use of topical cyclosporine A 0.5% in the treatment of SLK.

PURPOSE: To review the incidence, underlying pathophysiology, and clinical features of filamentary keratitis and to identify evidence-based best-practice strategies for managing filamentary keratitis. METHODS: A comprehensive review of published literature was undertaken. Recommendations for best-practice management strategies were based on the available evidence. Three cases are presented to illustrate the clinical findings and management of patients with chronic filamentary keratitis. RESULTS: Although the evidence base is limited by the absence of well-designed studies, current evidence indicates the following: (1) Aqueous-deficient dry eye (keratoconjunctivitis sicca) is the most common ocular condition associated with filamentary keratitis. (2) Current best-practice management of filamentary keratitis involves treating the underlying dry eye and specific treatments for the corneal filaments. Proposed treatments include nonpreserved lubricants, topical steroidal and nonsteroidal anti-inflammatory agents, and punctal plugs for aqueous-deficient dry eye as well as mechanical removal of filaments, hypertonic saline, mucolytic agents, and bandage contact lenses for the filaments. (3) Filamentary keratitis can be induced or exacerbated by contact lens wear and ocular surgical procedures such as cataract surgery and corneal graft surgery. Pre- and postoperative ocular surface management strategies should be considered in the surgical planning of patients with, or who are susceptible to, filamentary keratitis. Filamentary keratitis can also be induced and/or exacerbated by chronic use of ocular and/or systemic medications, and alternate medications or additional measures to manage the tear film and ocular surface may be required in these cases. CONCLUSIONS: Filamentary keratitis can be a chronic, recurrent, and debilitating condition. With a systemic approach to diagnosis and management, the condition can be effectively controlled and the incidence and severity of recurrences minimized.

To compare the efficacy and short-term safety of diclofenac sodium, 0.1% (Voltaren Ophtha; Ciba-Vision) and of sodium chloride, 5% ophthalmic solution, in the treatment of filamentary keratitis (FK) in patients with dry-eye syndrome due to secondary Sjögren's syndrome.Thirty-two patients (64 eyes) with dry-eye syndrome due to secondary Sjögren' syndrome were enrolled in a randomized study (patients and authors were aware of which medication was being used). All patients had FK. Sixteen patients were treated with sodium chloride, 5% drops, and 16 patients received diclofenac sodium, 0.1% eyedrops. Treatment regimen included instillation of 1 drop, 4 times a day for 28 days, for both groups. Clinical assessment was performed once a week during the study period. Data on the efficacy and safety of the different therapeutic regimens were collected and compared.Both medications achieved disappearance of filaments at the end of the study. Treatment with diclofenac sodium, 0.1%, revealed a significantly more rapid improvement of the clinical symptoms as compared with sodium chloride, 5%. No significant adverse effects were observed in both groups.Diclofenac sodium, 0.1%, may be an effective and safe topical therapy in patients with FK caused by secondary Sjögren's disease.

Purpose: The technique of impression cytology using cellulose acetate filter paper as a debriding agent was evaluated. Methods: Lesions were assessed using a slit-lamp biomicroscope before and after the impressions were taken and appropriate antibiotic therapy was started. The filter paper impressions were stained with hematoxylin-eosin and examined by light microscopy. The 72 corneal ulcers and three cases of suture infiltration around exposed corneoscleral cataract-related sutures were effectively debrided. Five of the six foreign bodies and all of the filaments in the six filamentary keratitis cases were removed with minimal damage to the surrounding cornea. Results: Results of microscopic examination showed that the cells that were transferred to the filter paper were primarily the affected cells. In corneal ulcers, the degenerated epithelial cells, inflammatory cells, and organisms were removed. The inflammatory cells superimposed on affected epithelial cells in suture infiltration and the filaments of filamentary keratitis were removed. In cases of superficial corneal foreign bodies, the foreign bodies overlying a sheet of degenerated epithelial cells were lifted up. Conclusion: "Impression debridement" improves the quality and efficiency of debridement for most of these conditions, with much less risk to the surrounding tissue than the conventional techniques. Besides being an adjunct to therapy, it simultaneously provides replicas of the lesions that give accurate histologic details after microscopic evaluation.

We sought to identify the types of, prevalence of, and predisposing factors for the development of surface keratopathy after penetrating keratoplasty. We reviewed the records of 120 corneal grafts performed over a 15-month period. Twenty patients were excluded from the study. Fifty-three men and 47 women composed the group studied. All transplants were performed by the same surgeon. Retrospective data from patients' records were gathered preoperatively and from postoperative visits at 1 week and at 1, 2, 3, and 4 months. Data included preoperative medical and demographic data, operative time, postoperative medication regimens, assessment of the presence and degree, if present, of punctate epithelial keratopathy (PEK), hurricane keratopathy, macroepithelial defects, microcystic edema, bullous edema, and filamentary keratitis. In addition, information on the donor material was recorded. Surface disease and normal groups were compared to identify risk factors for the occurrence of surface abnormalities. Thirty-three of the patients demonstrated persistent surface abnormalities. Coarse PEK was the most common surface abnormality in the sample studied and was most prominent in the first week after surgery. Postoperative surface keratopathy was not statistically associated with preoperative diagnosis, donor age, death-to-preservation time, preservation-to-surgery time, or donor epithelial status. However, corneal recipients in the group with surface keratopathy were significantly older (mean, 68.7 years) than patients in the group with no surface abnormalities (mean, 52.6 years; Mann-Whitney U test, p < 0.001). Although many factors may contribute to the normal integrity of the corneal surface after keratoplasty, recipient age is of key importance in the development of surface disease.