Conjunctival Epithelial Defects Research Articles

Customized Scleral Lenses: An Alternative Tool for Severe Dry Eye Disease—A Case Series

Purpose: Dry eye disease (DED) is a multifactorial condition significantly impacting patients’ quality of life (QoL). This study aims to present a case series highlighting the effectiveness of customized scleral lenses in managing severe DED and improving patient outcomes. Methods: This case series includes three patients with severe DED refractory to conventional treatments. Customized scleral lenses were fitted for each patient, and clinical outcomes were evaluated over a period of two months. Assessments included best-corrected visual acuity (BCVA), slit-lamp examination findings, and corneal National Eye Institute (NEI) scores. Results: All three patients demonstrated significant improvements in BCVA, reductions in ocular symptoms, and enhanced ocular surface health. Patient 1, with secondary Sjögren’s syndrome and suspected mucous membrane pemphigoid, showed resolution of conjunctival hyperemia and epithelial defects. Patient 2, with graft versus host disease, exhibited resolution of punctate keratitis and the absence of thread mucus. Patient 3, post-oncologic surgery, achieved complete resolution of keratoconjunctivitis sicca and the restoration of vision. Conclusions: Customized scleral lenses are a useful therapeutic option for severe DED, providing significant symptomatic relief and enhancing patients’ quality of life. Their use should be considered in refractory cases to optimize ocular surface health and visual outcomes.

Mycobacterium abscessus Corneal Ulcer with Conjunctival Toxicity due to Topical Amikacin

Purpose: This report presents a case of repeated toxic conjunctival necrosis caused by amikacin eye drops in a patient with a corneal ulcer induced by Mycobacterium abscessus (M. abscessus).Case summary: During treatment for herpetic keratitis with complaints of conjunctival hyperemia and eye pain in the right eye for 1 month. Slit-lamp microscopy revealed a circular corneal epithelial defect and stromal infiltration of her right eye. Gram staining and culture were performed, and eye drops were prescribed for empirical treatment. The bacterial culture grew M. abscessus. Antibiotic susceptibility tests showed resistance to quinolone. The patient was prescribed amikacin eye drops and the corneal epithelial defects improved. Two weeks later, circular conjunctival epithelial defects and hyperemia were observed on the inferior conjunctiva. Conjunctival necrosis caused by amikacin was suspected. The amikacin eye drops were discontinued and the conjunctival lesion improved. However, the patient’s corneal ulcer recurred. The amikacin eye drops were restarted, but conjunctival toxicity recurred, so she was treated with topical clarithromycin and moxifloxacin. The eye drops were gradually reduced and the lesion healed leaving mild corneal opacity.Conclusions: M. abscessus-induced keratitis resistant to quinolone antibiotics requires long-term combined therapy with multiple drugs. Amikacin eye drops should be used carefully as conjunctival toxicity may occur.

Personalized 3D-printed amniotic fornical ring for ocular surface reconstruction.

In the present work, we used three-dimensional (3D) printing technology to make a polylactic acid (PLA) amniotic fornical ring (AFR) for ocular surface reconstruction. This work is a retrospective and interventional case series of patients with ocular surface diseases who underwent either personalized 3D-printed AFR-assisted amniotic membrane transplantation (AMT) or sutured AMT (SAMT). Patient epidemiology, treatment, operative duration, epithelial healing time, retention time, vision changes, morbidity, and costs were analyzed. Thirty-one patients (40 eyes) and 19 patients (22 eyes) were enrolled in the 3D-printed AFR group and the SAMT group, respectively. The clinical indications of AFR and SAMT were similar, such as corneal and/or conjunctival epithelial defects due to chemical burns, thermal burns, Stevens-Johnson syndrome (SJS), or toxic epidermal necrolysis (TEN). The mean dissolution time was 15 ± 11 days in the AFR group, compared with 14 ± 7 days in the SAMT group. The percentage of healed corneal area was 90.91% (66.10%-100.00%) for AFR and 93.67% (60.23%-100.00%) for SAMT. The median time for corneal epithelial healing was 14 (7-75) days in the AFR group and 30 (14-55) days in the suture AMT group. There were no significant differences in the initial visual acuity, final visual acuity, or improvement in visual acuity between the two groups. The operation duration in the AFR group was significantly shorter than that in the SAMT group. Regarding the cost analysis, the average cost per eye in the AFR group was significantly lower than that in the SAMT group. Furthermore, 3D-printed and sterile AFR showed no obvious side effects on the eyes. Our results suggested that 3D-printed PLA scaffolds could be used as an AFR device for ocular surface disease. In addition, personalized 3D-printed AFR is superior to conventional AMT in operation duration and cost effectiveness, thereby reducing the financial burden on our health care system.

Subacute mycobacterial endophthalmitis after glaucoma valve surgery

A 73-year-old woman with primary open angle glaucoma presented due to irritation and decreased vision 1 month after Ahmed glaucoma valve revision surgery for tube exposure. Her tube had been initially implanted six years prior to the revision, for which a new cornea patch graft was placed with conjunctival advancement. There was 2+ conjunctival injection, a conjunctival epithelial defect overlying a corneal patch graft but no recurrent tube exposure, 1+ anterior chamber cell, a fluffy white lesion adjacent to the tube base, and trace anterior vitreous cell (Figure 1).

Ophthalmic findings of Mycoplasma-induced rash and mucositis (MIRM) distinct from Stevens-Johnson syndrome

To identify ophthalmic manifestations of Mycoplasma-induced rash and mucositis (MIRM). The medical records of patients with MIRM treated by the inpatient ophthalmology consult service at a single institution over a period of 4 years were reviewed retrospectively. Eye and skin findings, treatment, hospital course, and follow-up findings were documented and reviewed. MIRM was identified in 10 patients, 10-20 years of age (mean, 13.) All presented with oral mucosal findings and a prodrome. On initial examination, conjunctival epithelial defects were present in 2 patients; pseudomembranes, in 3. Five patients experienced progressive ophthalmic manifestations during hospitalization, including a new cornea epithelial defect in 1 patient and a new conjunctival epithelial defect in 3 patients. All were treated with topical steroids and antibiotics. Post-discharge follow-up obtained for 7 patients documented good visual outcomes and lack of significant ocular sequelae without requiring invasive intervention. MIRM, previously referred to as mycoplasma-associated Stevens-Johnson syndrome (SJS) among other names, is now understood to be distinct from SJS in the dermatology community. Our MIRM patients present with mild eye findings and required no surgery, similar to the mild course published in the dermatology literature. Patients with MIRM may have a more benign course than those with SJS.

Anterior Segment Optical Coherence Tomographic Angiography Assessment of Acute Chemical Injury

To compare routine clinical examination with optical coherence tomography angiography (OCTA) for the assessment of limbal conjunctival ischemia following a chemical burn. Validity analysis. We assessed 10 participants (15 eyes) with an acute chemical injury. Clinical photographs were used to determine the extent of any limbal conjunctival epithelial defect and ischemia. These were compared with the extent of limbal ischemia identified on OCTA images of the ocular surface. Quantitative and longitudinal analysis using the OCTA software were also performed. Correlations with visual outcome were sought using clinical and OCTA-derived variables. The extent of clinically determined limbal ischemia was less than that identified with OCTA (2.3±3.6 clock hours vs 5.1±4.2 clock hours, P= .003), which in turn was less than the size of limbal conjunctival epithelial defect (7.3±5.1 clock hours, P= .03). Longitudinal OCTA analysis showed that mean vessel area increased by 0.2%±0.1% during the study, corresponding to a rate of vascular recovery of 0.9mm2/d. Significant correlations were found between visual outcome at 3months and limbal conjunctival fluorescein staining (r= 0.67, P= .006), and limbal conjunctival ischemia on OCTA (r= 0.76, P= .001). OCTA can objectively identify and monitor the recovery of limbal ischemia following an acute ocular chemical injury. OCTA confirms that limbal ischemia is usually more extensive than is suggested by clinical examination, and the former is highly correlated with visual outcome. OCTA therefore is a useful tool in the management of ocular chemical injury.

3316 Mycoplasma Induced Rash and Mucositis: How Affected Are the Eyes?

OBJECTIVES/SPECIFIC AIMS: To demonstrate the prevalence of ocular complications in patients suffering with Mycoplasma Induced Rash and Mucositis (MIRM). METHODS/STUDY POPULATION: In this retrospective observational study, we identified all patients in our hospital database who were diagnosed with MIRM. Diagnosis was confirmed by clinical information and positive Mycoplasma pneumoniae serology. Only patients with available records with formal ophthalmology consults were included. Clinical and laboratory data were collected from our electronic medical record system to capture key components of their clinical course. RESULTS/ANTICIPATED RESULTS: A total of 12 patients satisfied all inclusion and exclusion criteria and were included in our study. The average age of our included patients was 21.2 ± 14.7 years, and the majority were male vs. female (66.7% vs. 33.3%). In all 24 eyes, the only acute ocular findings included conjunctival hyperemia (n=20, 83.3%), meibomitis (n=4, 16.7%), and conjunctival epithelial defects (n=1, 4.2%). None of the patients required or were recommended to receive an amniotic membrane transplantation in the acute phase. Only 2 patients were followed in the chronic phase, one of whom showed evidence of meibomitis in both eyes. Otherwise, no other chronic complications were seen in either patient with chronic follow-up. DISCUSSION/SIGNIFICANCE OF IMPACT: Ocular complications from MIRM may be much milder in comparison to ocular complications found in other bullous and inflammatory conditions such as Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis. Understanding MIRM’s specific sequelae is important in understanding disease manifestation and prognosis in order to better inform acute and chronic management.

Predictive Factors Associated With Acute Ocular Involvement in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

To suggest an objective score for grading the acute ocular severity of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), and to determine predictive factors for severe acute ocular involvement such as ocular surface epithelial defect and/or pseudomembrane formation. Retrospective cohort study. The medical records of SJS (n = 87) and TEN (n = 48) patients between 2005 and 2007 were reviewed. An acute ocular severity score was determined on a scale from 0 to 3 (none, mild, severe, and very severe) according to the existence of hyperemia, corneal or conjunctival epithelial defect, and pseudomembrane formation. The associations between the severe acute ocular involvement and factors such as patient age, exposed drugs, systemic severity, and the prevalence of ocular sequelae were examined. The number of cases with score grade 0, 1, 2, and 3 was 19 (21.8%), 31 (35.6%), 22 (25.3%), and 15 (17.2%) in 87 SJS cases and 12 (25.0%), 11 (22.9%), 17 (35.4%), and 8 (16.7%) in 48 TEN cases. Multivariate logistic regression analysis revealed that patient age (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96-0.99; P = .007) and nonsteroidal anti-inflammatory drugs NSAIDs or cold remedies (OR, 2.58; 95% CI, 1.26-5.29; P = .010) were predictive factors for severe acute ocular involvement. The prevalence of visual disturbance and eye dryness increased according to the increase of acute ocular severity (P = .001 and P = .007 in SJS; P = .007 and P = .014 in TEN, respectively). At the onset of SJS/TEN, strict attention should be paid to ocular involvement in young patients and in patients exposed to NSAIDs or cold remedies.

Evaluation of tularemia cases focusing on the oculoglandular form.

Tularemia is a zoonotic disease caused by Francisella tularensis. The oculoglandular form is one of the rarest forms. In this study, evaluated tularemia patients, focusing on the ocular form and the efficacy of early antibiotic therapy. During a tularemia outbreak, the epidemiological and clinical findings, laboratory assays, and drugs used for the treatment of 48 patients were recorded prospectively. The diagnosis of tularemia was confirmed with microagglutination test (MAT) as well as clinical findings. The mean age of the subject was 48.6 years; 23 (47.9%) of them were female. Thirty-six (81.25%) patients had clinical presentation compatible with oropharyngeal tularemia, seven (14.58%) with oculoglandular tularemia, and two (4.1%) with ulceroglandular tularemia. The most common symptoms were fever (91.6%) and sore throat (81.2%), and the most common findings were lymphadenopathy (91.6%) and tonsillopharyngitis (81.2%). In the oculoglandular form, fever, lymphadenopathy, periorbital edema, conjunctival injection, and chemosis were found. The most distinctive ophthalmic feature was follicular conjunctivitis and conjunctival epithelial defects. Forty-five cases had positive serological results with MAT. All the patients were treated with antibiotics considered effective against F. tularensis, and topical antimicrobial treatment was given to the patients with oculoglandular tularemia. Twenty-six (54.16%) patients, who were admitted within three weeks of the onset of symptoms, recovered without sequel. During tularemia outbreaks, ocular involvement should be considered carefully. The early administration of appropriate treatment will be more effective in resolving the infection and preventing complications. Along with systemic antibiotic therapy, topical treatment will help recovery.

Complications Related to a Cosmetic Eye-Whitening Procedure

To report sight-threatening complications following extensive bulbar conjunctival resection and postoperative mitomycin C therapy for cosmetic eye-whitening in the United States. Retrospective noncomparative case series. Multicenter report of 9 patients referred for evaluation and management of complications following bilateral cosmetic eye whitening. Seventeen eyes of 9 patients underwent cosmetic eye-whitening performed between 2 and 48 months prior to referral to one of the centers. Sixteen of the 17 eyes had persistent conjunctival epithelial defects, with 10 eyes requiring amniotic membrane grafting to facilitate re-epithelialization. Four eyes of 2 patients developed limbal stem cell compromise confirmed with in vivo confocal laser scanning microscopy. One patient developed infectious scleritis and diplopia resulting from Tenon capsule scarring. Another patient developed scleral necrosis, secondary infectious scleritis, and infectious endophthalmitis. This patient subsequently developed noninfectious scleritis that required 3-drug-regimen immunosuppression. Severe adverse effects can occur after extensive cosmetic conjunctival resection followed by topical mitomycin C application. Patients and physicians should be aware of the potential sight-threatening complications associated with this eye-whitening procedure.

The use of autologous fibrin as a scaffold for cultivating autologous conjunctiva in the treatment of conjunctival defect

The purpose of this study was to compare the use of autologous fibrin to human amniotic membrane (HAM) as a scaffold in cultivating autologous conjunctiva for transplantation in treatment of conjunctival defect. An experimental study was performed using 18 adult New Zealand white strain rabbits which were divided into 3 groups. Each group consists of 6 rabbits. The conjunctiva on the temporal site was excised to create a conjunctival epithelial defect. The excised area in the Group 1 was transplanted with autologous conjunctiva cultivated on autologous fibrin; Group 2 was transplanted with autologous conjunctiva cultivated on HAM and Group 3 was left bare. The rabbits were followed up at regular intervals until 6weeks. The mean period of complete conjunctival epithelization was 11.50±8.22days for the autologous fibrin group, 15.33±11.80days for the HAM group and 25.33±5.32days in the bare sclera group. The epithelization rate for the autologous fibrin group was faster compared to the other two groups. However all the results were not statistically significant (p value >0.05). There were no postoperative complications noted during the follow up. Autologous fibrin is comparable to HAM as a scaffold for cultivation of conjunctiva in the treatment of conjunctival defect.

Suppression of avascular bleb formation by a thin biodegradable film in a rabbit filtration surgery with mitomycin C

Avascularity of the bleb is regarded as a risk of bleb infection, which is the most serious complication after filtration surgery with mitomycin C (MMC). There is no perfect way to prevent avascular bleb formation. We hypothesized that keeping the conjunctiva away from direct exposure to aqueous filtration may suppress avascular bleb formation after filtration surgery with MMC. In order to prove our hypothesis, we investigated whether a thin biodegradable, honeycomb-patterned film (HPF) can reduce bleb avascularity in a rabbit model of filtration surgery with mitomycin C (MMC). A fornix-based full-thickness filtration surgery was performed in one eye of each of five rabbits (control group). The same surgery with intraoperative MMC treatment was done in both eyes of six rabbits, with one eye receiving a 14-μm-thick HPF made from poly(L-lactide-co-ε-caprolactone), which was placed subconjunctivally over the filtration site with the honeycomb surface facing up. Intraocular pressure (IOP) measurements, bleb evaluations using ultrasound biomicroscopy (UBM), and in vivo confocal microscopy (IVCM) were performed periodically for 4weeks postoperatively followed by histological examination. The postoperative IOP decrease and bleb survival were significantly greater in MMC-treated eyes than in control eyes, and were similar between MMC-only and MMC + HPF eyes. The avascular area in the bleb persisted for 4weeks in MMC-only eyes. Postoperative IVCM showed morphological changes of the conjunctival epithelial cells (i.e., enlarged and variable in size and shape) and epithelial defects in MMC-only eyes, and significantly lower density of connective tissue and vascularity in the subepithelial space in MMC-only eyes compared to the control eyes. These IVCM findings agreed with those by UBM and histology. Bleb avascularity shown by clinical bleb appearance, IVCM and histology, conjunctival epithelial damage shown by IVCM and histology, and loose subepithelial connective tissue shown by UBM, IVCM, and histology were all reduced in MMC + HPF eyes compared to MMC-only eyes. IVCM successfully showed the characteristic conjunctival damage in MMC-treated blebs. The concomitant use of a thin biodegradable HPF reduced avascularity and conjunctival damage in blebs, without compromising filtration in rabbits following filtration surgery with MMC.

Safety Evaluation of Nanoliposomes Containing Cyclosporine A After Ocular Administration

Aim: Cyclosporine A (CyA) is an anti inflammatory drug which modulates immune system. We prepared two liposomal formulations of CyA for ophthalmic administration. In the present study, the safety of these formulations was tested in rabbits.Materials and methods: Fusogenic and positively charged liposomes were prepared by solvent evaporation method. CyA concentration in ophthalmic preparations was 0.2% w/v. Twenty New Zealand albino rabbits (40 eyes) were divided into two groups. Right eyes were treated and left eyes served as control. Eyes were examined clinically in 1, 3, 7, 14 and 28th days of the study. Eleven eyes were enucleated for pathological evaluation at the end of the study.Results: Mean size and charge of positively charged and fusogenic liposomes were 110.7 ± 1.5 and 114.9 ± 15.2 nm; 19.0 ± 2.2 and 2.5 ± 0.5 mV, respectively. Clinically, there were transient conjunctival injections and corneal epithelial defects in a few cases which were not limited to the treated eyes. Positively charged liposomes caused conjunctival injection in two cases, while this complication occurred in only one eye after administration of fusogenic liposomes. Histopathological examination revealed the presence of follicular conjunctivitis in two eyes with conjunctival injection. Inflammation in cases received the fusogenic form of the drug was mild and non-specific.Conclusions: The results of this study suggest that fusogenic liposomal preparation of CyA is safe and can be useful for future studies.

Complications of Cosmetic Wide Conjunctivectomy Combined With Postsurgical Mitomycin C Application

To raise awareness among clinicians about the risk of severe complications after cosmetic conjunctivectomy plus postsurgical topical mitomycin C (MMC) treatment. We retrospectively reviewed the medical records of 48 consecutive patients who received cosmetic wide conjunctivectomy plus postsurgical topical MMC treatment to eliminate conjunctival injection and visited our outpatient clinic between January 2009 and January 2011. Forty-four patients (91.67%) developed complications after cosmetic wide conjunctivectomy plus postsurgical topical MMC treatment. Complications included chronic conjunctival epithelial defects (22 patients), scleral thinning with (19 patients) or without (2 patients) calcified plaques, fibrovascular conjunctival adhesion at the muscle insertion site (15 patients), chronic dysfunctional tear syndrome (11 patients), avascular zones (10 patients), abnormal vessel growth (5 patients), lymphangiectasis (3 patients), adhesions of Tenon capsule and the conjunctiva at the extraocular muscle insertion site (1 patient), extraocular muscle fiber exposure (1 patient), and diplopia (9 patients). The mean time between surgery and the onset of diplopia was 1.67 months (range, 1-3 months), and the mean deviation was 11.0 prism diopters (range, 0-25 prism diopters) in the primary position. Three patients underwent strabismus surgery due to incomitant esotropia. Eight patients underwent calcified plaque removal because of severe progression of the calcification. Five patients underwent conjunctival flap operation because of severe progressive scleral thinning. Cosmetic wide conjunctivectomy, which has been advertised as a simple and effective surgical option for the treatment of conjunctival injection, has caused disruption in the normal physiology of the ocular surface, which leads to various devastating complications.

Severe ocular injury and its management following self induced plant extracts: A case report

IntroductionHomemade and folk remedies’ use is widely practiced in under developed countries, of the used materials are plant extracts, lemon juice and some dried insect bodies. Case presentationWe report a case of severe ocular injury and its management after self administered plants seeds in both the eyes of a 47-year-old man who had bilateral severe ocular damage after he put the seeds of a plant Lepidium Sativum (Rashad) in his eyes. He reported severe ocular pain and redness, conjunctival epithelial defect and symblepharon. A conjunctival biopsy was taken which turned out to be negative for the immunological staining studies for Ocular Cicatricial Pemphegoid (OCP). The patient’s visual acuity improved from 20/40 before treatment to 20/25 after treatment with no further sequelae after 3months follow-up. ConclusionsSelf induced plant extracts can cause ocular complications. Public awareness is necessary to help in discouraging the use of these harmful plant extracts in human eyes.

A Case of Alkali Burn Treated With Amniotic Membrane Graft and Forniceal Reconstruction

Purpose: To report a case of alkali burn treated successfully with early surgical intervention including amniotic membrane graft and forniceal reconstructionand the restored visual acuity. Case summary: A 23-year-old woman was referred for alkali burn of her right eye after being splashed with a drop of 40% sodium hydroxide. Slit-lamp microscopic examination showed the patient's cornea was edematous, and hazy and limbal ischemia involved half of the cornea, which can supposedly lead to eyelid deformity and symblepharon. Debridement of all necrotic tissues, immediate amniotic membrane permanent graft and transient forniceal covering with amniotic membrane were conducted a day after the burn. Corneal and conjunctival epithelial defects were completely healed in five weeks, and visual acuity was restored to 20/20 in eight weeks. Additional surgeries for allogenic limbal transplantation and autologous oral mucosal graft were performed to resolve symblepharon.

Successful Treatment of Stevens-Johnson Syndrome with Steroid Pulse Therapy at Disease Onset

To evaluate the visual prognosis of patients with Stevens-Johnson syndrome (SJS) and its severe variant, toxic epidermal necrolysis (TEN), followed by general and topical high-dose corticosteroids administration from disease onset. Prospective, observational case series. Between May 1, 2003 and June 30, 2005, we enrolled 5 patients with SJS or TEN with ocular complications at the acute stage. Intravenous pulse therapy with methylprednisolone (steroid pulse therapy; 500 or 1000 mg/day for 3 to 4 days) was initiated within 4 days from disease onset. Topically, 0.1% betamethasone was applied over 5 times daily for at least 2 weeks. Visual acuity (VA) and slit-lamp microscopic appearance 1 year from disease onset were evaluated. At the first examination, corneal or conjunctival epithelial defects and pseudomembranous conjunctivitis were present in all cases. Skin eruptions dramatically improved after steroid pulse therapy. Although ocular inflammation increased for several days, pseudomembranes disappeared and corneal and conjunctival epithelium regenerated within 6 weeks. At the chronic stage, all eyes had clear corneas with the palisades of Vogt (POV), implying the presence of corneal epithelial stem cells. Best-corrected VA was 20/20 or better in all eyes. Five eyes showed superficial punctate keratopathy. No eye had cicatricial changes except for 1 with slight fornix shortening. No significant adverse effects of steroid occurred during all clinical courses. Steroid pulse therapy at disease onset is of great therapeutic importance in preventing ocular complications. Topical betamethasone also shows great promise for preventing corneal epithelial stem cell loss in the limbal region and cicatricial changes.

Secondary Glaucoma and Sclerokeratitis After Cosmetic Eye Whitening by Regional Conjunctivectomy with Mitomycin C Application

Purpose: To report a case of secondary glaucoma and sclerokeratitis after cosmetic eye whitening by regional conjunctivectomy with Mitomycin C application. Case summary: A 69 year-old man was referred to our clinic for a left ocular pain and ocular hypertension sustained for 3 months after cosmetic eye whitening by regional conjunctivectomy with Mitomycin C application for chronic conjunctival hyperemia. On first examination, the scleromalacia and large conjunctival epithelium defect in the nasal quadrant of the limbus area and diffuse sclerokeratitis were observed. Conjunctival and episcleral vessel deficit were seen except superior 30% portion in the left eye. The anterior chamber depth in the left eye was very shallow compared to the right eye and cell reaction in the left anterior chamber was detected. Intraocular pressure (IOP) in the left eye was 28 mmHg after Cosopt and 15% mannitol 500 ml use. Glaucomatous cupping was detected. During follow-up, left IOP increased over 40 mmHg despite the maximal medical treatment and the progression of visual field defects was detected, so then left phacoemulsification, Ahmed valve implantation and amnion membrane transplantation were done. After surgery, the conjunctival epithelial defect and sclerokeratitis were improved much and IOP was regulated 2030 mmHg without medication. Digital massage was done 2 times per day for decreasing IOP and wound remodeling after 1 month. At 3 month after surgery, the conjunctival epithelial defect recurred and scleromalacia was also progressed, so then we performed autoconjunctival flap and amnion membrane transplantation in left eye. The conjunctival epithelial defect were recovered completely, IOP was regulated 2436 mmHg without medication, and 2024 mmHg with Cosopt. The compliance of patient is very poor, further management may be needed for IOP control. Conclusions: Cosmetic eye whitening by regional conjunctivectomy with Mitomycin C application can cause serious complications such as scleromalcia and secondary glaucoma. This case shows that particular care should be taken in order to minimize these complications.

Temporary Sutureless Amniotic Membrane Patch for Acute Alkaline Burns

To evaluate the clinical outcome of a new sutureless approach for a temporary amniotic membrane patch (ProKera; Bio-Tissue, Inc, Miami, Florida) in eyes with acute burns. Retrospective review of 5 eyes of 5 patients with grades I to III acute alkaline burns, receiving ProKera insertion within 8 days of injury. These eyes had either total (2 cases) or extensive (60%-75%, 3 cases) corneal epithelial defects with limbal (120 degrees -360 degrees ) and conjunctival (30%-60%) epithelial defects. ProKera was inserted within a mean (SD) of 3.7 (3.1) days after burn and repeated 1 to 3 times for 3 cases. Conjunctival defects reepithelialized in 8.2 (5) days (range, 5-17 days), while limbal and corneal defects healed in 13.6 (8.3) days (range, 5-25 days). The latter was completed with circumferential closure of limbal defects followed by centripetal healing of corneal defects. In 3 eyes, early peripheral corneal neovascularization was followed by marked regression on completion of healing. During 16.8 (10.8) months of follow-up, all eyes retained a stable surface with improved corneal clarity, and without limbal deficiency or symblepharon. This sutureless application of an amniotic membrane patch allows for early delivery of its biologic actions, which may help preserve remaining limbal stem cells for rapid expansion and prevent late cicatricial complications in eyes with mild and moderate acute alkaline burns.

Sutureless Fixation of Amniotic Membrane Patch as a Therapeutic Contact Lens by Using a Polymethyl Methacrylate Ring and Fibrin Sealant in a Rabbit Model

To introduce and evaluate a sutureless technique by using a polymethyl methacrylate (PMMA) ring and fibrin sealant to fix an amniotic membrane (AM) patch on the ocular surface as a therapeutic contact lens in a rabbit model. PMMA rings were fabricated by duplicating an impression of a rabbit conjunctival fornix. The central cornea of the left eye in 16 rabbits was deepithelialized (diameter = 10 mm). A human AM patch was fixed to the ocular surface by using either a PMMA ring and fibrin sealant or interrupted 10-0 nylon sutures. The fibrin sealant was used to create the PMMA ring-AM complex but not to attach the AM/PMMA ring to the ocular surface. The rabbits were followed up with slit-lamp examination and fluorescein staining for 7 days. Reepithelialization and complications were recorded. The corneal epithelial defect was recovered in each rabbit of both groups after 5 days. In the sutureless group, all membranes remained in place and intact during the follow-up period. One eye was noted to have a partial conjunctival epithelial defect caused by exposure to the PMMA ring. In contrast, >50% of rabbits in the interrupted suture group exhibited complications including conjunctival edema, suture loosening, patch detachment, bleeding, and conjunctival epithelial defects. The sutureless technique that uses a PMMA ring and fibrin sealant for AM patch placement has a lower incidence of complications than the interrupted suture method. This sutureless technique may promote increased clinical use of AM patch by alleviating patients' pain and shortening surgical time.