ascorbic-acid and Corneal-Ulcer

To evaluate aetiology, demographic profile, clinical features and outcomes in cases of peripheral ulcerative keratitis (PUK).. Seventy-six eyes of 65 consecutive patients with PUK were evaluated in this prospective interventional study over an 18 month period, which were followed for 3 years. The main outcome measures were sociodemographic profile, aetiology, clinical features, management strategies and outcome.. Sixty per cent (39/65) of cases were men and mean age was 45.5 ± 17.9 years. Two-thirds (43/65) of the patients were from rural areas with majority (48/65) belonging to low socioeconomic status. Unilateral disease was present in 83% of patients (54/65) with nasal involvement in 60.5% (46/76) cases. The most common aetiology was Mooren's ulcer (31.5% cases (24/76 eyes)) followed by infection and systemic collagen vascular disease. Meibomian gland dysfunction (17/76: 22.3%) was the most common extraocular association and complicated cataract (12/76:15.7%) was the most common intraocular abnormality. In mild and moderate cases, no significant visual improvement was observed (p = 0.085 and p = 0.156) as compared with the pretreatment status. Surgical treatment was successful in maintaining anatomical integrity in 83.3% (30/36) eyes. Recurrence of the disease was seen in one eye in moderate disease and three eyes in severe disease.. Mooren's ulcer followed by collagen vascular diseases and infection are important causes of PUK in developing countries. Surgical intervention in perforated cases had good anatomical success and visual prognosis.

Topics: Adult; Age Distribution; Anti-Bacterial Agents; Antioxidants; Ascorbic Acid; Corneal Ulcer; Female; Fluorophotometry; Follow-Up Studies; Glucocorticoids; Humans; India; Male; Middle Aged; Prospective Studies; Rural Population; Social Class; Urban Population; Visual Acuity

The incidence of ulceration and perforation in the cornea of alkali-injured eyes is significantly reduced by treatment with trisodium citrate or sodium ascorbate. Topical citrate reduces the inflammatory response in the cornea by inhibiting polymorphonuclear leukocytes. Topical ascorbate elevates the depressed level of this vitamin in the alkali-injured cornea, reversing a scorbutic condition. The purpose of the current study was to determine whether combined treatment with topical citrate and ascorbate has an additional therapeutic value when compared with citrate alone. Adsorbotear without EDTA was used as the vehicle for both medications. Rabbit eyes were injured with 1N NaOH for 35 s using a 12-mm well and were rinsed. Group I (47 eyes) received two drops of 10% citrate every hour on the hour and Adsorbotear on the half-hour for 14 h/day. Group II (48 eyes) received two drops of 10% citrate every hour on the hour and 10% ascorbate every hour on the half-hour for 14 h/day. The citrate/ascorbate group had significantly fewer ulcerations during the experiment than did the group receiving citrate alone (2 of 48 versus 10 of 47, 0.01 less than p less than 0.02). Both anterior ulcers in the citrate/ascorbate group and five ulcers in the citrate group healed to no ulcer by the end of the experiment (0 of 48 versus 5 of 47, 0.02 less than p less than 0.05). The average depth of ulceration was significantly less for the citrate/ascorbate group (p less than 0.001). No descemetoceles or perforations were observed in either group.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Alkalies; Animals; Antacids; Ascorbic Acid; Burns, Chemical; Citrates; Citric Acid; Corneal Ulcer; Disease Models, Animal; Drug Combinations; Eye Burns; Rabbits

Immediate treatment of alkali-injured eyes with citrate or ascorbate has previously been shown to prevent corneal ulceration and perforation in the rabbit. Other experiments showed that while ascorbate treatment of established ulcers did not appear to lead to significant healing it did reduce perforations by prolonging the presence of descemetoceles. In the present experiment with established ulcers, alkali injuries were created with 1 N NaOH in a 12 mm corneal well for 35 seconds. Eyes were entered into the study with anterior, middle or posterior ulcers. When compared to controls, 10% citrate (q1/2 hr) significantly reduced the deepening of anterior stromal ulcers while 10% ascorbate/10% citrate (q1 hr/q1 hr-30 min apart) showed only a trend toward reduction of these ulcers (14 hr of dropping). The demonstration of healing (total vascularization or no ulcer) is significant when comparing the control group (8.3%) to the citrate treated group (58.3%, 0.01 less than P less than 0.009), but not the ascorbate/citrate group (18.2%). Sixty-seven percent of anterior stromal ulcers in the control group progressed to descemetocele or perforation, compared to 8.3% in the citrate treated (0.003 less than P less than 0.004), and 45.5% in the ascorbate/citrate treated group (not significant). While the numbers of ulcers entered as middle stromal were too few to analyze statistically, the reduced numbers of perforations and increased stability prior to perforation in both treatment groups suggest a positive effect by both citrate and ascorbate/citrate. Treatment of posterior stromal ulcers did not prevent the development of descemetoceles and perforations in either treatment group; however, the numbers in this category were too few to analyze.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Ascorbic Acid; Burns, Chemical; Citrates; Citric Acid; Corneal Ulcer; Drug Therapy, Combination; Eye Burns; Female; Male; Osmolar Concentration; Rabbits; Sodium Hydroxide; Solutions

We studied the effect of topical and systemic ascorbic acid on a rabbit model of corneal ulceration produced by thermal burn. Central stromal ulceration occurred in 77% to 100% of eyes in all treatment groups. The rate of ulceration was accelerated in animals treated with systemic ascorbic acid. Ulceration began after 5.80 +/- 2.14 days in control eyes and 2.75 +/- 1.26 days in the eyes of rabbits treated with both topical and systemic ascorbic acid (P less than .02). Subconjunctival ascorbic acid alone did not affect the rate of ulceration (average onset, 6 +/- 1 days). Once ulceration occurred in animals treated with both topical and systemic ascorbic acid, the incidence of perforation and descemetocele formation was increased and that of healing was decreased. The time required for healing was not significantly altered by treatment (9.50 +/- 2.28 days for control eyes vs 5.75 +/- 2.78 days for treated eyes) (P greater than .05).

Topics: Animals; Ascorbic Acid; Corneal Ulcer; Female; Hot Temperature; Male; Rabbits

Alkali-burned corneas were treated with 2% ascorbic acid. Topical applications and subconjunctival injections were given for 32 days. Treatment with ascorbic acid significantly decreases the incidence of corneal ulcerations and perforations compared to the control group that received the vehicle. These results confirm previous studies and strongly suggest that ascorbic acid presents a potential for use in the alkali-burned human eye.

Topics: Animals; Ascorbic Acid; Burns, Chemical; Corneal Ulcer; Eye Burns; Rabbits; Sodium Hydroxide

When established corneal ulcers induced by alkali burning were treated with 10% ascorbate drops, no perforation occurred, in contrast to a 25% incidence in the control group. If perforations and descemetoceles were grouped together, these difference became insignificant (i.e., 14.2% ascorbate-treated vs. 25% control). Prolongation of descemetocele presence without perforation in the ascorbate-treated group indicated some therapeutic effect. We conclude that topical ascorbate does not substantially alter the outcome of established corneal ulcers.

Topics: Administration, Topical; Alkalies; Animals; Ascorbic Acid; Burns, Chemical; Corneal Ulcer; Eye Burns; Rabbits

Alkali-burned eyes (45 sec, 12 mm, 4N NaOH) were subjected to topical treatment with 10% ascorbate, 20% acetylcysteine, 10% ascorbate together with 20% acetylcysteine, 10% citrate, or Adsorbotear vehicle. Only citrate-treated eyes showed a significant decrease in corneal ulcerations and perforations (17%) compared with ascorbate (88%), acetylcysteine (81%), ascorbate/acetyl-cysteine (100%), or Adsorbotear (75%). In the citrate-treated eyes there was a significantly reduced incidence of band keratopathy (17%) but an increased incidence of hyphema (100%). Both groups receiving acetylcysteine developed acellular corneal caps, the result of peripheral ulceration undermining the central cornea. Polymorphonuclear neutrophils (PMN) were substantially increased at the base of the cap in the acetylcysteine- and acetylcysteine/ascorbate-treated eyes at day 56. At the end of the experiment, citrate-treated eyes showed substantially fewer stromal PMN than any other group. These results show that topical citrate has a most favorable effect on the incidence of corneal ulceration and perforation after alkali burning.

Topics: Acetylcysteine; Administration, Topical; Alkalies; Animals; Ascorbic Acid; Burns, Chemical; Citrates; Citric Acid; Corneal Ulcer; Eye Burns; Rabbits

Severe ocular alkali burns in rabbits result in a decrease in aqueous humor ascorbate levels to one-third normal levels. If this deficiency is reversed by immediate treatment with parenteral or topical ascorbate, there is a significantly decreased incidence of subsequent corneal ulceration and perforation. The morphologic changes in these ulcerating corneas are typical of those noted in scorbutus (scurvy). It is concluded that alkali injury to the ciliary epithelial transport processes or ciliary body vasculature results in localized deficiency of ascorbic acid in the aqueous humor and cornea. The development of corneal ulceration is thought to be based on this deficiency which results in the failure of fibroblasts to produce sufficient collagen for repair. A randomized clinical trial of ascorbic acid in the treatment of human alkali burned eyes is now underway.

Topics: Alkalies; Animals; Aqueous Humor; Ascorbic Acid; Burns, Chemical; Cornea; Corneal Injuries; Corneal Ulcer; Disease Models, Animal; Eye Burns; Rabbits; Scurvy

Topics: Animals; Ascorbic Acid; Burns, Chemical; Cornea; Corneal Injuries; Corneal Ulcer; Eye Burns; Humans; Rabbits; Wound Healing

The corneas of albino rabbits were subjected to 45 sec, 12 mm, 2.3N hydrochloric acid burns. Of 18 eyes in nine rabbits receiving no treatment (controls), 11 (61%) developed ulceration sometimes progressing to descemetoceles and perforation. Of 17 eyes in nine rabbits receiving a daily subcutaneous injection of ascorbic acid (0.5 gm/kg), only one eye (5.9%) developed an anterior stromal ulcer. The difference in incidence of ulceration between the control and ascorbate-treated eyes was statistically significant (p less than 0.01). The aqueous humor level of ascorbate in untreated animals was 6.0 +/- 0.6 mg/dl compared to 33.0 +/- 2.7 in the treated group. This study therefore demonstrates that subcutaneous administration of ascorbic acid significantly raises the aqueous humor level of ascorbic acid in severely acid-burned eyes, thereby largely preventing the characteristic development of corneal ulceration. The mechanism of this effect is presumably the same as previously described for alkali-burned eyes.

Topics: Animals; Aqueous Humor; Ascorbic Acid; Burns, Chemical; Corneal Injuries; Corneal Ulcer; Eye Burns; Female; Hydrochloric Acid; Injections, Subcutaneous; Male; Rabbits

The leucocyte ascorbic acid levels were determined in six patients with infected corneal ulcers. These levels were significantly lower than in a control group matched for age and sex. The potential role of Corynebacteria as pathogens is discussed.

Topics: Adult; Aged; Ascorbic Acid; Bacteria; Cornea; Corneal Ulcer; Humans; Leukocytes; Male; Middle Aged

Topics: Administration, Topical; Alkalies; Animals; Aqueous Humor; Ascorbic Acid; Burns, Chemical; Cornea; Corneal Ulcer; Eye Burns; Female; Pharmaceutical Vehicles; Rabbits

A Candida albicans corneal ulcer developed in a 24-year-old man with a history of eczema, asthma, and multiple bacterial infections since childhood. The infection responded well to oral flucytosine (12 g/day for 15 days) and topical amphotericin B. Positive laboratory findings included eosinophilla, hyperimmunoglobulinemia E, and impaired neutrophil and monocyte spontaneous migration and chemotactic responses. Ascorbic acid corrected the monocyte defect in vitro and in vivo, but had no effect on neutrophil function.

Topics: Adult; Ascorbic Acid; Bacterial Infections; Candidiasis; Chemotaxis, Leukocyte; Corneal Ulcer; Humans; Hypergammaglobulinemia; Hypersensitivity, Immediate; Immunoglobulin E; Infections; Male; Monocytes; Neutrophils; Recurrence; Syndrome

Topics: Animals; Aqueous Humor; Ascorbic Acid; Autoradiography; Collagen; Cornea; Corneal Ulcer; Eye Burns; Female; Male; Proline; Rabbits; Sodium Hydroxide; Wound Healing

Depressed aqueous humor glucose and ascorbic acid levels returned to control values within 14 days following a 20 sec, 6 mm. diameter, 1N sodium hydroxide burn of the rabbit cornea. These corneas did not ulcerate or perforate. After a 20 sec., 12 mm. diameter, 1N sodium hydroxide burn, aqueous humor glucose levels returned to normal values, but ascorbic acid levels remained significantly depressed for up to 30 days. These corneas became markedly ulcerated in about 60 per cent of animals and frequently perforated. Following 12 mm. alkali burns, rabbits treated daily with 1.5 Gm. of subcutaneous ascorbic acid rarely developed corneal ulcerations and the corneas did not perforate. It is suggested that exogenous maintenance of adequate aqueous humor levels of ascorbic acid overcomes the relatively scorbutic state of the anterior segment induced by a 12 mm. alkali burn, thereby impairing the development of corneal ulceration and perforation. Elevated aqueous humor levels of ascorbic acid had no influence on corneal epithelial cell migration patterns following alkali burns.

Topics: Alkalies; Animals; Aqueous Humor; Ascorbic Acid; Burns, Chemical; Corneal Ulcer; Disease Models, Animal; Eye Burns; Female; Glucose; Male; Rabbits

Topics: Adult; Ascorbic Acid; Atropine; Chloramphenicol; Corneal Ulcer; Female; Humans; Sodium Chloride

Topics: Ascorbic Acid; Cornea; Corneal Ulcer; Humans; Male; Vitamins; Wound Healing

Topics: Ascorbic Acid; Cornea; Corneal Ulcer; Eye Diseases; Penicillins; Ulcer; Vitamins