الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Corneal wound healing involves several complex pathways that can be targeted by drugs with varying mechanisms of action. Furthermore, corneal sensitivity and pain are due to the high density of the nerve endings in the cornea. Corneal injuries can affect these nerves resulting in dry eye disease due to reduced blinking, altered tear production, and impaired release of trophic factors, which are necessary to maintain the structural and functional integrity of the cornea. Agents that numb the surface of the eye are imperative to achieving a proper diagnosis in addition to providing optimal management. There are a variety of agents used for corneal injuries from diagnostic (analgesic and staining agents) to therapeutic medications. With regard to the latter, there are a plethora of drug classes employed by ophthalmologists to control eye pain, combat inflammation, and treat ocular surface disease. Compiling a guide of available corneal agents is challenging due to the vast number of agents, the off-label use of oral agents, and recently developed novel agents. Although lists of ocular agents have been compiled previously in textbooks and other guides, these resources usually only discuss DROP therapies without mention of barrier therapies, amniotic membrane therapies (AMTs), blood-based therapies, or novel agents. Persistent corneal ulcers may lead to severe ocular morbidity and the main goal of therapy includes elimination of any cause and restoration of ocular surface. Despite the availability of a wide range of newer antimicrobials, new diagnostic techniques and recent treatment modalities, infective keratitis still considered a diagnostic and therapeutic challenge. Surgical treatment may be necessary in some situations; such as lid surgery for entropion or punctal plug insertion for dry eye. In fact, ocular surface restoration is an end point of successful persistent epithelial defect therapy. Healing of a corneal epithelial defect occurs in phases and is completed when the regenerated epithelium forms adhesions to the underlying stroma. A new treatment with the use of umbilical cord blood serum has proved beneficial in the treatment of persistent infective corneal ulcers as an adjunctive treatment. This study was conducted at Tanta University Hospitals aiming to elucidate the efficacy of umbilical cord blood serum in the management of persistent infective corneal ulcers. We included a total of 40 subjects who were divided into two groups; the cases group included cases who were treated with umbilical cord serum, and Control group which included the remaining 20 cases who were commenced on conventional testament plan. All patients received the specific treatment according to culture and sensitivity results for 3 weeks and when no obvious improvement, umbilical cord blood serum was tried as an adjunctive treatment on one of the two groups and the other continue with specific treatment alone and considered as a control group. All Patients were followed up at the 7th, 14th, 21st &30th days and until complete healing was achieved from the beginning of the procedure and data of healing, relapse or recurrence was recorded. Results of this study revealed the following: • The maximum affections were in the fifth decade while the least was in the second decade. • Males were more affected than females. • There were high incidence of affections and complications in unskilled workers and in rural area residents. • According to culture results, mixed bacterial and fungal organisms were the main cause of infective corneal ulcers. • Ocular trauma was the most common risk factor of resistant corneal ulcer. • Viral ulcers were associated mainly with a history of common cold illness. • Mixed bacterial and fungal ulcers were associated mainly with plant trauma. • Most of viral ulcers were central and paracentral, the prognosis of paracentral ulcers were better than central ulcers. • The prognosis of simple bacterial ulcers was better than mixed bacterial and fungal ulcers. • The worst prognosis was found in central mixed bacterial and fungal ulcers. BCVA showed significant difference between the two groups (p = 0.001). In CBS group about 40% of subjects gained 1 line and 30% of subjects gained 2 lines. Only 30% of subjects in the cases group showed no improvement. On the contrary, 70% of the included controls showed no improvement. Although statistical analysis showed no significant difference between the two groups regarding ulcer healing time, umbilical cord serum was associated with faster healing rates (2.38 vs. 4 weeks in controls). This rapid healing rate should be considered despite its insignificance.