Long term treatment with sodium hyaluronate-containing artificial tears reduces ocular surface damage in patients with dry eye

BACKGROUND/AIMS: Several studies have reported that sodium hyaluronate is able to improve both symptoms and signs in patients with dry eye but none have demonstrated an improvement of conjunctival epithelial cell abnormalities of the ocular surface. The aim of this study was to explore the effect of sodium hyaluronate-containing eye drops on the ocular surface of patients with dry eye during long term treatment. METHODS: A randomised double blind study was undertaken in 86 patients with medium to severe dry eye (that is, rose bengal and/or fluorescein test score of at least 3, tear film break up time <10 seconds, or Schirmer's test <5.5 mm). Patients were treated with either preservative-free sodium hyaluronate or saline for 3 months at a dose of one drop 4-8 times a day. Bulbar impression cytology, slit lamp examinations, and subjective symptoms were evaluated after 1, 2, and 3 months. Impression cytology was considered the primary efficacy parameter of the study. RESULTS: The efficacy analysis was performed on a total of 44 patients who were able to fully adhere to the protocol. After 3 months of treatment sodium hyaluronate improved impression cytology score (p = 0.024 v baseline). At the same time also the difference with respect to placebo was statistically significant (p = 0.036). Study medication was well tolerated and no treatment related adverse events occurred during the study. CONCLUSIONS: Sodium hyaluronate may effectively improve ocular surface damage associated with dry eye syndrome.     

新鲜羊膜移植治疗严重的急性炎症期及瘢痕期眼表疾病的临床研究

目的　探讨新鲜羊膜移植治疗严重的急性炎症期和瘢痕期眼表疾病的可行性并对其疗效进行评价。方法　选择本院急性化学伤、热烧伤共 5例 (6只眼 ) ,复发性蚕蚀性角膜溃疡 8例 (8只眼 ) ,各种原因导致的大面积睑球粘连 42例 (49只眼 ) ,共计 5 5例 (6 3只眼 )临床连续住院患者 ,分别行单纯新鲜羊膜移植术 38例 (46只眼 ) ,羊膜移植联合板层角膜移植术 8例 (8只眼 ) ,羊膜移植联合角膜缘移植术 9例 (9只眼 )。术后均经印迹细胞学追踪观察移植后羊膜上皮细胞存活的时间。术后随访观察 6～ 18个月 ,平均 11个月。结果　 5 5例术后临床上均未见新鲜羊膜植片急性排斥反应。严重急性眼烧伤的 6只眼中 ,术后 5只眼无角结膜进行性溶解和穿孔 ,无新生血管和假性胬肉侵入角膜表面 ,虹膜亦未见萎缩 ,视力有不同程度的提高。复发性蚕蚀性角膜溃疡 8只眼术后未见复发。严重睑球粘连 49只眼中 ,46只眼恢复了眼球的运动功能 ,3只眼术后 3个月再次发生睑球粘连。泪液分泌功能基本正常者羊膜上皮细胞移植后可存活约 3个月。结论　新鲜羊膜移植可有效地用于重建角结膜表面 ,减轻炎性反应 ,减少新生血管的生成 ,抑制纤维组织增生 ,同时可用于防止蚕蚀性角膜溃疡的复发。充分清除眼表的病变组织和羊膜移植片的缝合固定 ,对羊膜     

Fresh Ammiotic Membrane Transplantation for Conjunctival Surface Reconstruction

Purpose: To determine whether fresh human amniotic membrane can be used to reconstruct the conjunctival defect created during symblepharon lysis. Methods: Forty-two eyes of 39 consecutive patients with eye burns and Stevens -Johnson syndrome were randomized to accept fresh or preserved human amniotic membrane transplantation (AMT) during the period of severe scarring. Impression cytology was performed in 12 eyes with normal tear secretion which received fresh AMT. Results: During a mean follow-up of 11 months (range, 6 to 18 months), thirty-five patients (37 eyes) showed successful ocular surface reconstruction and resolution of motility restriction while four patients (2 eyes with fresh AMT, 3 eye with preserved AMT) with minimal recurrence of symblepharon. There was no significant difference statistically between two groups (Chi-square test). Amniotic epithelial cells can survive about three months after being transplanted onto ocular surfaces with normal tear secretion.Conclusion: Both fresh and pres     

Ocular surface and MUC5AC alterations in atopic patients with corneal shield ulcers

PURPOSE: To describe MUC5AC alterations and the ocular surface disorder in atopic patients with or without corneal ulcers. METHODS: Atopic patients' eyes were divided into two groups according to the presence and absence of corneal ulceration. The subjects underwent corneal sensitivity measurements, Schirmer test, tear film break-up time (BUT), fluorescein and Rose Bengal staining of the ocular surface and conjunctival impression cytology and brush cytology. Impression cytology samples underwent PAS and immunohistochemical staining for MUC5AC. Brush cytology specimens underwent evaluation for inflammatory cell expression and quantitative real-time PCR for MUC5AC mRNA expression. The differences related to the tear function and ocular surface examination parameters between patients with and without corneal ulceration and healthy control subjects were studied. In addition, the differences of the study parameters related to ocular surface epithelial health and inflammatory status between patient eyes with atopic keratoconjunctivitis (AKC) and vernal keratoconjunctivitis (VKC) were investigated. RESULTS: The mean corneal sensitivity and BUT values were significantly lower in atopic patients with corneal ulcers, compared to patients without ulcers and controls (p < 0.001). Brush cytology specimens from patients with corneal ulcers revealed significantly higher expression of inflammatory cells compared to patients without ulcers and controls (p < 0.001). Impression cytology samples from eyes with corneal ulcers showed significant squamous metaplasia and reduction in goblet cell density compared to eyes without ulcers and eyes of control subjects. The mean squamous metaplasia grade was significantly higher in eyes with AKC compared to eyes with VKC (p < 0.02). The mean goblet cell density was significantly lower in eyes with AKC compared to eyes with VKC (p < 0.01). Specimens from eyes with corneal ulcers showed PAS positive mucin pickup and did not stain positive for MUC5AC. MUC5AC mRNA expression was significantly lower in eyes with corneal ulcers compared to eyes without ulcers and eyes of control subjects. MUC5AC mRNA expression was also significantly lower in eyes with AKC compared to eyes with VKC. CONCLUSIONS: Ocular surface inflammation, tear film instability, and decreased conjunctival MUC5AC mRNA expression were thought to be important in the pathogenesis of noninfectious corneal shield ulcers in atopic ocular surface disease.     

Impression cytology and ocular characteristics in ocular rosacea

PURPOSE: To examine clinical findings and histologic changes on the conjunctival surface in ocular rosacea. METHODS: Thirty-five patients with ocular rosacea and 30 normal subjects underwent dermatologic and ocular examinations. Tear film break-up time, Schirmer tests with and without topical anesthesia, and conjunctival impression cytology were done. Patients were divided into the following groups according to quantity of ocular signs: mild (Group 1), moderate (Group 2), and severe (Group 3). Impression cytology was performed on both upper-bulbar and intrapalpebral inferonasal-bulbar conjunctiva. RESULTS: Patients had significant cell alteration on the conjunctival surface compared with normal eyes. The most frequent ocular signs and symptoms were feelings of dryness and blepharitis. Average tear break-up times for patients with ocular rosacea were 8.2 seconds in Group 1, 5.69 seconds in Group 2, and 5 seconds in Group 3 (17.2 seconds in normal subjects). Schirmer test results with anesthesia were 11.5 mm, 7.6 mm, and 5.0 mm, and without anesthesia were 14.8 mm, 13.6 mm, and 7.0 mm, in Groups 1, 2, and 3, respectively. These results were 18.7 mm with anesthesia and 24.7 mm without anesthesia in normal controls. Schirmer tests and tear film break-up time were significantly lower in patients with ocular rosacea than in normal controls (p < 0.05). Impression cytology showed that both upper bulbar and inferonasal interpalpebral bulbar ocular surface had significant cell alterations compared with those obtained from normal subjects. CONCLUSIONS: Patients with ocular rosacea not only had decreased tear production but also tear instability. Ocular surface epithelium had significant degeneration in patients compared with normal subjects.     

Topical bevacizumab and ocular surface neovascularization in patients with stevens-johnson syndrome

PURPOSE: To evaluate the efficacy and safety of topical bevacizumab on ocular surface neovascularization among patients with Stevens-Johnson syndrome. METHODS: This was a retrospective, interventional case report. Three eyes of 2 patients were examined. Bevacizumab (25 mg/mL) eyedrops were applied 4 times daily for a period of 3 months. Main outcome measures were improvement of symptoms, visual acuity, degree of ocular surface neovascularization, corneal opacification, conjunctival injection, and occurrence of adverse events. RESULTS: Both patients completed the 3-month observation period and reported that it significantly improved ocular comfort. At the end of the study period, visual acuity improved in all 3 eyes; all eyes were observed to have decreased ocular surface neovascularization, corneal opacification, and conjunctival injection. No serious adverse events were reported. CONCLUSIONS: Topical bevacizumab is well tolerated and may be effective in improving comfort and inducing regression of ocular surface neovascularization, conjunctival injection, and corneal opacification in patients with ocular surface disease caused by Stevens-Johnson syndrome. Further controlled and long-term studies are needed to fully evaluate the long-term effects of this novel treatment.     

Transplantation of the submandibular gland in absolute dry eyes. Effect on the ocular surface

BACKGROUND: In absolute dry eyes the use of pharmaceutical lubricants can be insufficient to prevent progressive conjunctival and corneal epitheliopathy and the severe symptoms associated. In this situation a microvascular autologous submandibular gland transplant can be used to continuously provide a natural tear substitute. We studied the effect of this salivary tear film on the ocular surface in a prospective controlled clinical study. PATIENTS AND METHODS: We examined 20 eyes with a viable submandibular gland transplant and 20 severely dry eyes without or with a nonviable transplant as a control for the first postoperative year. Visual acuity, baseline-tear secretion, fluorescein break-up time and slit-lamp microscopical grading of ocular surface features, Rose Bengal staining and conjunctival impression cytology were evaluated. RESULTS: Postoperatively baseline-tear secretion and break-up time were significantly better in the group with a viable submandibular gland transplant than in the controls. The biomicroscopical staging of eyes with a salivary tear film was stable or showed a trend to improvement, while controls showed a trend to deteriorate. A successful submandibular gland transplant reduced the conjunctival and corneal neovascular hyperaemia. However, in 6 eyes with an excessive salivary epiphora, a microcystic epithelial oedema was observed. The epiphora and the associated oedema could be successfully controlled by means of a surgical reduction of the transplant. CONCLUSIONS: Following successful autologous submandibular gland transplantation lubrication and comfort are significantly improved and the ocular surface is stabilised during the first postoperative year. Severe preoperative morphological alterations and the salivary character of the new tear film prevent a more obvious improvement of the ocular surface.     

高浓度自体血清滴眼治疗眼表疾病

目的：探讨100%浓度自体血清滴眼治疗眼表疾病的疗效。 方法：回顾性分析因各种原因引起的持续角膜上皮缺损或溃疡35例35眼,经常规的药物治疗或联合羊膜移植或板层角膜移植治疗后效果不佳,采用100%浓度自体血清治疗2～6wk,观察其症状及角膜上皮修复情况。 结果：患者35例35眼中,治愈率34.3%,好转率40.0%,无效率25.7%。在病毒性角膜炎和神经营养性角膜炎中治愈率和好转率均为47.6%,95.2%的患者角膜上皮和溃疡在滴用100%自体血清1mo修复。未发生感染及不良反应。 结论：100%浓度自体血清滴眼治疗眼表疾病是安全有效的,可明显促进角膜上皮的修复,对于病毒性角膜炎和神经营养性角膜炎引起的持续角膜上皮缺损或溃疡疗效更佳。     

Tear function and ocular surface changes with topical mitomycin (MMC) treatment for primary corneal intraepithelial neoplasia

PURPOSE: To evaluate the tear function and ocular surface alterations in patients with primary CIN before and after treatment with topical mitomycin (MMC). PATIENTS AND METHODS: We describe seven patients with unilateral CIN treated with 0.04% topical MMC three times daily until full eradication of the lesion. The patients underwent tear and ocular surface examinations including Cochet-Bonnet corneal sensitivity measurements, tear film break-up time (BUT), Schirmer test, and Rose-Bengal staining before, at the time of resolution of the CIN, and at the final follow-up. Conjunctival impression cytology was performed before treatment and at the last visit. RESULTS: The mean pretreatment corneal sensitivity was 30.3 +/- 7.4 mm and improved to 55 +/- 5 mm at the final visit (P < 0.05). There were no aqueous-deficient eyes. The BUT values and Rose-Bengal staining scores also showed significant improvement at the last follow-up compared with the pretreatment values (P < 0.05). Initial impression cytology specimens showed goblet cell loss, higher grades of squamous metaplasia, areas of isolated keratinized, binucleated, and actively mitotic disfigured epithelial cells in all patients. The mean goblet cell density and squamous metaplasia grade were observed to improve significantly at the last visit (P < 0.05). MMC-induced cytologic changes were seen to persist long after cessation of treatment in some patients. All eyes remained free of recurrence and complications during the follow-up period. CONCLUSION: We found 0.04% topical MMC treatment tid until full eradication to be effective in the management of CIN. The ocular surface disease of CIN was characterized by disturbance of tear film stability, goblet cell loss, and increased squamous metaplasia in all patients. Impression cytology proved useful in attaining the diagnosis of CIN, evaluating the effect of treatment, and showing MMC-related long-term changes on the ocular surface.     

Botulinum toxin A treatment in patients suffering from blepharospasm and dry eye

BACKGROUND: Many patients with essential blepharospasm also show dry eye signs and symptoms. Botulinum toxin A is an effective treatment for reducing spasms in these patients. In this investigation, the effect of botulinum toxin A injections on tear function and on the morphology of the ocular surface in patients suffering from blepharospasm in combination with a dry eye syndrome was investigated. METHODS: Botulinum toxin A injections were applied to 16 patients with blepharospasm. All patients complained of dry eye symptoms and had reduced tear break up time values. A subjective questionnaire and ocular examinations including tear break up time, Schirmer test without local anaesthesia, and rose bengal staining were evaluated before, 1 week, 1 month, and 3 months after injection. Impression cytology was performed before, 1 month, and 3 months after botulinum toxin A treatment. RESULTS: Although all patients were relieved of blepharospasm after botulinum toxin injections, only three noticed an improvement in dry eye symptoms. Eight patients noticed no difference and five complained of worsening. Tear break up time was found to be increased 1 week and 1 month after injections. Schirmer test measurements were reduced up to 3 months. Rose bengal staining slightly increased 1 week after injections. Impression cytology showed no definite change in conjunctival cell morphology 1 month and 3 months after botulinum toxin A injections. CONCLUSION: In the patients presented here suffering from blepharospasm and dry eye, botulinum toxin A injections were effective in relieving blepharospasm but were not successful in treating dry eye syndrome.     

Allogeneic serum eye drops for the treatment of severe dry eye in patients with chronic graft-versus-host disease

PURPOSE: To describe the use of allogeneic serum eye drops to treat 2 patients with chronic graft-versus-host disease (GVHD)-induced severe ocular surface disease. METHODS: Small case series. RESULTS: Conventional therapy failed to control the ocular symptoms of 2 patients with GVHD who presented with severe dry eye syndrome. Because autologous serum was unavailable in these cases, we used allogeneic serum eye drops as an alternate option for treating their ocular surface disease. Both donors had serologic tests performed before donation. Use of the allogeneic serum eye drops had a beneficial clinical effect, with marked attenuation of the patients' symptoms. This therapy proved to be safe during 10 months of treatment. CONCLUSIONS: Allogeneic serum eye drops may be a good alternative treatment for patients with severe dry eyes caused by GVHD.     

Clinical application of living-related conjunctival-limbal allograft.

PURPOSE: To report one successful case of conjunctival-limbal allograft for the treatment of a severe ocular surface disorder. METHODS: Interventional case report. A 9-year-old patient suffering from Stevens-Johnson syndrome with total keratinization of the ocular surface of both eyes was treated in the left eye by corneal and conjunctival stem cell transplantation. Oral cyclosporin A and topical autologous serum and corticosteroids were administered. RESULTS: Mucosal epithelial phenotype was maintained in the left eye at most recent examination for more than 3 years after ocular surface reconstruction. CONCLUSION: A total keratinized ocular surface may be treated with the combination of conjunctival and corneal stem cell transplantation.     

Short-term effect of topical brinzolamide-timolol fixed combination on ocular surface of glaucoma patients

AIM: To evaluate the short-term effect of the fixed combination of brinzolamide-timolol on the ocular surface in glaucoma patients. METHODS: This is a prospective study of 23 eyes of 23 patients with newly diagnosed glaucoma. Schirmer I test, tear break-up time (BUT) measurement, conjunctival impression cytology and central corneal thickness (CCT) measurements were performed in one of the eyes of each patients before and 4 weeks after brinzolamide-timolol fixed combination therapy. All patients were asked to answer the OSDI questionnaire form about the ocular surface symptoms at baseline and at 1 week and 4 weeks follow-up visits. RESULTS: After brinzolamide-timolol fixed combination theraphy Schirmer I, BUT and CCT values decreased but the only statistically significant decrease was seen in BUT test (P=0.03). OSDI scores increased during the follow-up but this increase was not statistically significant (P=0.22, P=0.42 respectively). Impression cytology findings ranged from 0.78±0.42 to 0.95±0.36 according to the Nelson classification. There was no statistically significant difference between baseline and 4 weeks follow up in impression cytology grades (P=0.15). CONCLUSION: The results of our study indicate that short-term use of brinzolamide-timolol fixed combination theraphy does not have a profound effect on ocular surface except BUT values.     

自体血清治疗眼化学伤的效果分析

目的探讨自体血清治疗严重眼化学烧伤的效果。方法22例（30眼）严重眼化学烧伤随机分为2组,治疗组11例（15眼）采用自体血清治疗,对照组11例（15眼）未加用自体血清,余治疗方法同治疗组,对两组进行临床疗效分析。结果治疗组治愈率80％,总有效率100％;对照组治愈率33．3％,总有效率93．3％（P〈0．05）。治疗组平均疗程比对照组缩短8d（P〈0．01）。结论使用自体血清治疗严重眼化学烧伤安全,有效,无毒副作用。     

原发性开角型青光眼和高眼压患者及正常人群结膜印迹细胞学检查的比较

目的：比较原发性开角型青光眼和高眼压患者及拥有健康眼球表面的正常人群的泪膜功能和印象细胞学检查的数值。
　　方法：此前瞻性研究中纳入了原发性开角型青光眼患者11例11眼(平均年龄：62.7±6.1岁),高眼压患者12例12眼(平均年龄：62.8±6.4岁)及健康人12例12眼(平均年龄：62.9±6.03岁)。这些患者均是最近被诊断出患有原发性开角型青光眼及高眼压,且之前未接受过抗青光眼方面的治疗。均行结膜印迹细胞学检查、泪膜破裂时间和基础泪液分泌试验。每组印迹细胞学检查的样本根据Nelson分级法分为0~3级。应用Kruskal-Wallis检验和Dunn多重比较检验进行统计分析。
　　结果：原发性开角型青光眼患者,高眼压患者及正常人群平均基础泪液分泌值分别为10.4±1.3,10.9±1.2和11.1±1.1 mm/5min,其差距没有统计学意义(P=0.33);三组的泪膜破裂时间分别为11.2±1.1,11.3±1.1和11.8±1.2s,其差距没有统计学意义(P=0.35)。原发性开角型青光眼患者中6眼(54.5%)为0级,5眼(45.5%)为1级。高眼压患者中6眼(50%)为0级,6眼(50%)为1级,健康人中6眼(50%)为0级,6只眼(50%)为1级(P=0.97)。
　　结论：氧化应激可能会导致青光眼,眼表疾病,泪腺功能障碍及机体杯状细胞所分泌的黏液减少。原发性开角型青光眼患者,高眼压症患者及健康人群间的印象细胞学检查数值并无显著差异。     

Surface features and morphology of bulbar conjunctival cells of bovine eyes obtained from a slaughterhouse: a scanning electron microscope and impression cytology study

PURPOSE: To qualitatively and quantitatively assess the surface cells of the bulbar conjunctiva of slaughterhouse-obtained bovine eyes by impression cytology (IC) and scanning electron microscopy (SEM). METHODS: After quality-control measures and careful surface washing of recently enucleated bovine eyes over 20 min, impression cytology samples were taken from the nasal bulbar conjunctiva with a MILLCELL filter, or the ocular surface fixed in a moist chamber by a dropwise application of buffered isotonic glutaraldehyde solution. Impression cytology samples were stained with Geimsa or haematoxylin-periodate-Schiff. Fixed samples, that included the nasal bulbar conjunctiva, were prepared for SEM. From overlays of light microscope images of IC material or SEM images, cell areas, nucleus areas and cell and nucleus dimensions were measured with a digitiser pad. RESULTS: Impression cytology routinely showed large cells with an average area of 1035 +/- 368 microm(2), and a low nucleus-to-cytoplasmic (N/C) ratio of 0.112 +/- 0.048. The cells had dimensions averaging 46 microm (long) and 29 microm (short). Similar areas and dimensions were also found using SEM, which also showed the surface cells to have a range of lighter and darker electron reflexes and to be decorated with microplicae or microvilli. Goblet cells were not evident with either method of viewing. CONCLUSIONS: The superficial cells of the bovine bulbar conjunctiva appear to routinely be of a squamous cell phenotype.     

带角膜缘板层角膜移植治疗眼表烧伤

目的探讨带角膜缘板层角膜移植治疗[表角膜烧伤及疗效。方法采用带角膜缘板层角膜移植治疗化学伤、热灼伤56例58[,其中[睑皮肤缺损32例32[、睑球粘连36例38[;术前角膜印迹细胞学检查,角膜表面有杯状细胞56例58[。结果术后视力提高46[,角膜上皮保持完整48[,因[睑缺损而影响角膜上皮愈合,行睑裂闭合手术10[,术后排斥21[,用Cs-A或FK-506、皮质激素控制,对术后发生青光[中的6[进行手术,术后板层角膜表面行印迹细胞检查出现杯状细胞19[。结论带角膜缘板层角膜移植,可用于严重[表烧伤的角膜结膜化病人。酸性化学伤、[附属器完好、[表植床条件好的,手术后角膜上皮覆盖完好,角膜再度结膜化程度低。     

Impression cytology study of conjunctival epithelial phenotypes on the healing ocular surface after pterygium excision

PURPOSE: To compare the process of conjunctival epithelial regeneration after three types of pterygium excision procedures. METHODS: Thirty-eight patients (45 eyes) with primary pterygium were randomly assigned to a bare-sclera procedure (group 1, 15 eyes of 12 patients), bare-sclera with intraoperative mitomycin C (MMC 0.02% for 30 seconds; group 2, 15 eyes of 14 patients), or pterygium excision with conjunctival autografting (group 3, 15 eyes of 12 patients). Controls were healthy fellow eyes and seven eyes of age- and sex-matched subjects. Impression cytology was performed preoperatively, at 1 and 2 weeks, and at 1, 3, 6, and 12 months after surgery. The nucleus-to-cytoplasm (N/C) ratio of nongoblet epithelial cells and goblet cell density (GCD) in the pterygial area were calculated and compared over time across treatment groups. RESULTS: Pterygium excision wounds healed in a similar four-stage process in all groups, but at different rates and with different final results. The N/C ratio was highest at about 1 month postoperatively in groups 1 and 2 and at 2 weeks in group 3, before gradually returning to control levels. Preoperatively, the GCD in treated eyes was almost twice that in control eyes (p = 0.001) but fell to zero immediately postoperatively. Goblet cells first appeared (with the most rapidly increased density) in group 3, followed by group 1. At 12 months, the mean GCD in groups 1 and 3 were not significantly different from those in controls, whereas the mean GCD in group 2 was still less than that of control (p = 0.02). CONCLUSIONS: Healing of conjunctiva is delayed by MMC and is promoted by autografting. Even 1 year after surgery, the ocular surface remains abnormal with respect to epithelial phenotypes in eyes treated by any of the three techniques.     

Midterm results on ocular surface reconstruction using cultivated autologous oral mucosal epithelial transplantation

PURPOSE: To perform a midterm assessment of the integrity and reproducibility of cultivated autologous oral mucosal epithelial sheets, and to evaluate the clinical efficacy of their transplantation in ocular surface. DESIGN: Observational case series. METHODS: Cultivated autologous oral mucosal epithelial sheets were created using amniotic membrane and buccal mucosal epithelium from 12 patients with Stevens-Johnson syndrome, chemical and thermal injury, pseudo-ocular cicatricial pemphigoid, and idiopathic ocular surface disorder. They were transplanted onto 15 eyes from these patients who were then followed up for a mean of 20 months; with the longest follow-up being 34 months. We assessed their clinical outcomes with special reference to neovascularization. RESULTS: Cultivated autologous oral mucosal epithelial sheets could be generated from all patients. On the second postoperative day, 14 of 15 sheets transplanted demonstrated total re-epithelialization on the cornea. During the follow-up, the ocular surface was stable and transparent without any major complications in 10 of 15 eyes (67%), and the transplanted epithelium survived for at least 34 months. There were five eyes (33%) with small but long-standing epithelial defects, three of these healed spontaneously, and two (13%) required reoperation. In 10 eyes, postoperative visual acuity was improved by more than 2 lines. All eyes manifested some peripheral corneal vascularization. CONCLUSIONS: We established a successful tissue-engineering technique to generate cultivated autologous oral mucosal epithelial sheets and succeeded in reconstructing the ocular surface. We suggest that this surgical modality may be both safe and useful, especially in younger patients with the most severe ocular surface disorders.     

Autologous serum eye drops for dry eye after LASIK

PURPOSE: To evaluate the efficacy of autologous serum eye drops for dry eye after LASIK in a prospective, randomized study. METHODS: Fifty-four eyes of 27 male patients who underwent LASIK were divided into two groups; patients who used autologous serum eye drops and those who used artificial tears postoperatively. Schirmer test with anesthesia, tear break-up time (BUT), and rose bengal and fluorescein staining for the ocular surface were prospectively compared between the groups. All values were also compared before and after surgery (at 1 week [except for Schirmer test], 1 month, 3 months, and 6 months) in each group. RESULTS: Tear BUT was greater in the autologous serum eye drops group than in the artificial tears group at 6 months postoperatively. Rose bengal score was lower in patients using autologous serum eye drops than in patients using artificial tears at 1 month and 3 months postoperatively. No significant difference was noted between patients using autologous serum eye drops and patients using artificial tears in the value of Schirmer test with anesthesia and fluorescein scores. In the autologous serum eye drops group, tear BUT was increased at 3 months after LASIK, rose bengal score was lower at 1 month and 3 months, and fluorescein score was lower at 1 month after LASIK compared to preoperative values, respectively. In the artificial tears group, all values (Schirmer test, tear BUT, rose bengal score, and fluorescein score) showed no differences between before and after LASIK. No differences were noted in the subjective scores for dryness between the autologous serum eye drops and artificial tears groups. CONCLUSIONS: The autologous serum eye drops group showed prolongation of the tear BUT and a reduction in rose bengal staining score.