EyeWorld India September 2020 Issue

CORNEA 42 EWAP SEPTEMBER 2020 used for filamentary keratitis and severe dry eye. What’s more, Dr. Jurkunas said in their previous in vitro and cell studies, N-acetylcysteine was able to reverse the mechanism involved in Fuchs, so they tested it in the animal model, giving it to some mice in drinking water for 3 months after UV light exposure. “The mice that were drinking N-acetylcysteine had significant reduction of the findings, both female and male mice,” Dr. Jurkunas said. While this points to a potential therapeutic target, a research pathway for Fuchs, Dr. Jurkunas said clinical studies are needed to prove it, and it’s too early for ophthalmologists to start recommending it to patients. In the meantime, Dr. Jurkunas said doctors can advise that patients protect their eyes from the sun by wearing hats and/or sunglasses. “For a long time [Fuchs] was viewed as a genetic-only disorder. A lot of research focused on finding a gene there. I think this is the first study showing that there are modifiable risk factors, like UV light,” Dr. Jurkunas said. EWAP Reference 1. Liu C, et al. Ultraviolet A light induces DNA damage and estrogen-DNA adducts in Fuchs endothelial corneal dystrophy causing females to be more affected. Proc Natl Acad Sci USA. 2020;117:573–583. Editors’ note: Dr. Jurkunas is associate professor of ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, and has a patent filed for the N-acetylcysteine compound. Adult stem cells treat advanced keratoconus – from page 40 the authors are suggesting is just a different way to approach it,” Dr. Karamichos said. Practice impact More expansive results like those in the study could impact Dr. Nattis’ practice. “I think that if success can be shown in larger patient cohorts, this may become a treatment modality for some difficult- to-treat keratoconus cases in the future,” Dr. Nattis said. “Additionally, the techniques described may serve as a novel way to treat other corneal dystrophies down the road.” Dr. Karamichos stressed the need for more established results before this technique could make it to clinical practice. Need continues The current standard of care for keratoconus management— aside from spectacles, contact lenses, and intracorneal ring segments to improve vision—consists of collagen crosslinking and corneal transplantation. Crosslinking has risks of decreased or distorted vision from corneal haze, and corneal transplants can result in astigmatism, risk of rejection, haze, and scarring, the study authors noted. Dr. Nattis said having another treatment modality that offers lower visual risks would be welcome. Very advanced cases of keratoconus, which often are contraindicated for crosslinking, were treated with this technique, which Dr. Nattis said could fill an unmet need. EWAP Reference 1. Alio JL, et al. Regenerative surgery of the corneal stroma for advanced keratoconus: 1-year outcomes. Am J Ophthalmol. 2019;203:53–68. Editors’ note: Dr. Nattis is associate clinical professor of ophthalmology and surgery, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York. Dr. Karamichos is Director of Research, North Texas Eye Research Institute and professor of pharmaceutical sciences and pharmacology and neuroscience, University of North Texas Health Science Center, Fort Worth, Texas. Neither declared any conflicts of interest.