Subconjunctival Tissue Research Articles

The Possible Protective Effect of Chia Seed Oil on Atropine Induced Dry Eye Model in Male Adult Albino Rat: A Histological Study

Abstract Background Dry eye disease is a multifactorial disease that could be presented by discomfort, burning, itching, redness, light sensitivity, visual problems, and instability of the tear film. It might be complicated by damage to the surface of the eye. The nutritional composition of chia seed oil (CSO) provided many health-promoting properties. CSO is generally considered to be the best plant source of Omega-3 fatty acids. In ophthalmology, omega-3 is considered as essential fatty acid for ocular surface homeostasis. It works by blocking proinflammatory eicosanoids and reducing cytokines through anti-inflammatory activity. Aim of the Work assess possible protective effect of chia seed oil on atropine induced dry eye in male adult albino rat. Materials and Methods Forty adult male albino rats were used in this study and were divided in to four groups (10 in each group): Group I (Control group), Group II (CSO group) CSO 2. 5 ml/kg/day orally by gavage feeding tube for 14 days, Group III (DED group) induction of DED by injecting 1 mg/kg atropine (single dose) into the extra orbital lacrimal gland in the right eye, Group IV (treated group) CSO was given as in group II and on day 7, dry eye was induced as in group III. Results In group III, there was prominent detachment in the corneal epithelium and increase in the conjunctival epithelium thickness with irregular cellular arrangement. Newly formed blood vessels were observed in substantia propria of cornea with irregular organization of collagen lamellae. Inflammatory cells infiltration was seen in subconjunctival connective tissue. All these findings showed improvement in group IV. Conclusion Chia seed oil extract could be beneficial in reducing the symptoms associated with DED.

Celastrol alleviates subconjunctival fibrosis induced by silicone implants mimicking glaucoma surgery

Subconjunctival fibrosis is critical to the outcomes of several ophthalmic conditions or procedures, such as glaucoma filtering surgery. This study aimed to investigate the anti-fibrotic effect of celastrol on subconjunctival fibrosis and to further reveal the underlying mechanisms. We used celastrol-loaded nanomicelles hydrogel hybrid as a sustained-release drug. A rabbit model of subconjunctival fibrosis following silicone implantation was used for in vivo study, and TGF-β1-induced human pterygium fibroblast (HPF) activation as an in vitro model. The effects of celastrol on inhibiting TGF-β1-induced migration and proliferation of HPFs were evaluated by scratch wound assay and CCK-8, respectively. Immunofluorescence and western blotting were used to examine the effect of celastrol on the expression of α-SMA, collagen I, fibronectin, and the targets of the Hippo signaling pathway. We found that in vivo celastrol treatment reduced the expression of YAP and TAZ in subconjunctival tissue. Moreover, celastrol alleviated collagen deposition and subconjunctival fibrosis at 8 weeks. No obvious tissue toxicity was observed in the rabbit models. Mechanistically, celastrol significantly inhibited TGF-β1-induced proliferation and migration of HPFs. Pretreatment of HPFs with celastrol also suppressed the TGF-β1-induced protein expression of α-SMA, collagen I, fibronectin, TGF-βRII, phosphorylated Smad2/3, YAP, TAZ, and TEAD1. In conclusion, celastrol effectively prevented subconjunctival fibrosis through inhibiting TGF-β1/Smad2/3-YAP/TAZ pathway. Celastrol could serve as a promising therapy for subconjunctival fibrosis.

Development and Verification of a Novel Three-Dimensional Aqueous Outflow Model for High-Throughput Drug Screening.

Distal outflow bleb-forming procedures in ophthalmic surgery expose subconjunctival tissue to inflammatory cytokines present in the aqueous humor, resulting in impaired outflow and, consequently, increased intraocular pressure. Clinically, this manifests as an increased risk of surgical failure often necessitating revision. This study (1) introduces a novel high-throughput screening platform for testing potential anti-fibrotic compounds and (2) assesses the clinical viability of modulating the transforming growth factor beta-SMAD2/3 pathway as a key contributor to post-operative outflow reduction, using the signal transduction inhibitor verteporfin. Human Tenon's capsule fibroblasts (HTCFs) were cultured within a 3D collagen matrix in a microfluidic system modelling aqueous humor drainage. The perfusate was augmented with transforming growth factor beta 1 (TGFβ1), and afferent pressure to the tissue-mimetic was continuously monitored to detect treatment-related pressure elevations. Co-treatment with verteporfin was employed to evaluate its capacity to counteract TGFβ1 induced pressure changes. Immunofluorescent studies were conducted on the tissue-mimetic to corroborate the pressure data with cellular changes. Introduction of TGFβ1 induced treatment-related afferent pressure increase in the tissue-mimetic. HTCFs treated with TGFβ1 displayed visibly enlarged cytoskeletons and stress fiber formation, consistent with myofibroblast transformation. Importantly, verteporfin effectively mitigated these changes, reducing both afferent pressure increases and cytoskeletal alterations. In summary, this study models the pathological filtration bleb response to TGFβ1, while demonstrating verteporfin's effectiveness in ameliorating both functional and cellular changes caused by TGFβ1. These demonstrate modulation of the aforementioned pathway as a potential avenue for addressing post-operative changes and reductions in filtration bleb outflow capacity. Furthermore, the establishment of a high-throughput screening platform offers a valuable pre-animal testing tool for investigating potential compounds to facilitate surgical wound healing.

Evaluating surgical outcome of pterygium excision with conjunctival autograft using autologous blood: Can it be a new norm?

To evaluate the surgical outcome of use of autologous blood as an adhesive agent in pterygium excision with conjunctival auto-grafting. To observe the effectiveness of autologous blood adherence on the scleral bed and to know whether autologous blood technique can be made as a standard procedure in pterygium surgery or not.The present study is a retrospective observational study. The records of 94 cases of primary pterygium surgery done during August 2022- January 2023 were taken. All patients underwent comprehensive ocular examination pertinent to the disease. Pterygium was dissected and remaining subconjunctival pterygium tissue was separated and excised. The conjunctival limbal auto-graft was taken secured in place by autologous blood and dressing done. Follow-up was done on second post operative day,1st week and 1 month. The study displayed excellent surgical outcome with minimal post operative complications, which too resolved in a week. The most common complication was subconjunctival hemorrhage in 38 cases followed by graft edema in 32 cases. Though graft displacement was observed in 4 cases, they were later rearranged successfully. We did not observe even a single graft loss in our study.Pterygium excision with conjunctival auto-grafting with autologous blood is very safe, less time consuming, easy to perform with less learning curve, economical with excellent postoperative outcome and most importantly more patient satisfaction, thus, making it equivalent to or rather superior to other comparable procedures.

A Study of Correlation between Tear Film Break - Up Time (TBUT), Pterygium and Pinguicula on Patents Attending a Tertiary Centre, North Bengal Medical College & Hospital, Darjeeling, Sub Himalayan Region, India

Introduction: Degenerative changes in conjunctive are quite common in India, especially after 40 years of age. Degenerative changes like Pterygium and Pinguicula occurs especially due to prolonged exposure to ultra violet rays who lives in dry windy area and having pre-existing dry eye syndrome. Pterygium is a elastotic degeneration of the subconjunctival tissue approaches towards the cornea in a triangular fashion. Pterygium is mostly prevalent on the palpebral aperture mostly in the nasal side. It is thought that the predominantly nasal location is related to reflection of light from the nasal bridge on to the nasal conjunctiva. The ultraviolet light may be mediated by mutation in the P53 gene.

Treatment of filtration bleb dysfunction after glaucoma surgery by needle revision of filtration bleb combined with conbercept.

Filtration surgery (Trabeculectomy) is the main treatment for glaucoma. The scarring of the filtration bleb and obstruction of the outflow of aqueous humor through the filtration channel are the main reasons of the surgery failure. The objective of this study was to determine the clinical efficacy of needle revision of filtration blebs combined with subconjunctival injection of conbercept on the functional bleb formation in glaucoma patients with eye pressure out of control after trabeculectomy. A total of 48 eyes with poor filtration bleb function after trabeculectomy for glaucoma were treated with needle revision of filtration bleb combined with subconjunctival injection of conbercept. After the treatment, the patients were followed up for 3 months during which visual acuity, intraocular pressure, slit lamp and ultrasound biomicroscope examinations were performed. Intraoperative and postoperative complications were recorded. The visual acuity and intraocular pressure were significantly improved after the needle revision of filtration blebs. Among the 48 eyes, 39 eyes still had functional blebs at the end of the follow-up period, and filtration blebs failed in 9 eyes 2 to 8 weeks after the removal of the needle. The survival rate of filtration blebs at 3 months after needle revision was (79.06 ± 3.42%), and 81.25% (39/48) of the eyes showed good formation rate of functional bleb at the last follow-up. Three months after needle revision, there was local scar formation in some filtration blebs. Part of the filtration blebs showed mild thickening of the local subconjunctival tissue, and the filtration bleb was slightly raised and diffuse, showing a multi-cavity and thin-walled shape in some blebs. Ultrasound biomicroscopy examination showed relative structural manifestations. Subconjunctival hemorrhage occurred in 43 patients during and after the operation. Low intraocular pressure occurred in 8 patients with the lowest pressure of 5 mm Hg. Choroidal edema was observed in 3 patients. Five patients had intraoperative conjunctival hemorrhage in the anterior chamber, and hyphema occurred. All complications were self-limited and resolved without surgical intervention. Needle revision of filtration bleb combined with anti-VEGF drugs is a safe and effective method for the treatment of filtration bleb dysfunction after surgery of glaucoma.

Celastrol-based nanoporous membranes prevent subconjunctival fibrosis by activating autophagy

Subconjunctival fibrosis is the final manifestation of various ocular surface injuries and inflammatory diseases; however, clinical treatment is not currently available to prevent or reverse this condition. Celastrol, a triterpene derived from Tripterygium wilfordii, is a potent antifibrotic agent. However, the underlying mechanism of the effect of celastrol on subconjunctival fibrosis remains unknown. It is difficult to choose the method of administration to improve the antifibrotic effect of drugs on subconjunctival fibrosis. In this study, we developed a class of porous nanofibrous membranes loaded with celastrol for sustainable release and hyaluronic acid as a coating layer to prevent burst release. The SEM images indicated that the nanopores and coating layer were clearly observed. In addition, Western blot and confocal microscopic analysis of human pterygium fibroblasts revealed that celastrol induced autophagy. Moreover, celastrol increased the expression of LC3 II in subconjunctival tissue and inhibited the expression of FN and COLⅠ in rats. This finding suggests that autophagy induction by celastrol protects against subconjunctival fibrosis. Furthermore, we revealed that celastrol activated autophagy by inhibiting the PI3K/Akt/mTOR pathway. Moreover, the porous nanofibrous membrane exhibited excellent biocompatibility for potential application in future clinical translation. Thus, this study reveals the importance of autophagy as a possible therapeutic target and celastrol as a potential candidate drug against subconjunctival fibrosis, demonstrating an alternative to inhibit fibrosis, and extend ocular sustainable delivery of various drugs to treat eye diseases.

Impairment of autophagy promotes human conjunctival fibrosis and pterygium occurrence via enhancing the SQSTM1-NF-κB signaling pathway.

Pterygium is a common ocular disease with a high recurrence rate, characterized by hyperplasia of subconjunctival fibrovascular tissue. Autophagy, an important process to maintain cellular homeostasis, participates in the pathogenic fibrosis of different organs. However, the exact role of autophagy in pterygium pathogenesis remains unknown. Here, we found that autophagic activity was decreased in human pterygium tissues compared with adjacent normal conjunctival tissues. The in vitro model of fibrosis was successfully established using human primary conjunctival fibroblasts (ConFB) treated with transforming growth factor-β1 (TGF-β1), evidenced by increased fibrotic level and strong proliferative and invasive capabilities. The autophagic activity was suppressed during TGF-β1- or ultraviolet-induced fibrosis of ConFB. Activating autophagy dramatically retarded the fibrotic progress of ConFB, while blocking autophagy exacerbated this process. Furthermore, SQSTM1, the main cargo receptor of selective autophagy, was found to significantly promote the fibrosis of ConFB through activating the PKCι-NF-κB signaling pathway. Knockdown of SQSTM1, PKCι, or p65 in ConFB delayed TGF-β1-induced fibrosis. Overexpression of SQSTM1 drastically abrogated the inhibitory effect of rapamycin or serum starvation on TGF-β1-induced fibrosis. Collectively, our data suggested that autophagy impairment of human ConFB facilitates fibrosis via activating the SQSTM1-PKCι-NF-κB signaling cascades. This work was contributory to elucidating the mechanism of autophagy underlying pterygium occurrence.

Study of Association of Tear Film Abnormalities in All Grades of Primary Pterygium Cases using Schirmer’s Test 1 & 2

Background: One of the frequent ocular disorders affecting people in their middle and advanced years of age is pterygium. It is a benign, proliferative disorder of the conjunctiva and subconjunctival tissue that has the potential to impair vision. Clinical examination can quickly diagnose and stage it. Sunlight exposure is believed to be the most significant element in the development of pterygium. Dry eyes, smoking, prolonged outdoor activity, low socioeconomic position, and high altitudes are additional risk factors. If it grows onto the cornea's centre, a major problem is the obliteration of the visual axis. Another reason for impaired vision is the development of irregular astigmatism brought on by flattening of the cornea in the horizontal meridian. Aim: The aim of the study was to determine the association of Tear film abnormalities with all grades of pterygium Materials and Methods: The current study was a single-center observational study that was conducted out from December 2020 to July 2022 in the ophthalmology division of Sri Siddhartha Medical College hospital and Research Centre, Tumkur, on patients who attended the OPD with primary pterygium, regardless of treatment. According to the study's inclusion criteria, a total of 91 participants who were diagnosed with pterygium were enrolled. Results: The majority of participants (34.07%) were between the ages of 61 and 70. Pterygium prevalence was higher in females (65.93%) than in males (34.07%) with a 1.96:1 ratio. The majority of the participants (69.23%) had progressive pterygium, followed by regressive pterygium (15.38%) & atrophic pterygium (15.38%). The mean scores of the schirmers tests 1 and 2 in both eyes differed significantly statistically depending on the degree of pterygium (p=0.03). Conclusions: Pterygium is one of the most common ocular conditions in our nation, primarily affecting people from lower socioeconomic backgrounds. Pterygium has been linked to tear film abnormalities. Keywords: Dry eyes, Pterygium, Tear Film.

Development and optimization of an ocular hydrogel adhesive patch using definitive screening design (DSD).

Adhesive hydrogels based on chemically modified photocrosslinkable polymers with specific physicochemical properties are frequently utilized for sealing wounds or incisions. These adhesive hydrogels offer tunable characteristics such as tailorable tissue adhesion, mechanical properties, swelling ratios, and enzymatic degradability. In this study, we developed and optimized a photocrosslinkable adhesive patch, GelPatch, with high burst pressure, minimal swelling, and specific mechanical properties for application as an ocular (sclera and subconjunctival) tissue adhesive. To achieve this, we formulated a series of hydrogel patches composed of different polymers with various levels of methacrylation, molecular weights, and hydrophobic/hydrophilic properties. A computerized multifactorial definitive screening design (DSD) analysis was performed to identify the most prominent components impacting critical response parameters such as adhesion, swelling ratio, elastic modulus, and second order interactions between applied components. These parameters were mathematically processed to generate a predictive model that identifies the linear and non-linear correlations between these factors. In conclusion, an optimized formulation of GelPatch was selected based on two modified polymers: gelatin methacryloyl (GelMA) and glycidyl methacrylated hyaluronic acid (HAGM). The ex vivo results confirmed adhesion and retention of the optimized hydrogel subconjunctivally and on the sclera for up to 4 days. The developed formulation has potential to be used as an ocular sealant for quick repair of laceration type ocular injuries.

SURGICAL OUTCOME OF CONJUNCTIVALAUTOGRAFT USING AUTOLOGOUS BLOOD IN PATIENTS UNDERGOING PTERYGIUM SURGERY AT A TERTIARY CARE CENTRE IN KASHMIR

Background: Pterygium refers to a wing shaped brovascular growth of subconjunctival tissue that encroaches onto the cornea. Main modality of treatment of pterygium is surgical. Aim: To determine the surgical outcome of conjunctival autograft xation using autologous blood in patients attending OPD of Department of Ophthalmology, Government Medical College, Srinagar. Methods: This was a prospective interventional study conducted on 60 patients with primary pterygium attending the Department of Ophthalmology of a tertiary care centre in Kashmir over a period of 2 years from June 2019 to June 2021. Patients with recurrent pterygium, past history of ocular trauma and patients with bleeding diathesis were excluded from the study. Proper history was taken from all the patients and a detailed ophthalmological examination was done which included uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), IOP measurement. Detailed anterior segment and posterior segment examination was done. Results: Our study indicated mean age of patients as 55±3 years. There were 40 female patients (66.7%) and 20 male patients (33.3%). Majority of patients presented with grade-2 and grade-3 pterygium accounting for 50% and 25% cases respectively. Postoperative complications such as subconjunctival haemorrhage, graft edema, graft retraction and corneal epithelial defect were seen in 10%, 55%, 5% and 50% cases respectively. Graft loss and conjunctival granuloma were not seen in any of the patients in our study. Overall surgical outcome was good in our study patients with no postoperative complications at the end of 6 weeks follow-up. Conclusion: Our study concluded that majority of the patients who underwent pterygium excision with graft xation using autologous blood were females with grade-2 and grade-3 pterygium. Surgical outcome using autologous blood as a bioadhesive is a useful and good alternative to xation of conjunctival autograft using sutures or brin glue.

The role of conjunctival lymphangiogenesis in filtering blebs formation after non-penetrating deep sclerectomy

Purpose: to study the concentration of vascular endothelial growth factor (VEGF A) in the tear fluid (TF) of patients with primary open-angle glaucoma after non-penetrating deep sclerectomy (NPDS) at different stages of the perioperative period and to perform immunohistochemical identification of the lymphatic structures of filtering blebs in groups differing in the hypotensive effect of the surgery.Material and methods. 12 months after surgery, POAG patients were divided into 2 groups. Group 1 was composed of patients who experienced a hypotensive effect after NPDS (n = 23; mean age 63.7 ± 4.4 years), while group 2 had no such effect of NPDS (n = 21, mean age 64.3 ± 3.9 years). The concentration of VEGF A (121 and 165) in TF was determined by ELISA method (VEGF-ELISA-Best, Vector Best, Russia). Immunohistochemical examination of conjunctival and subconjunctival tissue samples was performed 12 to 18 months after NPDS in 12 POAG patients and 8 patients aged 62.36 ± 6,31 with no glaucoma, which served as a control group.Results. Significant differences in the concentration of VEGF A (121 and 165) in TF were found in two groups 2 weeks and 2 months after the surgery. Excessive scarring of filtering blebs was accompanied by an initially low level of VEGF A, its moderate increase 2 weeks after surgery and significant suppression 2 months after surgery, which was significantly different from group 1 (a twofold VEGF A increase has been established toward the second month after surgery). From 5 to 7 vessels with lymphatic character were found in tissue samples of group 1. Podoplanin was found in individual cells and sphere-like formations, which may represent reduced lymphatic vessels.Conclusion. The study showed an important role of VEGF A in conjunctival lymphangiogenesis. Suppression of conjunctival lymphangiogenesis and subsequent “hypotensive failure” of glaucoma surgery in some patients who underwent anti-inflammatory and antifibrosis therapy requires optimization, the development of new treatment methods aimed at activating prolymphangiogenic factors.

Rational Design of Microfluidic Glaucoma Stent.

Glaucoma is a common, irreparable eye disease associated with high intraocular pressure. One treatment option is implantation of a stent to lower the intraocular pressure. A systematic approach to develop a microchannel stent meshwork that drains aqueous humor from the anterior chamber of the eye into the subconjunctival space is presented. The stent has a large number of outlets within its mesh structure that open into the subconjunctiva. The development approach includes a flow resistance model of the stent. Local adaption of the stent’s tubular dimensions allows for adjustment of the flow resistance. In this way, an evenly distributed outflow into the subconjunctiva is achieved. We anticipate that microblebs will form at the stent outlets. Their size is crucial for drainage and control of intraocular pressure. An analytical model for bleb drainage is developed based on the porous properties of the subconjunctival tissue. Both models—the stent flow resistance model and the bleb drainage model—are verified by numerical simulation. The models and numerical simulation are used to predict intraocular pressure after surgery. They allow for a systematic and personalized design of microchannel stents. Stents designed in this way can stabilize the intraocular pressure between an upper and lower limit.

Development and Characterization of Curcumin-Silver Nanoparticles as a Promising Formulation to Test on Human Pterygium-Derived Keratinocytes.

Pterygium is a progressive disease of the human eye arising from sub-conjunctival tissue and extending onto the cornea. Due to its invasive growth, pterygium can reach the pupil compromising visual function. Currently available medical treatments have limited success in suppressing efficiently the disease. Previous studies have demonstrated that curcumin, polyphenol isolated from the rhizome of Curcuma longa, induces apoptosis of human pterygium fibroblasts in a dose- and time-dependent manner showing promising activity in the treatment of this ophthalmic disease. However, this molecule is not very soluble in water in either neutral or acidic pH and is only slightly more soluble in alkaline conditions, while its dissolving in organic solvents drastically reduces its potential use for biomedical applications. A nanoformulation of curcumin stabilized silver nanoparticles (Cur-AgNPs) seems an effective strategy to increase the bioavailability of curcumin without inducing toxic effects. In fact, silver nitrates have been used safely for the treatment of many ophthalmic conditions and diseases for a long time and the concentration of AgNPs in this formulation is quite low. The synthesis of this new compound was achieved through a modified Bettini’s method adapted to improve the quality of the product intended for human use. Indeed, the pH of the reaction was changed to 9, the temperature of the reaction was increased from 90 °C to 100 °C and after the synthesis the Cur-AgNPs were dispersed in Borax buffer using a dialysis step to improve the biocompatibility of the formulation. This new compound will be able to deliver both components (curcumin and silver) at the same time to the affected tissue, representing an alternative and a more sophisticated strategy for the treatment of human pterygium. Further in vitro and in vivo assays will be required to validate this formulation.

Study of clinical profile and surgical outcome of pterygium in adult patients at rural tertiary care hospital.

Introduction: Pterygium is a benign, degenerative condition of the subconjunctival tissue, for which many surgical techniques ranging from McReynaud’s operation to conjunctival autograft and amniotic membrane graft, have been discussed in the literature. Grafts prevent a recurrence, acting as a barrier, and have proven to be the gold standard. Here we have studied the clinical profile and surgical outcome of pterygium surgery by various techniques at a Rural tertiary care hospital (RTCH). Aims/ Objectives: Our primary aim was to study demographical factors and clinical profile of pterygia along with the surgical outcome and postoperative complications of pterygium surgery by various techniques, at RTCH. Materials and Methods:  In this, hospital-based observational descriptive longitudinal study, we studied 75 patients, with primary progressive pterygium, who underwent pterygium surgery from September 2019- March 2021 and recorded their pre-operative, intraoperative, and postoperative data with a follow-up period of 3 months. Results: 74.6% of the population were females, with a bimodal peak incidence in 31-40 years and 61-70 years (22.6%).  Most common presentation in both eyes (46.6%) with 97.3% cases presenting with nasal pterygium. 66.6% of patients presented with a grade 2 pterygium. 50 patients had a pre-operative “with the rule astigmatism”. Pre-operative keratometry readings could not be assessed for 5 patients due to excessive distortion of the corneal surface. 37 patients underwent graft fixation with no suture no glue while 38 patients underwent graft fixation with sutures. The most common complication was graft edema which was seen in 53 patients, while recurrence was seen in 2 patients. Conclusion: The occurrence of pterygium is very common in rural areas, which in most cases, is neglected due to lack of awareness. Surgical excision with conjunctival autograft continues to be the gold standard of treatment for the same.

AGTR1 blocker attenuates activation of Tenon's capsule fibroblasts after glaucoma filtration surgery via the NF-κB signaling pathway

Activation of Tenon's capsule fibroblasts limits the success rate of glaucoma filtration surgery (GFS), the most efficacious therapy for patients with glaucoma. Angiotensin type 1 receptor (AGTR1) is involved in tissues remodeling and fibrogenesis. However, whether AGTR1 is involved in the progress of fibrogenesis after GFS is not fully elucidated. The aim of this study was to investigate the role of an AGTR1 in scar formation after GFS and the potential anti-fibrosis effect of AGTR1 blocker. AGTR1 expression level was increased in subconjunctival tissues in a rat model of GFS and transforming growth factor-beta 2 (TGF-β2)-induced human Tenon's capsule fibroblasts (HTFs). AGTR1 blocker treatment suppressed TGF-β2-induced HTF migration and α-smooth muscle actin (α-SMA) and fibronectin (FN) expression. AGTR1 blocker treatment also attenuated collagen deposition and α-SMA and FN expression in subconjunctival tissues of the rat model after GFS. Moreover, AGTR1 blocker decreased TGF-β2-induced P65 phosphorylation, P65 nuclear translocation, and nuclear factor kappa B (NF-κB) luciferase activity. Additionally, BAY 11–7082 (an NF-κB inhibitor) significantly suppressed HTF fibrosis. In conclusion, our results indicate that AGTR1 is involved in scar formation after GFS. The AGTR1 blocker attenuates subconjunctival fibrosis after GFS by inhibiting the NF-κB signaling pathway. These findings indicate that targeting AGTR1 is a potential approach to attenuate fibrosis after GFS.

Benzalkonium chloride-induced myofibroblastic transdifferentiation of Tenon\u2019s capsule fibroblasts is inhibited by coculture with corneal epithelial cells or by interleukin-10

Benzalkonium chloride (BAC) is used as a preservative in eyedrops but induces subconjunctival fibrosis that can result in failure of glaucoma surgery. Tenon’s capsule fibroblasts in subconjunctival tissue interact with the corneal epithelium through tear fluid. With the use of a coculture system, we have now investigated the effect of human corneal epithelial (HCE) cells on myofibroblastic transdifferentiation of human Tenon fibroblasts (HTFs) induced by BAC (5 × 10−6%). Immunofluorescence and immunoblot analyses revealed that the BAC-induced expression of α smooth muscle actin (αSMA) in HTFs was suppressed by coculture of these cells with HCE cells (p < 0.01). The concentration of interleukin-10 (IL-10) in culture supernatants of BAC-treated HTFs was increased by coculture with HCE cells (17.26-fold, vs. coculure, p < 0.001). Immunofluorescence and immunoblot analyses also showed that exogenous IL-10 (300 pg/ml) suppressed the BAC-induced expression of αSMA by 43.65% (p < 0.05) as well as the nuclear translocation of myocardin-related transcription factor-A (MRTF-A) by 39.32% (p < 0.01) in HTFs cultured alone. Our findings suggest that corneal epithelial cells may protect against subconjunctival fibrosis by maintaining IL-10 levels and preventing the MRTF-A-dependent transdifferentiation of HTFs into myofibroblasts.

Dermatological and Ophthalmological Inflammatory, Infectious, and Tumoral Tattoo-Related Reactions: A Systematic Review.

The purpose of this work was to review the scientific evidence about dermatological and ophthalmological inflammatory, infectious, and tumoral tattoo-related reactions published in the literature. We conducted a literature search from January 1, 2000 to July 15, 2020 in MEDLINE, COCHRANE, EMBASE, and LILACS. Limits regarding the language and period of publication were used. A data collection form was designed in Excel. Four reviewers independently extracted relevant details about the design and the results of each study. One hundred four studies were included, most of them were conducted in Europe and North America. The remaining studies were conducted in Asia, South America, Africa, and Oceania. We included 52 case reports, 21 cross-sectional studies, 20 case series, 10 case-control studies, and 1 cohort study. Eighty-six studies described skin tattoos, of which 7 were publications of eyebrow tattoos and 6 of eyelid tattoos, and 5 articles included cases of subconjunctival tissue tattoos (eyeball). Fifty-seven studies described local reactions related to tattoos and 47 studies reported systemic reactions or reactions in different locations from the tattoo site. The types of reactions described in the studies were: infections in 45 studies, inflammatory reactions in 53 studies, neoplasia in 4 studies, and hypertrichosis in 2 studies. This literature review evidenced a close relationship between the application of tattoos on dermatological and ophthalmological tissues, and the possible immunological complications, neoplasms, and infectious complications. Dermatologists and ophthalmologists should be aware of the consequences caused by even small amounts of ink applied on skin and eyes, generating the need for strict regulations for its use.

A Comparative Study To Evaluate The Outcome Of Sutures Versus Fibrin Glue In Conjunctival Autograft Technique For Primary Pterygium Excision

Background: Pterygium is degenerative condition of the subconjunctival tissue which proliferates as vascularized granulation tissue and is characterized by formation of a triangular fold of conjunctiva encroaching on the cornea leading to visual impairment, restriction of ocular motility, chronic inflammation and cosmetic concerns. Surgical removal is the treatment of choice, but recurrence can be a problem. Now, Fibrin glue is being tried since few years to secure grafts in place of the sutures. The objective of this study was to compare duration of surgery, immediate postoperative complications which includes an inflammation, subconjunctival hemorrhage, patient comfort, graft stability between the uses of fibrin glue versus sutures. Methods: A total of 40 patients having primary pterygium were included in the study. 20 patients were underwent pterygium excision surgery and conjunctival autografting using absorbable vicryl 8-0 suture and 20 patients underwent pterygium excision surgery and conjunctival autografting using fibrin glue. These 2 groups were compared in terms of duration of the surgery, inflammation, degree of postoperative discomfort, subconjunctival haemorrhage and graft stability at postoperative day 1. Results: The mean surgery time in fibrin glue group was 15 minutes and mean surgery time in suture group was 28 minutes (p=0.000). Fibrin glue group had significantly lesser inflammation (p=0.001) as well as postoperative discomfort (p=0.000) compared to suture group at postoperative day 1. There was no significant difference found in the degree of subconjunctival haemorrhage between the fibrin glue versus sutures groups (p=0.887 and p=0.797 at day 1). The grafts secured with fibrin glue were as stable as those secured with the sutures (p=0.745, 0.644 at day 1). Conclusion: The fibrin glue group in conjuctival autografting had significantly less surgery time, which also produces significantly less postoperative discomfort as well as inflammation with grafts being as stable as those secured with sutures. Fibrin glue can be used regularly if patients can be pooled together and operated on, by making it cost effective procedure.

Increased Age and Long Working Period Associated with Increased Severi-ty of Pterygium Among Fishermen in Kedung Cowek Sub-District, Surabaya, East Java-Indonesia

Pterygium is a degenerative and invasive disorder of the subconjunctival tissue that can reach the cornea area which is become a worldwide health problem. UV exposure is the biggest risk factor for pterygium. A profession as a fisherman is one of the occupations that are often related to the appearance of pterygium, because of long-term exposure to UV rays. This study aimed to determine the correlation between age and duration as a fisherman with the degree of pterygium in Kedung Cowek village, Bulak Surabaya district, East Java - Indonesia. The research design was an analytic observational using consecutive sampling during March - July 2011; with the total number of respondents is 42 fishermen who met the inclusion criteria. The results of the statistical analysis test showed that there was a strong and significant relationship between the age of the fishermen (p = 0.007; coefficient correlation = 502) and the duration of working as a fisherman (p = 0.029; coefficient correlation = 409) with the severity of the pterygium. Based on these results it can be concluded that the age and duration of work as fishermen are related to the severity of the pterygium in fishermen in the Kedung Cowek sub-district, Surabaya, East Java-Indonesia.