Letter to Editor

Topical Umbilical Cord Serum for Corneal Epithelial
Defects after Diabetic Vitrectomy

Arjun Srirampur, MS, FRCS

Anand Eye Institute, Habsiguda, Hyderabad, India

ORCID:
Arjun Srirampur: https://orcid.org/0000000230168336

J Ophthalmic Vis Res 2021; 16 (1): 145–146

Dear Editor,
I have read with great interest the article

by Moradian et al on “Topical Umbilical Cord
Serum for Corneal Epithelial Defects after Diabetic
Vitrectomy.”[1] They have performed the study to
investigate whether topical umbilical cord serum
(TUCS) has any beneficial role in healing corneal
epithelial defects (CED) after diabetic vitrectomy.
However, I have a few concerns about the
study.

Firstly, the postoperative intraocular pressures
(IOP) were not mentioned in both groups. Elevated
IOP (which is common after a vitreoretinal surgery)
is known to cause corneal edema and increase
the risk of corneal complications such as epithelial
defect and non- healing epithelial defect.[2] It would
be more informative if the authors had provided
IOP measurements in both groups, as it could
influence the healing pattern of the epithelial
defects.

Secondly, it is mentioned that all 80 eyes
underwent deep vitrectomy but it is not mentioned
what type of intraocular tamponade agent such as
air, Sulphur hexafluoride (SF6), perfluoropropane

Correspondence to:

Arjun Srirampur, MS, FRCS. Consultant – Cornea,
Cataract and Refractive surgery, Anand Eye Institute,
Habsiguda, Hyderabad 500007, India.
E-mail: sarjuneye@gmail.com
Received: 24-04-2019 Accepted: 11-12-2020

Access this article online

Website: https://knepublishing.com/index.php/JOVR

DOI: 10.18502/jovr.v16i1.8264

(C3F8), or silicone oil was used during the
surgery. Intraocular tamponade of long-acting
expansile gases may induce corneal endothelial
cell toxicity. The loss of corneal endothelial
cells has also been reported to be significantly
greater in eyes with C3F8 than in those with
SF6.[3] This endothelial damage especially in a
diabetic eye can lead to corneal edema and
loose adhesions between the Bowman’s layer
and stroma which delays the epithelial healing
mechanism.

Thirdly, even though the authors have
admitted for the absence of dry eye testing
in these eyes, they should have performed
simple corneal sensations. It is well-known that
diabetic eyes have corneal hypoesthesia due
to peripheral neuropathy. The development
of diabetic keratopathy has been suggested
to be related to loss of nerve-derived trophic
factors following a decrease in corneal sensation.
This reduced corneal sensations can lead to
neurotrophic keratopathy which can lead to
disturbance in the healing of the epithelial
defects. Diabetic keratopathy may be associated
with neuropathic keratitis in patients with
a persistent corneal epithelial defect, and
dry eyes may occur secondary to a reflex
decrease of tear secretion due to corneal

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How to cite this article: Arjun Srirampur, MS, FRCS. Topical Umbilical Cord
Serum for Corneal Epithelial Defects after Diabetic Vitrectomy. J Ophthalmic
Vis Res 2021;16:145–146.

© 2021 ARJUN SRIRAMPUR. THIS IS AN OPEN ACCESS ARTICLE DISTRIBUTED UNDER THE CREATIVE COMMONS ATTRIBUTION LICENSE | PUBLISHED BY

KNOWLEDGE E 145

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Letter to Editor; Arjun Srirampur

hypoesthesia and/or secondary to reduced
tear and mucin secretion due to efferent nerve
dysfunction.[4]

Also, the risk of allergies and possibilities of
transmitting parenterally transmitted organisms
must also be kept in mind when using TUCS
apart from the legal and ethical issues. A routine
testing of the mothers and a rapid test on the
sera for viral contaminants is required. When
the event to the time between the testing of
the mother for HIV and the preparation of cord
serum from the placental blood is more than
six months, HIV testing should be undertaken
again at the time of serum delivery to account
for the window period of the infection.[5] In
consideration of the window period of HIV
infection, additional HIV testing with a shortened
window period, such as p24 antigen detection
method, should be performed before the use of
the TUCS.

REFERENCES

1. Moradian S, Ebrahimi M, Kanaani A, Faramarzi A, Safi
S. Topical umbilical cord serum for corneal epithelial
defects after diabetic vitrectomy. J Ophthalmic Vis Res
2020;15:160–165.

2. Ytteborg J, Dohlman CH. Corneal edema and intraocular
pressure II. Clinical results. Arch Ophthalmol 1965;74:477–
484.

3. Mitamura Y, Yamamoto S, Yamazaki S. Corneal endothelial
cell loss in eyes undergoing lensectomy with and without
anterior lens capsule removal combined with pars plana
vitrectomy and gas tamponade. Retina 2000;20:59–
62.

4. Toshida H, Nguyen DH, Beuerman RW, Murakami
A. Evaluation of novel dry eye model: preganglionic
parasympathetic denervation in rabbit. Invest Ophthalmol
Vis Sci 2007;48:4468–4475.

5. Vajpayee RB, Mukerji N, Tandon R, Sharma N, Pandey
RM, Biswas NR, et al. Evaluation of umbilical cord serum
therapy for persistent corneal epithelial defects. Br J
Ophthalmol 2003;87:1312–1316.

146 JOURNAL OF OPHTHALMIC AND VISION RESEARCH VOLUME 16, ISSUE 1, JANUARY-MARCH 2021