Management Of Ocular Surface Disease Research Articles

Manejo terapéutico de la queratopatía asociada a aniridia congénita

To attempt to review the aniridia keratopathy pathogenesis and establish a treatment protocol according to the severity of the symptoms. Personal experience in aniridic keratopathy management and a bibliography review. The ocular manifestations of this anomaly include defects of the cornea, glaucoma, lens subluxation, cataracts, hypoplasia of the iris, fovea and optic nerve, amblyopia and nystagmus. The keratopathy occurs in a 20% of patients with aniridia. The correct PAX6 expression is necessary for normal corneal development, limbal stem cell activity and correct corneal epithelial cell migration and adhesion. The management of ocular surface diseases due to limbal stem cell deficiency in aniridia is complex but has changed in recent years, as an understanding of the limbal stem cells and their microenvironment has modified the therapeutic approach. The use of autologous serum eye drops, amniotic membrane transplantation, limbal transplantation or cultivated limbal cell transplantation have all been reported as a treatment for several ocular surface diseases.

Incidence and Prevalence of Glaucoma in Severe Ocular Surface Disease

To describe the incidence and prevalence of glaucoma in a patient population with severe ocular surface disease (OSD). A retrospective case series was compiled from all charts of patients in the Cincinnati Eye Institute/University of Cincinnati and University of Minnesota population with a diagnosis of severe OSD from 1991 to 2003. The incidence and prevalence of glaucoma in the overall patient population were identified, and stratified into disease subgroups. Of the 108 eyes evaluated in this study, 71 were diagnosed with glaucoma. The overall prevalence of glaucoma in patients with severe OSD is 65.7%, with a range from 42.9% to 88.4%. Analysis by subgroup shows the highest percentage of patients with concurrent glaucoma fall into the categories of aniridia and chemical injury, and the lowest was noted in those patients with autoimmune or iatrogenic OSD. Overall, the incidence of glaucoma was 20.4%, with a range of 13.6% to 60%. Compared with previous studies, our results show a significantly higher prevalence of glaucoma in patients with severe OSD. This information warrants increased attention to treatment and management of OSD and concurrent glaucoma.

Cornea and external disease

New developments in cornea and external disease therapy are frequent and influence many aspects of the management of eye disease, including infectious disease, ocular surface disease, corneal surgery, and correction of refractive errors. Although media attention often highlights the novelty or potential impact of any advance, putting the new developments into proper perspective requires a more judicious and critical appraisal. The contributors to this issue of the Ophthalmology Clinics of North America provide that appraisal with respect to anti-infectious therapy, management of ocular surface disease, contact lens wear, novel surgical management of endothelial disease, and options for correction of refractive errors. The Charles T. Campbell Ophthalmic Microbiology Laboratory of the Eye and Ear Institute of the University of Pittsburgh provides a review of present-day ophthalmic microbiology. Regis Kowalski, MS, is the Technical Director of the Campbell Laboratory and reviews the experience of the laboratory with respect to antimicrobial sensitivity and emerging resistance; Francis Mah, MD, is the Associate Medical Director and reviews the scope of antibiotics and outlines new developments in antimicrobial options. A review of the present understanding of ocular surface disease summarizes dry eye therapy and management of meibomian gland disease. A summary of the new surgical approaches to treating ocular surface disease includes an overview of amniotic membrane transplantation by Thomas John, MD, and the options for limbal stem cell resurfacing by Drs. Kim and Holland. Perry Rosenthal, MD, describes the results of silicone scleral contact lens therapy for ocular surface disorders. New developments in contact lens therapy include the new generation of extended and continuous wear high-Dk materials, which are described by Peter Donshik, MD. An overview of the options for the use of therapeutic contact lenses completes an update of the evolving contact lens armamentarium. Finally, there is a presentation of novel innovations in surgical treatment of the cornea, which includes discussion and comparison of the flap (anterior) and limbal pocket (posterior) approaches to endothelial replacement. The issue concludes with a review of developments in LASIK and LASEK refractive surgery. To the authors who contributed to this issue, I extend my thanks and appreciation. To the reader, I express my hope that this review of the new developments in corneal and external disease treatment proves useful and provides perspective for optimal patient care.

Conjunctival grafting for ocular surface disease.

The procedure of transplanting healthy conjunctiva onto eyes with damaged ocular surface epithelium was first described by Thoft in 1977. Today, conjunctival autografting is widely used in pterygium surgery and has been shown to be both safe and effective in reducing pterygium recurrence. Several randomized, controlled, clinical trials have been reported in the literature, and conjunctival autografting is now recognized to have an efficacy equal to that of such adjunct therapies as beta-irradiation and mitomycin C, and yet it is safer than these treatments. Recent modifications of the conjunctival autograft include the conjunctival rotation autograft and the inferior conjunctival transposition flap, both of which have been reported to be associated with low rates of recurrence. With the discovery of the role of limbal stem cells in the maintenance and stability of the corneal surface, recent forms of ocular surface transplantation that have supplanted Thoft's conjunctival transplantation procedure include limbal autograft transplantation and limbal allograft transplantation. In addition, the adjunct use of human amniotic membrane in these ocular surface transplantation procedures has improved success and survival rates in the management of ocular surface disease, which still presents significant challenges to clinicians today.

Combined Penetrating Keratoplasty and Limbal Allograft Transplantation for Severe Corneal Burns

The management of ocular surface disease presents a significant challenge to ophthalmologists. Recent advances in the etiology and pathophysiology of ocular surface diseases, such as chemical and thermal burns or Stevens-Johnson syndrome, include the concept of the limbal stem cell. Limbal stem cell theory suggests that the corneal limbus contains epithelial stem cells that are responsible for a continuous supply of corneal epithelial cells, which not only migrate from the deep to superficial epithelial layers, but also progress in a centripetal direction, inward from the limbus. Support for this concept is provided indirectly by the relatively poor prognosis for penetrating keratoplasty for these types of ocular surface diseases. In such cases, it is suggested that limbal damage and depletion is present and is a significant factor in loss of integrity of the ocular surface; therefore, conventional penetrating keratoplasty, which does not include limbal tissue, does not have a high success rate.

The management of ocular surface disease.

The management of ocular surface disease.