Transplantation of autologous cultivated conjunctival epithelium for the restoration of defects in the ocular surface.

Ocular surface disorders are often characterised by partial or complete loss of corneo-conjunctival epithelium, which causes dramatic functional and cosmetic problems. Depletion of stem cells and the scarcity of donor tissue available make large or bilateral defects challenging to reconstruct, and usually require the transplantation of heterotopic or allogeneic grafts. We investigated the feasibility of restoring severely damaged ocular surfaces with autologous cultivated conjunctival epithelium. Conjunctival cells were harvested from the healthy eyelid bed of four patients with oculopalpebral diseases. An epithelial sheet reproducing the original conjunctival epithelium was generated by serial cell culture. This was transplanted for the first time ever to our knowledge on to the ocular surface of the same patients. Take was excellent and the cultivated epithelium was stable, resulting in great improvement of patient's symptoms and cosmesis. Transplantation of cultivated conjunctival cells opens new perspectives in the treatment of severe ocular surface disorders.     

Reconstruction of the ocular surface by transplantation of a serum-free derived cultivated conjunctival epithelial equivalent

PURPOSE: The purpose of this study was to investigate the use of a serum-free derived cultivated conjunctival epithelial sheet for ocular surface transplantation and reconstruction. METHODS: Seven subjects with various ocular surface disorders were selected for the procedure: one patient had an extensive conjunctival nevus, three patients had pterygium, two patients had persistent leaking trabeculectomy blebs, and one patient had bilateral superior limbic keratoconjunctivitis. Conjunctival epithelial cells were harvested from the forniceal conjunctiva of patients 2 weeks before the definitive surgery. Cultivation of conjunctival epithelial cells on human amniotic membrane (HAM) was carried out under serum-free conditions. At the time of transplantation, the area of diseased conjunctiva was excised and the cultured conjunctival epithelium-HAM composite was transplanted onto the surgical defect. Patients were followed up with serial slit-lamp examinations, fluorescein staining, and photographic documentation. RESULTS: A confluent stratified conjunctival epithelial sheet was formed on the HAM within 12 to 14 days. Transplanted grafts remained well-epithelialized after surgery. A successful outcome, defined as resolution of the disease, maintenance of conjunctival epithelialization, maintenance of graft integrity, and absence of significant complications, was obtained in all seven patients. A good functional and cosmetic result was achieved in all eyes. The mean follow-up period was 11.6 months (range, 6-18 months). CONCLUSIONS: Transplantation of a serum-free derived autologous cultivated conjunctival epithelial sheet on HAM was successfully performed in seven patients with ocular surface disorders. This may provide a novel method for conjunctival replacement in conditions where the normal conjunctiva is damaged or deficient.     

组织工程角膜上皮联合羊膜移植治疗眼表化学伤效果观察

目的：探讨组织工程角膜上皮联合羊膜移植治疗眼表化学烧伤的临床效果.方法：34例（41只眼）跟表化学烧伤患者按来院先后顺序编号,随机分为两组.观察组18例（22只眼）行组织工程角膜上皮联合新鲜羊膜移植,对照组16例（19只眼）行结膜囊冲洗、前房冲洗和促角膜上皮生长药物点眼等治疗,观察两组临床疗效.术后随访观察角膜上皮化情况和视力恢复情况.结果：全部患者保存了眼球,观察组患者在术后1周内角膜植片水肿明显减轻,术后2～3周角膜缘植片基本透明,未见感染或排斥反应;术后4～6周内,眼表上皮重新上皮化,无瘢痕增生和新生血管化,角膜上皮修复好;术后视力较术前视力明显提高,差异有统计学意义（P〈0.05）;术后随访2～10个月,无假性胬肉及睑球粘连并发症发生.对照组3周内6例眼部炎症基本控制,3例眼部炎症持续超过21 d,4例角膜血管化,3例角膜持续性上皮缺损;治疗后视力较入院时视力变化差异无统计学意义（P〉0.05）.结论：组织工程角膜上皮联合羊膜移植是一种有效的治疗眼表化学烧伤的方法.     

Ocular surface reconstruction using amniotic membrane allograft for severe surface disorders in chemical burns: case report and review of the literature

Ocular chemical burns are frustrating disorders. The conjunctival surface provides a defense mechanism protecting against infection, desiccation, and injury, being centered in the epithelial lining of the ocular surface. A monocular case of severe acid chemical burn is presented. Postinjury-stratified epithelium in the inferior cul-de-sac with eye movement and contact with the lower eyelid resulted in repeated corneal abrasions, vascularization, and scarring. This vexing problem was recalcitrant to medical and conservative treatment because of delayed and prevented healing from continuous conjunctival abrasive irritation inflicted on the corneal surface. Amniotic membrane allograft transplantation in destructive lesions of the conjunctiva acts as a reconstructive graft in nonhealing lesions of the ocular surface. Successful placement of an amniotic membrane allograft (AmbioDry) in conjunction with excision of an extensive amount of stratified epithelial scar tissue was accomplished. Marked improvement followed surgery, and a definitive solution resulted for the severely burned right eye.     

新鲜羊膜移植在结膜囊成形术中的应用

目的探讨新鲜人羊膜移植治疗结膜囊狭窄临床应用的可行性及疗效. 方法 2001年3月～2003年3月,用新鲜羊膜对30例(30只眼)结膜囊狭窄患者行羊膜移植结膜囊成形术.术前在无菌条件下切取羊膜组织,将其上皮面向上平铺于手术粘贴纸上,剪成5 cm×8 cm大小数块,放入含庆大霉素(4×106 U/ml)生理盐水的密封湿房中,4℃冰箱保存12小时.术中充分分离球结膜与筋膜组织达眶缘,游离并剪除结膜下粘连的瘢痕组织,修剪羊膜组织使其稍大于结膜缺损区约10 mm,其上皮面向上置于结膜缺损区,用7/0尼龙线将其连续缝合于结膜游离创缘上;同时行下穹窿加深成形术,部分患者行羟基磷灰石义眼座二期植入术和/或外伤性上睑下垂矫正术. 结果 30例(30只眼)均于术后10、14天拆除羊膜移植缝线及下穹窿加深成形术缝线,所有移植羊膜均成活,结膜囊下穹窿充分加深,配戴义眼效果满意.术后随访3～18个月,未发现植片感染、挛缩,以及免疫排斥反应和羊膜溶解,手术获得成功. 结论新鲜人羊膜移植部分结膜囊成形术是一种取材简便、疗效肯定的手术方法.     

严重眼部烧伤急性期处理及组织工程角膜上皮移植的效果分析

目的：通过对严重眼部烧伤急性期处理及组织工程角膜上皮移植治疗眼角膜烧伤的效果分析,探讨治疗眼部烧伤的行之有效的途径.方法：对2005年1月-2009年12月收治的32例43眼（年龄1～43岁）严重急性期眼部烧伤患者,按致伤原因不同,分别进行急性期处理及对角膜创面进行羊膜和/或行自体/同种异体组织工程角膜上皮移植,观察视力、角膜创面愈合及新生血管生成情况.结果：43只眼中有11只在1周内角膜上皮愈合,矫正视力0.5以上,12只在行单纯羊膜覆盖后伤后2周上皮愈合,矫正视力＜0.5;12只在行单纯羊膜覆盖＋角膜缘干细胞组织工程角膜移植后于伤后3周上皮愈合,角膜血管翳（＋）（新生血管P1）,矫正视力0.02;8只在行羊膜覆盖＋角膜缘干细胞人工角膜移植后于伤后4周上皮愈合,角膜血管翳（＋＋）（新生血管P2）,矫正视力＜0.02.结论：化学伤明显重于单纯热烧伤,而碱烧伤及其复合灼伤则后果更为严重.早期处理极为重要,其中对碱烧伤的24 h持续冲洗,甚至结膜下冲洗、前房穿刺等措施十分必要.羊膜覆盖可有效地保护创面,而自体角膜缘干细胞体外培养后的组织工程角膜上皮移植可有效地促进角膜创面愈合,减少新生血管的产生.     

Histologic differences in the conjunctiva of black and white glaucoma patients.

We compared perioperative conjunctival biopsy specimens from 31 consecutive trabeculectomy patients to determine if there were any histologic differences between black and white glaucoma patients. We found a statistically significantly greater mean and distribution of mast cells and neutrophils in the white patients. No significant difference was found in the mean number of goblet cells, eosinophiles, macrophages, fibroblasts, plasma cells, or lymphocytes; or in thickness of the epithelium, vascular density, or collagen or mucopolysaccharide staining. We conclude that histological conjunctival factors that could be evaluated preoperatively probably are not related to the poor results in black patients of filtration surgery noted by some investigators.     

Development of cultivated mucosal epithelial sheet transplantation for ocular surface reconstruction

Regenerative medicine via tissue engineering is a newly developed medical field based on the use of somatic stem cells to generate biological substitutes and improve tissue functions. The achievement of these objectives depends on two important factors: stem cells, which are high in proliferability and differentiability, and the substrates that support them. In order to reconstruct the ocular surface in patients with severe ocular surface diseases, we decided to investigate the feasibility of human amniotic membrane as an epithelial carrier, and found that denuded amniotic membrane was the most appropriate substrate for this purpose. To develop the surgical treatment using denuded amniotic membrane as a carrier, we established the tissue engineering system for making transplantable epithelial sheets of either corneal or oral mucosal epithelial cells for ocular surface reconstruction.     

腹部腹腔镜手术后眼结膜充血临床观察

目的观察分析腹腔镜手术后眼结膜充血的可能发病原因、机制及防治措施。方法回顾性分析2004年5月至2012年5月腹腔镜气腹手术710例、免气腹腔镜212例的临床资料及术后眼结膜充血的发生晴况。结果腹腔镜组手术后眼结膜充血发生28例,发生率约4．0％,免气腹组手术后眼结膜充血发生2例,发生率为0．5％。手术时间长短、气腹压力大小、是否使用气腹的发病率差异有统计学意义,术前合并高血压和／或糖尿病并发结膜炎的发病率差异无统计学意义。结论气腹是两组术后眼结膜充血发生率差别的主要原因。气腹压力大小可能是发病的独立危险因素。气腹内压过高导致毛细血管过度充盈受损可能是眼结膜充血的发生机制。控制腹内压是预防结膜充血发生的关键。合并高血压和,或糖尿病可能促进结膜充血的发生。     

Alterations in ocular surface and corneal thickness in relation to metabolic control in patients with chronic renal failure

AIM: Ocular surface changes and ocular symptoms may be encountered in patients with chronic renal failure (CRF) undergoing haemodialysis. The ocular surface changes and its relationship with metabolic control in CRF patients were aimed to be emphasized in this study. METHODS: Thirty-eight CRF patients (75 eyes) undergoing haemodialysis were enrolled. Patients underwent a complete ocular examination together with Schirmer, tear break-up time tests, pachymetric measurements and conjunctival impression cytologies. Blood calcium, phosphate levels and total body volume changes after haemodialysis were recorded. RESULTS: The most common findings were conjunctival calcification with red eye (81.3%) and dry eye (62.7%, according to tear break-up time test) in 75 eyes of 38 patients. Impression cytologies were graded as 0 in 57.3% of eyes and 2-3 in 40% of eyes showing positive correlation with the extent of conjunctival calcification (R = 0.486, P = 0.0001). Serum calcium and phosphate levels were also positively correlated with the degree of conjunctival calcification (R = 0.684, P = 0.0001 and R = 0.428, P = 0.0001, respectively) as well as with the grades of impression cytology (R = 0.587, P = 0.0001 and R = 0.385, P = 0.0001, respectively). Furthermore, the mean corneal thickness decreased significantly (9.31 +/- 26.9 mum) following haemodialysis (Paired t-test, P = 0.002). CONCLUSION: Dry eye and irritational symptoms are major ocular symptoms in CRF patients. Serum calcium and phosphate levels seem to have a prognostic importance for the ocular findings and symptoms in patients with CRF.     

266例多孔高密度聚乙烯义眼座眶内置入术分析

目的 探讨眼球摘除后同期多孔高密度聚乙烯（Medpor）义眼座置入或者二期置入矫正眼窝凹陷畸形的术后并发症和外观效果。方法 对2001年至2004年行Medpor义眼座置入术的266例患者进行回顾性研究。结果 术后随访3-26个月。术后出现并发症者共23例，占8．6％。其中2例（0．8％）出现炎性肉芽肿，4例（1．5％）发生中重度上睑下垂，8例（3．0％）仍有上睑凹陷畸形合并轻度上睑下垂，2例（0．8％）出现下睑松弛。5例（1．9％）出现创口裂开义眼座暴露，其中3例保守治疗后愈合，另2例经手术修补愈合。2例（0．8％）出现结膜囊持续性脓性分泌物，经抗生素局部和全身治疗无效后最终取出义眼座。一期置入术共159例，术后并发症明显少于二期置入术。一期置入术后义眼座活动度优148例（56％），良11例（4％）；二期置入术共107例，术后义眼座活动度优36例（14％），良68例（26％），差3例（1％），眼座活动度一期置入术明显优于二期置入术（P〈0．05）。结论 Medpor义眼座置入术矫正眼窝凹陷畸形总体效果良好，虽有一些并发症，但通过保守治疗或手术治疗均能矫正。     

羊膜移植治疗眼烧伤疗效的观察

目的评价羊膜移植治疗眼部烧伤的疗效。方法2000年10月～2002年5月，对20例患者(28眼)采用羊膜移植治疗眼烧伤，其中碱烧伤6例(10眼)，酸烧伤8例(10眼)，热烧伤6例(8眼)。年龄8～45岁，平均28．6岁．烧伤部位包括角膜、结膜。受伤至手术时间1～21天，平均10天。结果28眼术后3～7天眼部炎症控制，角、结膜均未见继续溶解，无穿孔，无虹膜萎缩，视力有不同程度提高；16眼角膜恢复透明，4眼角膜白斑，8眼全角膜浑浊。全部患者均保存了眼球，眼表稳定，无免疫排斥反应及继发感染发生。结论羊膜移植可以减轻炎性反应，减少新生血管的生成，抑制纤维组织增生，对重建眼表功能及保存眼球有较高的价值，可有效地用于眼部烧伤的治疗，烧伤后手术愈早效果愈好。     

Giant cysts of the conjunctiva following scleral buckling

Four patients developed giant conjunctival cysts following scleral buckling for retinal detachment. Histologically these cysts showed a core of fibrous tissue lined by stratified, non-keratinizing epithelium and with goblet cells. They probably arose from inadvertent implantation of epithelium during surgery. In three cases the cysts were surgically excised without recurrence. Alternate modes of therapy are discussed.     

Autologous fibrin-cultured limbal stem cells permanently restore the corneal surface of patients with total limbal stem cell deficiency.

BACKGROUND: Ocular burns cause depletion of limbal stem cells, which leads to corneal opacification and visual loss. Autologous cultured epithelial cells can restore damaged corneas, but this technology is still developing. We sought to establish a culture system that allows preservation of limbal stem cells and preparation of manageable epithelial sheets and to investigate whether such cultures can permanently restore total limbal stem cell deficiency. METHODS: We selected a homogeneous group of patients whose limbal cell deficiency was evaluated by scoring the gravity of the clinical picture and the keratin expression pattern. Stem cells, obtained from the limbus of the contralateral eye, were cultivated onto a fibrin substrate and their preservation was evaluated by clonal analysis. Fibrin cultures were grafted onto damaged corneas. RESULTS: Fibrin-cultured limbal stem cells were successful in 14 of 18 patients. Re-epithelialization occurred within the first week. Inflammation and vascularization regressed within the first 3-4 weeks. By the first month, the corneal surface was covered by a transparent, normal-looking epithelium. At 12-27 months follow-up, corneal surfaces were clinically and cytologically stable. Three patients had a penetrating keratoplasty approximately 1 year after restoration of their corneal surface. Their visual acuity improved from light perception or counting fingers to 0.8-1.0. CONCLUSIONS: Preservation of limbal stem cells in culture gives new perspectives on the treatment of ocular disorders characterized by complete limbal stem cell deficiency. The multicenter nature of this study and the handiness and ease of long-distance transportation of the fibrin-cultured epithelial sheets suggest that this technology can now be widely applied.     

Hepatic Resection for Metastatic Melanoma: Distinct Patterns of Recurrence and Prognosis for Ocular Versus Cutaneous Disease

Background Resection of melanoma metastatic to the liver remains controversial. We evaluated the efficacy of hepatic resection in patients with metastatic ocular and cutaneous melanoma and assessed factors that could affect survival after resection. Methods Forty patients with hepatic melanoma metastasis underwent resection at four major hepatobiliary centers. Clinicopathologic factors were evaluated with regard to recurrence and survival by using χ² and log-rank tests. Results The primary tumor was ocular in 16 patients and cutaneous in 24. The median disease-free interval from the time of primary tumor treatment to hepatic metastasis was the same for both groups (ocular, 62.9 months; cutaneous, 63.1 months; P = .94). Most patients underwent either an extended hepatic resection (37.5%) or hemihepatectomy (22.5%). Twenty-six patients (65%) received perioperative systemic therapy. Thirty (75.0%) of 40 patients developed tumor recurrence. The median time to recurrence after hepatic resection was 8.3 months (ocular, 8.8 months; cutaneous, 4.7 months; P = .3). Patients with primary ocular melanoma were more likely to experience recurrence within the liver (53.3% vs. 17.4%; P = .015), whereas patients with a cutaneous primary tumor more often developed extrahepatic involvement. The 5-year survival rate for patients with a primary ocular melanoma was 20.5%, whereas there were no 5-year survivors for patients with cutaneous melanoma (P = .03). Conclusions Patterns of recurrence and prognosis after resection of hepatic melanoma metastasis differ depending on whether the primary melanoma is ocular or cutaneous. Resection should be performed as part of a multidisciplinary approach, because recurrence is common.     

Benign polyps with prostatic-type epithelium of the urethra and the urinary bladder. A suggestion of histogenesis based on histologic and immunohistochemical studies

The clinicohistologic features of seven urethral and four urinary bladder polyps with prostatic-type epithelium are described. The average age of the patients was 50 years. Seven patients had prior cystoscopies and in none of them was the lesion noted initially. Histologically the lesions were papillary or polypoid and the surface was lined predominantly by prostatic-type epithelium with interspersed transitional epithelial cells or by transitional epithelium with interspersed prostatic-type epithelial cells. The prostatic-type columnar cells contained foamy, faintly eosinophilic cytoplasm, which stained strongly for prostate specific antigen and prostatic acid phosphatase. In all the lesions, there were prostatic acini in the underlying fibrovascular stroma, which was devoid of smooth muscle. The intermingling of prostatic-type cells and transitional epithelium, on the surface of the polyps, the absence of lesions at previous cystoscopies, the coexistence of cystitis cystica glandularis (a metaplastic lesion), and the older age group of our patients suggest that the prostatic-type epithelium in the polyps of urethra and urinary bladder is an acquired lesion, most likely a metaplastic response of transitional epithelium, which embryologically was multipotential.     

360-degree retinectomy for severe ocular rupture

Ocular rupture, with severe complications and poorprognosis, is a serious eye injury and hard todeal with. It remains a significant surgicaldilemma and frustrates many ophthalmologist. With thelatest improvement in vitreoretinal surgery, treatmentmodalities for severe ocular rupture have beendeveloped. Therefore, many patients with severeocular rupture can reserve their eyes and restore somevisual function. Between January 1999 and January2002, 78 consecutive patients with ocular rupture were…     

眼烧伤的激素治疗

目的：为改善眼球烧伤预后差的现状,观察激素治疗眼球烧伤的新方法。方法：激素治疗组：1997－2000年眼球烧伤的入院患12例（18只眼）,常规加皮质激素和人重组生长激素治疗,皮质激素伤后立即开始,全身与局部同时应用,疗程2－4周,生长激素伤后1周开始,持续2周。对照组：1993－1996年的住院患9例（12只眼）,常规治疗眼球烧伤,比较两组治疗方法的效果。结果：激素治疗组12例患烧伤眼球全部愈合,溃疡和穿孔发生少,视力恢复良好,较对照组明显改善。结论：皮质激素和人重组生长激素联合应用;有益于眼球烧伤的治疗。     

Oxygen Tension Monitoring in Uremic Patients During Hemodialysis Treatment

The aim of this study was to evaluate the influence on cerebral and cutaneous vascular regions of PaO2 reduction during acetate dialysis, by monitoring conjunctival oxygen tension (PcjO2) and transcutaneous oxygen tension (PtcO2) during hemodialysis (HD) treatment. The study was performed on 23 patients with end-stage renal disease in chronic HD. All patients underwent dialytic treatment with cuprophan membranes and acetate containing dialysate. PcjO2 and PtcO2 were recorded and PaO2 and arterial carbon dioxide tension (PaCO2) were also measured. Results of the study show that hypoxemia during acetate dialysis with cuprophan membranes is not accompanied by changes of PcjO2 and therefore by changes in cerebral oxygenation. Moreover, PtcO2 remains constant during dialysis treatment. Furthermore, maintenance of normal oxygen tension at the conjunctival level is not obtained at the expense of the peripheral region of the skin.     

Ocular injury in the United States: Emergency department visits from 2006–2011

IntroductionOcular complaints represent a sizeable burden to emergency departments, accounting for an estimated 2.4 million ED visits annually. We sought to characterise visits associated with ocular injury and examine factors contributing to inpatient admission.MethodsWe searched the Nationwide Emergency Department Sample between 2006 and 2011 and identified cases in which patients presented with a primary or secondary diagnosis of ocular trauma. We described these cases according to age, sex, external mechanism of injury, payer status, and identified relationships between these variables. Logistic regression models were employed to identify crude and adjusted relative odds of admission to inpatient status based on patient demographics, mechanism of injury, payer status, and the existence of multiple injuries.ResultsBetween 2006 and 2011, a total of 5541,434 visits were made to EDs in the United States with a primary or other diagnosis of ocular trauma; ocular trauma was the primary diagnosis in 77.9% of these cases. Overall, mean age at presentation was 33.8 years and the majority of patients were male (64.8%). Male sex, older age, being struck by or against an object, the existence of multiple injuries, and Medicaid as a primary payer were all associated with significantly higher odds of hospital admission.DiscussionThe distribution of primary external mechanism of injury suggested that individuals are at higher risks for different injury types at each successive stage of life. Age and injury mechanism were correlated with odds of admission to inpatient status, with the highest odds among older adults who had been injured by being struck by or against an object.ConclusionsOcular injury plays a substantial role in the ED. Further work is necessary to determine whether developing and implementing age- and sex-appropriate prevention strategies could reduce the incidence of ocular injury and reduce morbidity related to these types of injuries.