Corneal changes after fulguration and cross-linking in experiment

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Abstract

BACKGROUND: Severe progressive forms of infectious keratitis are often associated with the risk of violation of the structural integrity of the eyeball and the development of endophthalmitis. In the presence of negative dynamics against the background of conservative etiotropic therapy for severe keratitis, it is advisable to use surgical methods of treatment. The combination of two surgical methods of influencing a pharmacoresistant infectious process in the cornea — cross-linking and fulguration — is promising and requires further investigation.

AIM: In the experiment, to evaluate the effect on the corneal tissue of various modes of direct current fulguration, as well as in combination with cross-linking as well.

MATERIALS AND METHODS: An in vivo experimental study was carried out on 19 rabbits (38 eyes) of the Soviet Chinchilla breed, the average body weight of the animals was 2.5–4.0 kg. Depending on the stage of the study, the type and power of exposure during fulguration, the rabbits were divided into 3 groups.

RESULTS: When the cornea was exposed to fulguration in mode 5, the changes covered only 10–15 % of the anterior stroma, about 50 μm, and both clinically and histologically were not sufficient. When exposed to mode 6 and 7 after 3 months, changes in the stromal structure extended by about 150 µm. When using mode 8, there was a slight proliferation of connective tissue between the Descemet’s membrane and the endothelium. The combination of cross-linking with fulguration made it possible to obtain a more compact structure of the anterior layers of the corneal stroma and stability of the epithelium.

CONCLUSIONS: Fulguration may be a relatively safe treatment for the cornea in pharmacoresistant progressive keratitis. Fulguration and corneal cross-linking can potentiate each other’s effect. Fulguration mode 7 (1.5 W) is optimal at corneal exposition for the eradication of infectious agents.

About the authors

Rafik Boutaba

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: dr.rafik_boutaba@mail.ru
ORCID iD: 0000-0002-3700-8255
SPIN-code: 3416-3915
Russian Federation, 6–8 L’va Tolstogo st, Saint-Petersburg, 197022

Sergey V. Trufanov

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: trufanov05@mail.ru
ORCID iD: 0000-0003-4360-793X
SPIN-code: 1603-8931

MD, Dr. Sci. (Medicine)

Russian Federation, Saint Petersburg

Inna A. Riks

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: riks0503@yandex.ru
ORCID iD: 0000-0002-5187-1047
SPIN-code: 4297-6543

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Maggie Ezugbaya

Diagnostic Center No. 7 (ocular)

Email: maggie-92@mail.ru
ORCID iD: 0000-0002-0421-1804
Russian Federation, Saint Petersburg

Galina Yu. Yukina

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: pipson@inbox.ru
ORCID iD: 0000-0001-8888-4135
SPIN-code: 2533-2084

Cand. Sci. (Biology), Assistant Professor

Russian Federation, Saint Petersburg

Elena G. Sukhorukova

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: len48@inbox.ru
ORCID iD: 0000-0001-5521-7248
SPIN-code: 2115-9041

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Sanasar S. Papanyan

Diagnostic Center No. 7 (ocular)

Email: Dr.papanyan@yandex.ru
ORCID iD: 0000-0003-3766-2211
SPIN-code: 9794-4692

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Svetlana L. Nikolaenko

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: nikolaenkos@yandex.ru
ORCID iD: 0000-0002-5184-3775

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Olga V. Gorchakova

Academician I.P. Pavlov First St. Petersburg State Medical University

Author for correspondence.
Email: gorchakova-spmu@yandex.ru
ORCID iD: 0000-0001-5458-4329

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

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Supplementary files

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2. Fig. 1. Coagulates on the rabbit cornea, mode 8

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3. Fig. 2. Rabbit eye during cross-linking

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4. Fig. 3. Fragment of the cornea after exposure in subgroup 1a. Fulguration, mode 5. Stained with hematoxylin and eosin. Magnification ×100

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5. Fig. 4. Fragment of the cornea 3 months after exposure in subgroup 1a. Fulguration, mode 6. Stained with hematoxylin and eosin. Magnification ×40

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6. Fig. 5. Fragment of the cornea after exposure in subgroup 1a. Fulguration, mode 7. Stained with hematoxylin and eosin. Magnification ×100

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7. Fig. 6. Fragment of the cornea after exposure in subgroup 1a. Fulguration, mode 8. Stained with hematoxylin and eosin. Magnification ×40

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8. Fig. 7. Fragment of the cornea after exposure in subgroup 1a. Crosslinking. Stained with hematoxylin and eosin. Magnification ×100

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9. Fig. 8. Fragment of the cornea after exposure in subgroup 1b. Cross-linking + Fulguration, mode 5. Stained with hematoxylin and eosin. Magnification ×40

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10. Fig. 9. Fragment of the cornea after exposure in subgroup 1b. Crosslinking + Fulguration, mode 6. Stained with hematoxylin and eosin. Magnification ×100

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11. Fig. 10. Fragment of the cornea after exposure in subgroup 1b. Crosslinking + Fulguration, mode 7. Stained with hematoxylin and eosin. Magnification ×40

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12. Fig. 11. Fragment of the cornea after exposure in subgroup 1b. Cross-linking + Fulguration, mode 8. Stained with hematoxylin and eosin. Magnification ×100

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13. Fig. 12. Fragment of the cornea after exposure in group 2. Fulguration, mode 6. Stained with hematoxylin and eosin. Magnification ×100

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14. Fig. 13. Fragment of the cornea after exposure in group 2. Fulguration, mode 7. Stained with hematoxylin and eosin. Magnification ×40

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15. Fig. 14. Fragment of the cornea after exposure in group 2. Cross-linking + fulguration, mode 6. Stained with hematoxylin and eosin. Magnification ×40

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16. Fig. 15. Fragment of the cornea after exposure in subgroup 2. Crosslinking + fulguration, mode 7. Stained with hematoxylin and eosin. Magnification ×40

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17. Fig. 16. Fragment of the cornea after exposure in group 3. Fulguration, mode 7. Leukocytes in the stroma of the cornea. Stained with hematoxylin and eosin. Magnification ×100

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