Autologous Conjunctival Transplantation Research Articles

Efficacy of seamless autologous conjunctival transplantation in the treatment of pterygium

Efficacy of seamless autologous conjunctival transplantation in the treatment of pterygium

Efficacy of cultured autologous conjunctival cells transplantation in lacrimal duct reconstruction

Objective To evaluate the clinical efficacy of cultured autologous conjunctival cells transplantation in lacrimal duct reconstruction. Methods A prospective study. Total of 55 eyes of 52 cases with severe obstruction of lacrimal duct and absence or atrophy of lacrimal sac from Jun. 2016 to Jun. 2018 were enrolled in this study. They were treated with cultured autologous conjunctival cells transplantation in lacrimal duct reconstruction. The clinical efficacy was observed after operation. Results After operation, 41 eyes (74.54%) were cured, improved in 12 eyes (21.82%) and ineffective in 2 eyes (3.64%). The total effective rate was 96.36%. Conclusion The reconstruction of lacrimal duct with cultured conjunctival cells transplantation is effective. Key words: Conjunctival cells, autologous, culture, in vitro; Reconstruction, lacrimal passage; Obstruction, lacrimal passage, severe; Missing, lacrimal sac; Atrophy, lacrimal sac

OUTCOME OF AUTOLOGOUS LIMBAL CONJUNCTIVAL TRANSPLANTATION IN TERMS OF RECURRENCE RATE, AS THE MAIN OUTCOME MEASURE AND COMPLICATIONS AS THE SECONDARY OUTCOME

Purpose: To find the outcome of autologous limbal conjunctival transplantation in terms of recurrence rate, as the main outcome measure and complications as the secondary outcome.
 Methods: The present study retrospective study conducted from a tertiary eye care hospital. Pterygium excision with limbal conjunctival autograft from the affected eye was performed for primary pterygium. Secondary pterygia resulting from inflammation, trauma and other diseases were excluded. Patients were followed up for 18 months for recurrence and other complications.
 Results: A total of 36 eyes of 36 patients with primary pterygia from November 2016 and October 2017 were included in the study. The study recruited 19 (52.7%) males and 17 (47.2%) females with mean age of 38.2 ±10.42 years. Pterygium was diagnosed more commonly in left eye(55.5%) as compare to right eye(44.4%). Out of 36 cases 32 (88.8%) cases of nasal and 4 (11.1%) cases of temporal pterygium noted. Out of 36 cases Graft edema in 1 (2.7%) case, graft retraction in 2 (5.5%) cases and 1 (2.7%) case of granuloma were noted. Any kind of pterygium recurrence and graft necrosis was not noted in present study.
 Conclusions: Pterygium excision with autologous limbal conjunctival autograft is safe and effective method to treat primary pterygium.

Efficacy of deproteinized calf blood extract eye drops on early recovery after pterygium surgery

Objective: To investigate the effect of deproteinized calf blood extract eye drops on early postoperative recovery in primary pterygium patients. Methods: This is a prospective randomized controlled study. Patients diagnosed with primary pterygium in single eye at affiliated Xiamen Eye Center of Xiamen University during March 2016 to May 2016 were enrolled. After Pterygium excision with autologous conjunctival transplantation, patients were randomly assigned into four groups by a random number table, treated with anti-inflammaroty drugs only (control group) or combined with the following agents: deproteinized calf blood extract eye drops (DCBE group), carboxymethylcellulose sodium eye drops (CMC group), and recombinant human epidermal growth factor eye drops (rEGF group). Short-form McGill pain questionnaire, slit lamp and corneal fluorescein sodium staining, non-contact intraocular pressure, uncorrected visual acuity (UCVA) and best corrected visual acquity (BCVA) as well as redness score of bulbar conjunctiva were performed before surgery (d0) and on day 1 (d1), day 2 (d2), day 3 (d3), day 7 (d7) and day 14 (d14) after surgery. Results: One hundred and fourteen patients including 43 males and 71 females, aged (48.9±12.5) years, were eventually included in this study. The McGill scores gradually decreased after surgery in all groups. On d2, the McGill score in DCBE group, control group, CMC group and rEGF group was (1.42±0.67), (2.21±0.88), (1.93±1.08) and (1.77±1.18), respectively; On d3, the score was (1.32±0.54), (1.93±0.72), (1.79±0.87) and (1.52±0.77), respectively. On d2 and d3, statistical difference was recorded among groups (d2, F=3.43, P=0.019; d3, F=4.047, P=0.009), and the McGill score of DCBE group was significantly lower than that of CMC group (d2, P=0.047, d3, P=0.017). On d2, the percentage of corneal epithelium defect in DCBE group, control group, CMC group and rEGF group was 8.6%±1.9%, 11.7%±1.7%, 11.5%±1.9% and 10.4%±1.8%, respectively; On d3, the percentage was 4.5%±2.2%, 9.2%±2.4%, 7.4%±2.5% and 5.9%±2.3%, respectively. On d2 and d3, statistical difference of corneal epithelium defect percentage was recorded among groups (d2, F=17.17, P<0.001; d3, F=21.4, P<0.001). On d2, the percentage of corneal epithelium defect in DCBE group was significantly lower than the other three groups (P<0.01); On d3, the percentage of corneal epithelium defect in DCBE group was significantly lower than control group and CMC group (P<0.001), while no difference was found between DCBE group and rEGF group (P>0.05). However, no statistical differences were recorded in the number of patients with vision improvement among the groups (P>0.05). The intraocular pressure remained stable. No differences in the conjunctival redness score were found among the groups after surgery (P>0.05). Conclusion: Our data demonstrated the efficacy of deproteinized calf blood extract eye drops on the postoperative management in patients with primary patients, with faster pain relief and promoted epithelium recovery. (Chin J Ophthalmol, 2019, 55:134-140).

Clinical observation of pterygium excision combined with conjunctival autograft for the treatment of pterygium

Objective To observe the therapeutic effect of pterygium excision combined with autologous conjunctival transplantation in the treatment of pterygium. Methods The medical records of 95 eyes of 80 cases with pterygium in our hospital from February 2011 to January 2012 were analyzed.The patients were divided into two groups randomly.The observation group had 47 eyes of 40 cases and the control group had 48 eyes of 40 cases.The pterygium had been resected under a microscope.The patients of the observe group had been transplanted with autologous limbal conjunctiva on the the pterygium excised area.All patients had been followed-up for 3 years after surgery. Results 86 eyes of 71 cases (90.53%) of pterygium were fully cured with normal wound healing and transparent corneal epithelia. Only 9 cases (9.47%) had recurrenced, in which 1 case from the observation group and 8 cases from the control group. The recurred cases returned to normal after the secondary operation. Conclusion Pterygium excision with conjunctival autograft transplantation promotes the rapid recovery of ocular surface structure and function, and it has important significance to reduce the recurrent rate. Key words: Pterygium; Transplantation, conjunctival, limbal

翼状胬肉术后患者应用角膜绷带镜的护理体会

目的：探讨和评价翼状胬肉切除联合自体结膜移植术后患者应用角膜绷带镜、改善舒适度的护理方法。方法：选取64例翼状胬肉患者的64只患眼，胬肉侵入角巩膜缘内 ≥2 mm，均接受翼状胬肉切除联合自体结膜移植术，随机分为2组，每组32眼。A组术毕即刻佩戴博士伦纯视角膜绷带镜，B组为对照组，不佩戴绷带镜，两组均术后包扎1日后打开用药。术后用药两组相同。术后患者对不适症状(疼痛、异物感、畏光、流泪)进行自测评分。医生(非术者)对于角膜创面完全愈合情况天数进行对比。结果：A组术后不适症状评分均低于B组，差异均具有统计学意义(P < 0.01)。A组角膜创面上皮全部愈合时间为3.6 ± 0.7天，B组角膜创面上皮全部愈合时间为5.8 ± 0.8天，差距具有统计学意义(P < 0.01)。A组患者佩戴角膜绷带镜期间未发现不良反应。结论：角膜绷带镜对于翼状胬肉术后患者可显著缓解术后不适症状，促进角膜创面愈合。 Objective: To explore and evaluate the nursing methods of using corneal bandage lens for patients, whose pterygiums were excised and combined with autogenous conjunctival transplantation. Method: 64 eyes with pterygium of 64 patients were selected. The pterygium invaded corneoscleral limbus more than or equal to 2 mm. These patients underwent pterygium excision combined with autologous conjunctival transplantation and then were divided into 2 groups; each group consisted of 32 eyes. Group A worn Bausch & Lomb pure optic corneal bandage lens immediately after surgery; Group B, as control group, didn’t wear a bandage contact lens. The two groups were bandaged for 1 month after surgery, and began to use medicine after removing the bandage. The two groups used the same medicine. The patients gave a score for the postoperative symptoms (pain, foreign body sensation, photophobia, tears). The days to complete healing of the corneal wound were compared by doctors (not the surgeons). Result: The postoperative discomfort symptom scores of group A were lower than those of group B, and the difference was statistically significant (P < 0.01). In group A, the corneal wound healing time was 3.6 ± 0.7 days, while the time in group B was 5.8 ± 0.8 days. The difference was statistically significant (P < 0.01). No adverse reactions were found in patients of group A who were wearing bandage lenses. Conclusion: Bandage contact lens for patients after pterygium surgery can significantly relieve postoperative discomfort and promote corneal wound healing.

Safety profile and complications of autologous limbal conjunctival transplantation for primary pterygium

PurposePrimary pterygium is a fibrovascular proliferation over the nasal cornea, probably resulting from the limbal stem cell deficiency. Intraoperative mitomycin-C application seems to associate with reduced recurrences, however produced ocular surface problems and vision threatening complications. The present clinical study investigated the safety profile of autologous limbal conjunctival transplantation in terms of recurrence rate, as the main outcome measure and complications as the secondary outcome. MethodsThe present study was randomised, interventional and prospective clinical study conducted from a tertiary Hospital. Pterygium excision was performed with limbal conjunctival autograft availed from the affected eye. Secondary pterygia resulting from inflammation, trauma and other diseases were excluded. Patients were followed up for 18months for recurrence and other complications. Microsoft Office Excel 2007 was used for statistical analysis. ResultsA total of 71 eyes of sixty-eight patients with primary pterygia included between November 2007 and October 2010. The study recruited 35 (51%) males and 33 (49%) females with mean age of 36.9 with ±12.82years standard deviation (mean, SD) ranging from 19 to 75years. Age grouped by range intervals categorised into six groups. Pterygium was diagnosed in 32 (45%) right eyes and 39 (55%) left eyes. There were 65 (91.55%) nasal and 4 (5.63%) temporal pterygium and no case of double head pterygia found. Average horizontal extension of the pterygium measured was 1.67mm (±4.23) from the apex to the corneal limbus. Graft oedema in 1 (0.71%) patient, graft bleed in 2 (1.42%) cases and 1 (0.72%) case of granuloma observed. No recurrences encountered during 18months follow up. ConclusionsPterygium occurred predominantly in the younger population group 36.9mm (±12.82) probably due to the increased outdoor activity with high exposure to sunlight and dusty atmosphere. Absence of recurrences was probably attributable to the smaller pterygium size of 1.67mm (±4.23), use of the autologous limbal conjunctival graft and treatable intra and post operative complications successfully.

Autologous conjunctival epithelium transplantation and scleral patch graft for postlensectomy wound leakage in Marfan syndrome

We report a case of woman with Marfan syndrome and longstanding postlensectomy scleral wound dehiscence. A 34-year-old woman with Marfan syndrome who underwent lensectomy 20 years ago had conjunctival leakage with chronic hypotony and conjunctival cystic degeneration secondary to scleral wound dehiscence. Presentation, clinical evaluation, and particular treatment with autologous cultivated conjunctival epithelium transplantation and scleral patch graft are described. A 6-month follow-up confirmed complete epithelization of the ocular surface and absence of leaking from the wound with normal intraocular pressure. Transplantation of autologous cultivated conjunctival epithelium appears to be a valid strategy in the treatment of ocular disease requiring extensive excision of the conjunctiva.

Research progress in angiogenesis mechanism and management of pterygium

Pterygium is a common ocular surface disorder,which causes lowing of vision even blindness once invading into cornea.The pathogenesis of pterygium is still incompletely clear.Recently studies showed that the interaction of a lot of factors lead to the proliferation of pterygium,and angiogenesis may play an important role in the formation and progression of pterygium.The therapies of pterygium focus on surgical resection with autologous conjunctival transplantation,amniontransplantation or transplantation of limbal stem cells,but a high recurrence rate of pterygium is worth studying.The angiogenesis of pterygium is a key problem.This article summarized the research outcomes in regulation and treatment about angionesis in pterygium. Key words: Pterygium; Angiogenesis; Regulation; Treatment

Management of severe ocular burns with symblepharon

To evaluate the effect of lamellar keratoplasty combined with limbal stem cells, using amniotic membrane, autologous conjunctiva, and pseudopterygium to reconstruct external eyes for severe ocular burns with symblepharon. Thirty eyes of 29 patients had severe symblephara resulting from eye burns. According to the range of the symblepharon and the loss of limbal stem cells, partial lamellar keratoplasty combined with partial limbal stem cell treatment was performed in 19 eyes, and total lamellar keratoplasty with total limbus was performed in 11 eyes. All patients had amniotic membrane and autologous conjunctival transplantation, and the pseudopterygium was preserved to reconstruct the fornix. Symblephara were completely relieved in 19 eyes. They remained partially in ten eyes in strip-like form, but seven of these were completely relieved after further autologous conjunctival transplantation. One eye was treated with tarsorrhaphy for eyelid malformation. The remaining pseudopterygium became thinner after the operation and showed no symblepharon. Immune rejection occurred in eight corneal grafts; clarity was restored in four of these, while there was graft neovascularization in the remaining four. Depending on the area of symblepharon and the loss of limbal stem cells, partial or total lamellar keratoplasty combined with limbal stem cells, using amniotic membrane, autologous conjunctiva and pseudopterygium to reconstruct external eyes appears to be effective in treating severe ocular burns with symblepharon. Pseudopterygium can partly substitute autologous conjunctiva in ocular surface reconstruction.

Autologous Cultivated Conjunctival Transplantation for Recurrent Viral Papillomata

To describe the use of an autologous serum-free derived cultivated conjunctival epithelial equivalent in the treatment of extensive recurrent viral papillomata. Interventional case report. A 10-year-old child with extensive recurrent viral papillomata involving the superior and inferior tarsal, forniceal, and bulbar conjunctiva underwent surgical excision of all diseased areas and double freeze-thaw cryotherapy. Autologous serum-free cultivated conjunctival equivalents were used to reconstruct the ocular surface and conjunctival fornices. Almost complete epithelialization was achieved within 5 days postoperatively. A good cosmetic and functional result was obtained, and no recurrences or cicatricial complications developed during 12-month follow-up. Transplantation of autologous cultivated conjunctiva was effectively used in the reconstruction of the ocular surface after extensive excision of recurrent viral papillomata. This modality of treatment may be useful in the treatment of ocular surface disorders in which extensive conjunctival and fornix reconstruction is required.

Autologous cultivated conjunctival transplantation for pterygium surgery

To investigate the safety and efficacy of autologous cultivated conjunctival transplantation for the treatment of primary pterygium. Prospective nonrandomized clinical trial. Forty patients with primary pterygium were recruited. Excision of the pterygium was followed by reconstruction using a serum-free derived autologous cultivated conjunctival equivalent in 22 patients (group A) and conventional denuded amniotic membrane transplantation in 18 patients (group B). In group A patients, conjunctival epithelial equivalents were constructed by the ex vivo expansion of conjunctival epithelial cells on human amniotic membranes (HAM). The main outcome measures were conjunctival epithelialization, recurrence, survival analysis, and incidence of complications. The mean follow-up was 14.1 +/- 3.9 months (range, 12 to 25 months). Complete epithelialization was achieved within five days after surgery in group A patients compared with approximately three weeks for group B patients. The proportion of patients that had true recurrences was 22.7% in group A and 25.0% in group B. The mean time to recurrence was 4.8 +/- 1.6 months in group A and 5.0 +/- 2.9 months in group B. No ocular complications were noted in group A, while one eye (6.0%) in group B developed scleral necrosis associated with a persistent epithelial defect. Transplantation of an autologous cultivated conjunctival epithelial sheet facilitated early postoperative epithelialization and recovery, and may aid in preventing serious complications associated with simple denuded HAM transplantation, such as scleral necrosis and secondary infection. This may provide a novel method for conjunctival epithelial replacement in the treatment of ocular surface disorders.

Treatment of Contact Lens-related Ocular Surface Disorders with Autologous Conjunctival Transplantation

The authors describe two cases of chronic ocular surface disorder caused by the use of soft contact lenses. These cases demonstrated persistent corneal epithelial abnormalities, indolent ulceration, superficial stromal scarring, peripheral vascularization, and decreased visual acuity (worse than 20/400). Both cases were refractory to medical management, including discontinuation of contact lenses and topical medications. Autologous conjunctival transplantation restored the ocular surface with the return of good visual acuity (better than 20/40). Tissue culture demonstrated a decreased replication rate in the limbal epithelial cells, which suggests that epithelial stem cell dysfunction may be responsible for this ocular surface disease.

Conjunctival Transplantation

Autologous conjunctival transplants have been used successfully for restoration of damaged ocular surfaces. Homologous (allogeneic) conjunctival grafts have been explored less systematically. We developed a nonhuman primate model for comparison of autologous and homologous conjunctival transplantation in order to assess the clinical viability and immunopathologic characteristics of these grafts. Autologous or homologous grafts were performed in nine adult rhesus monkeys. Both autologous and homologous grafts were compared for clinical viability and immunopathologic change. Clinical results suggest that, although homologous grafts incited a greater inflammatory and scarring response, there was minimal graft shrinkage and a normal surface epithelium. Immunopathologic studies using laminin, bullous pemphigoid antigen, and fibronectin indicate that, despite the increased inflammatory response seen in homografts, the epithelial surface is normal. With our increasing ability to modulate the immune response, conjunctival homografts may play a role in restoration of the ocular surface.

Conjunctival Autograft Transplantation for Unilateral Ocular Surface Diseases

Rehabilitation of the diseased ocular surface by autologous conjunctival transplantation as first described by Thoft has expanded the possibilities for eventual visual restoration of patients with severe ocular surface disease. This paper will introduce a new surgical technique for diseased ocular surface preparation and for the acquisition, transfer, and placement of a 360° ring of autologous conjunctiva in patients with unilateral surface pathology. Patients representing different unilateral surface diseases with up to 2 years follow-up are presented and discussed. Key words

Reconstruction of the Periocular Mucous Membrane by Autologous Conjunctival Transplantation

We have extended the concept of autologous conjunctival transplantation for corneal resurfacing as recommended by Thoft1 to reconstruction in 14 patients with unilateral abnormalities of the bulbar and palpebral conjunctiva caused by alkali burns (2), irradiation (2), neoplasms (3), degenerative diseases (5), trauma (1). and developmental anomalies (1). Large, free conjunctival grafts from bulbar and forniceal donor sites were used. No complications have been noted at the recipient or donor sites. Grafts of normal conjunctiva provided intact basement membrane, goblet cells, and epithelium that help restore normal ocular and lid surfaces. The use of free conjunctival grafts provides significant advantage over the use of buccal mucous membrane grafts. The techniques and results of our experience with free conjunctival grafts in 14 patients are discussed.