Subconjunctival Tissue Research Articles

A Successful Alternative: Repair of a Penetrating Limbal Wound by Lamellar Keratoplasty

To report repair of a penetrating limbal wound by lamellar keratoplasty 1 year post-traumatically. Interventional case report. A 5-year-old boy had a self-inflicted injury leading to a limbal penetrating wound. The wound closed spontaneously by prolapsed subconjunctival uveal tissue and no intervention was planned. One year later surgical closure of the defect was necessary, as the amount of prolapsed tissue had increased. After excising the prolapsed tissue the wound was closed with a lamellar corneal graft, resulting in a quiet and stable anterior segment and a best-corrected visual acuity of 20/16. Lamellar keratoplasty can be a useful technique to repair a limbal penetrating wound. Corneal allografts have adequate tensile strength, low immunogenicity, and are easy to obtain.

Study on a rat model of filtering bleb scarring formation

To investigate a rat animal model of filtering bleb scarring formation. Thirty-five of Sprague-Dawley (SD) rats were used in this experiment. The filtration surgery was performed on one eye of each rat and the other eye served as control. The presence of postoperative bleb and clinical manifestation was evaluated. Each group of three rats were sacrificed and the eyes enucleated on day 1, 3, 7, 14, and 28. After the eyes were fixed by 10% formalin, serial paraffin sections of three eyes were labeled with HE staining and the pathological morphology was observed under a microscope. A conjunctival bleb was successfully formed in 35 rats lasting from 8 to 21 days after surgery. An obvious dilatation of blood vessels, infiltration of a great number of neutrophil, and a severe edema of the subconjunctival tissue were observed on day 1 and the above morphological changes plus increased infiltration of macrophages were found on day 3. The dilated blood vessels were lessened while the proliferation of fibroblast was presented with abundant endochylema in oval-shaped nucleus of fibroblasts, which were closely associated with the deposition of small amount of new loose collagen fibers on day 7. The collagen fibers became tight on day 14 and subsequently, the early scar was formed on day 28. The rat model of filtering bleb scarring formation may be useful for the investigation of preventing and treating conjunctival scarring resulted from glaucoma filtration surgery and other related eye diseases in the future.

The expression of nuclear factor-kappa B in lipopolysaccharide-induced keratitis of rats and the effect of pyrrolidine dithiocarbamate on its expression

To investigate the expression of nuclear factor-kappa B (NF-kappaB) and cytokines in lipopolysaccharide (LPS)-induced keratitis of rats, and the effect of pyrrolidine dithiocarbamate (PDTC) on its expression. A LPS-induced keratitis model was established in Wistar rats. Thirty minutes before LPS exposure, PDTC and normal saline were injected into subconjunctival tissues separately. At 0.5, 1.0, 3.0, 6.0, 12.0, 24.0 and 72.0 h after LPS exposure, the rats were examined with slit-lamp microscope. Then they were sacrificed and the corneas were excised for routine histological analysis. Immunohistochemical staining with an antibody against activated NF-kappaB was performed to detect the expression of NF-kappaB. The change of TNF-alpha mRNA expression was identified by reverse transcriptase polymerase chain reaction (RT-PCR). Histology findings demonstrated that corneas exposed to LPS showed significant changes in corneal structure, edema and pronounced inflammatory cells infiltration were observed. Both symptoms and damages of the cornea were lesser in the rats of PDTC group than that of the control keratitis group. Compared with PDTC group, the activation of NF-kappaB and the expression of TNF-alpha mRNA were significantly upregulated after LPS challenge 0.5 - 24.0 h (P < 0.01), separately; peak expression of NF-kappaB and TNF-alpha mRNA were observed at 3.0 - 12.0 h after LPS exposure. The expression of NF-kappaB and TNF-alpha mRNA induced by NF-kappaB plays an important role in the pathogenesis of keratitis. The inhibitor of NF-kappaB, PDTC, can relieve the cornea from damages produced by keratitis.

Effects of Antiglaucoma Drops on MMP and TIMP Balance in Conjunctival and Subconjunctival Tissue

To study the effects of antiglaucoma drugs on metabolism within the extracellular matrix (ECM) of the ocular surface, including corneal, conjunctival, and subconjunctival tissue. Several antiglaucoma drugs--including beta-blockers, alpha/beta-blockers, alpha1-blocker, alpha2-agonist, and prostaglandin derivative-were topically administrated to rat eyes daily for 2 weeks or were incubated with human corneal cells or human fibroblasts for 72 hours. Thereafter, expression and enzymatic activity of the matrix metalloproteinases (MMPs), a group of enzymes proteolyzing ECM and their inhibitors, called tissue inhibitors of metalloproteinase (TIMPs), were evaluated. Quantitative RT-PCR revealed significantly upregulated and downregulated expression of MMPs and TIMPs, respectively, in rat conjunctival and subconjunctival tissue on the administration of alpha/beta-blockers, alpha1-blocker, alpha2-agonist, and prostaglandin derivative, suggesting that these drugs may enhance ECM degradation. However, in contrast, beta-blocker administration caused reverse effects--that is, upregulation and downregulation of TIMPs and MMPs, respectively. Enzymatic activity of MMPs in rat conjunctival and subconjunctival tissue analyzed by biochemical assay and zymography was markedly enhanced on the administration of alpha/beta-blockers, alpha1-blocker, alpha2-agonist, and prostaglandin derivative, but not of beta-blockers. Similar effects of these antiglaucoma drugs were observed in cultured human corneal cells and human fibroblast cells. The present experimental observations suggest that some alpha/beta-blockers, alpha1-blocker, alpha2-agonist, and prostaglandin derivative stimulate ECM degradation of ocular surface tissue by modulating the balance between MMPs and TIMPs.

Diffuse granulomatous necrotizing scleritis

A 34-year-old man presented with anterior scleral thinning in the right eye (RE) and a painful nodular scleritis in the left eye (LE). Fundus examination showed a healed vasculitis and an inferior epiretinal neovascular membrane in the LE. Topical and systemic oral steroids and antiviral medication were prescribed. One year later, optic disc hyperaemia and swelling and macular oedema became apparent in the LE. Pulsed intravenous steroids were administered for 1 year, when a nasal septum perforation and vitreous haemorrhage in the LE were diagnosed. The eye was enucleated 3.5 years after the initial complaint. Necrotizing granulomatous tissue replacing the sclera and subconjunctival granulomatous tissue were observed. Six months later, oedema and neovascularization of the right optic disc were observed and cyclophosphamide was started, with regression of the clinical signs. No systemic abnormalities have so far become apparent. Posterior scleritis is most often observed in patients with no signs of associated systemic autoimmune disease. The diagnosis in this case is most probably one of Wegener's granulomatosis (WG). In WG, the diagnosis is based on necrotizing granulomas of the respiratory tract, generalized focal necrotizing vasculitis and focal necrotizing glomerulonephritis. Eye involvement with WG has been reported in up to 58% of cases. Evaluation of the scleritis patient should include a detailed medical history, chest X-rays, blood tests, autoantibody serology and analysis of urinary sediment. Cyclophosphamide is the treatment of choice for patients with ocular manifestations of WG, polyarteritis nodosa or rheumatoid arthritis, either alone or in combination with systemic steroids. Visual loss is expected in 85% of individuals with severe necrotizing posterior scleritis.

Complications Following Ex-Press Glaucoma Shunt Implantation

To report post-operative course and complications in patients who underwent Ex-Press glaucoma shunt placement. Small case series. Four patients were referred for management following Ex-Press shunt implantation. Patients underwent complete ophthalmologic evaluation and were appropriately managed. Of the four patients, two had inadequate control of intraocular pressure related to bleb failure caused by subconjunctival scar tissue formation. One patient experienced suprachoroidal hemorrhage 5 days after shunt placement followed a year later with conjunctival erosion and shunt rim exposure. Endophthalmitis from conjunctival erosion over the Ex-Press shunt rim was observed in one patient. Patients with subconjunctival implantation of the Ex-Press shunt should be monitored closely for possible conjunctival erosion that can lead to endophthalmitis and failure from fibrosis.

Ocular pulse amplitude after trabeculectomy

The ocular pulse amplitude (OPA) is the difference between the minimum and maximum values of the pulsatile intraocular pressure (IOP) wave contour. The OPA depends on ocular perfusion and IOP, which are both affected by a trabeculectomy (TE). The aim of this study was to investigate how the OPA changes after TE and whether an early change in OPA can be used as a prognostic marker for a successful long-term outcome. Fourteen consecutive patients (26-84 years old) with medically uncontrolled primary open-angle or pseudoexfoliation glaucoma were included in the study. IOP and OPA were measured with a dynamic contour tonometer before and after TE on days -1, +1, +7, +14, +21, +28, +42, +56, +70, and +84. The OPA of the contralateral eye was used to control for variations in systemic haemodynamics. TE was regarded as successful if a persistent drop in IOP of at least 20% without the use of IOP-lowering treatment was achieved. Data were analysed using receiver operating characteristic curves, Kaplan-Meier survival curves and Mann-Whitney two-sample analysis. Five out of 14 TEs had an entirely successful outcome. The other 9 patients required additional interventions such as suturolysis, needling of subconjunctival scar tissue and antimetabolite injections during the 3-month period after the TE. On the first day after surgery, OPA decreased in 12 patients and increased in 2 patients compared with the preoperative measurements. In the 5 patients with a successful long-term outcome, OPA dropped by 3.38+/-1.79 mmHg (mean+/-SE), whereas the initial OPA drop in those cases that required additional interventions was 0.62+/-1.81 mmHg only (p<0.01). IOP dropped by 13.10+/-2.14 mmHg in the successful group and by 5.84+/-2.51 mmHg in the unsuccessful group (p=0.19). Kaplan-Meier estimates of survival showed that patients with an initial OPA drop of more than 2.0 mmHg had a significantly better chance of an entirely uncomplicated 3-month outcome after TE than patients with an initial OPA drop of less than 2.0 mmHg (log rank p<0.01). This pilot study indicates that an early drop in OPA of more than 2.0 mmHg after TE may be a good prognostic parameter for successful long-term control of IOP.

Subconjunctival mucosa-associated lymphoid tissue (MALT) lymphoma arising in Tenon’s capsule

We report the first case of subconjunctival mucosa-associated lymphoid tissue (MALT) lymphoma arising in Tenon's capsule (fascia bulbi). A 75-year-old woman presented with painless swelling of the superior bulbar conjunctiva in her left eye. During the biopsy of the bulbar lymphoid lesion, it was noticed that the conjunctiva was movable and that the lesion was located in the subconjunctiva. The tissues were studied by conventional light microscopy, immunohistochemistry, flow cytometry, and gene rearrangement analysis. Histopathological examination revealed that a diffuse lymphoid infiltrate consisting of small-sized lymphoid cells was present in Tenon's capsule but not in the substantia propria of the conjunctiva. Immunohistochemical and flow cytometric studies documented tumor cells of B-lymphocyte lineage. Molecular analysis demonstrated positive immunoglobulin heavy chain gene rearrangement. The final diagnosis was subconjunctival MALT lymphoma arising in Tenon's capsule. Ophthalmologists and pathologists need to distinguish the subconjunctival lymphoma that arises in Tenon's capsule from the conjunctival lymphoma in the substantia propria during diagnosis of epibulbar lymphoid tumors.

Comparison of Topical Dexamethasone and Topical FK506 Treatment for the Experimental Allergic Conjunctivitis Model in Balb/c Mice

To evaluate the efficacy of topical dexamethasone and topical FK506 treatment on allergic inflammation in conjunctiva, we performed a comparative study using a mouse experimental allergic conjunctivitis model. The experimental allergic conjunctivitis model was developed by ovalbumin (OVA) instillation after OVA sensitization by intraperitoneal application of a mixed solution of OVA and aluminum hydroxide. The Balb/c mice of the experimental allergic conjunctivitis model were divided into three groups, depending on whether or not they received topical treatment and which type of treatment they received. The allergy group comprised six mice without topical treatment; the dexamethasone (Dx) group comprised six mice receiving topical 0.1% dexamethasone ointment treatment; and the FK506 (FK) group comprised six mice receiving topical 0.1% FK506 ointment treatment. The negative control group comprised six mice with neither sensitization nor topical treatment. For the histological examination, frozen sections of the eyelids, eyeballs, and lacrimal glands were stained with acid Giemsa stain or, in the immunohistochemical method, with alkaline phosphatase-antialkaline phosphatase (APAAP), for CD4. Densities of eosinophils and CD4-positive lymphocytes in the conjunctival tissue were counted. Productive C epsilon gene expression in the conjunctival tissue, including the lacrimal gland, was also evaluated by reverse transcriptase polymerase chain reaction (RT-PCR). In the histological study, the cell density of eosinophils infiltrating into subconjunctival tissues was 66.3 +/- 34.7 cells/mm(2) (mean +/- SD) for the allergy group, 2.5 +/- 4.2 cells/mm(2) for the Dx group, 4.2 +/- 8.6 cells/mm(2) for the FK group, and 3.7 +/- 7.6 cells/mm(2) for the negative control group. The cell density of CD4-positive cells infiltrating into subconjuctival tissues was 145.9 +/- 66.4 cells/mm(2) for the allergy group, 10.0 +/- 12.9 cells/mm(2) for the Dx group, 10.1 +/- 15.5 cells/mm(2) for the FK group, and 21.7 +/- 17.8 cells/mm(2) for the negative control group. The allergy group showed significant differences in the density of eosinophils and CD4-positive cells compared with those of the Dx (P < 0.0001) and FK (P < 0.0001) groups. In the RT-PCR study, the expression of productive C epsilon gene was positive in the Dx group, but negative in the allergy group, the FK group, and the negative control group. Topical Dx and FK506 treatments were both efficacious in suppressing eosinophil and lymphocyte infiltration into subconjunctival tissue in the mouse experimental allergic conjunctivitis model. However, the influence of their IgE productive mechanisms seemed to differ, causing different efficacy of productive C epsilon gene expression in the conjunctival tissue.

Intraoperative Mitomycin C and Amniotic Membrane Transplantation for Fornix Reconstruction in Severe Cicatricial Ocular Surface Diseases

To investigate whether intraoperative application of mitomycin C may enhance the success of amniotic membrane transplantation in symblepharon lysis and fornix reconstruction in severe cicatricial ocular surface diseases. Noncomparative interventional case series. Sixteen patients (8 female, 8 male; 18 eyes) with a mean age of 41+/-23.4 years (range, 3-79) and suffering from severe chemical/thermal burns (7 eyes), multiple recurrent pterygia and pseudopterygia (5 eyes), Stevens-Johnson syndrome (4 eyes), and ocular cicatricial pemphigoid (2 eyes) were consecutively enrolled. All except for 2 eyes had had prior surgical attempts of surgical reconstruction, including 6 eyes with a mucous membrane graft (MMG), but still presented with symblepharon and persistent ocular surface inflammation. After excision of subconjunctival fibrovascular tissues, 0.04% mitomycin C was applied for 5 minutes in the deep fornix before amniotic membrane transplantation. Deeper fornix, noninflamed ocular surface, and full motility. The mean epithelial healing time was 4.2+/-1.9 weeks. During the follow-up of 14.16+/-5.2 months, all eyes showed a marked reduction of conjunctival inflammation, a deep fornix, and a continuous tear meniscus. Of 12 eyes with motility restriction, 2 eyes with multiple recurrent pterygia and 1 eye with severe thermal burn showed recurrence of partial motility restriction 2 months after surgery. The vision of 9 eyes was successfully restored by an additional keratolimbal allograft with subsequent penetrating keratoplasty (6 eyes). Intraoperative application of mitomycin C is an effective means to reduce chronic and deep-seated conjunctival inflammation, and helps amniotic membrane restore a deep fornix after symblepharon lysis, even in eyes that had a failed MMG. Restoration of deep fornix and tear meniscus is an important prerequisite to achieve successful reconstruction by subsequent limbal stem cell transplantation.

Chronic Monocytic Leukemia in an Inland Bearded Dragon, Pogona vitticeps

ABSTRACT Chronic monocytic leukemia with infiltration to the liver, small intestine, kidneys, and subconjunctival tissues was diagnosed in a 5-year-old, male, captive-bred inland bearded dragon, Pogona vitticeps, that presented with lethargy, weight loss, and dehydration. Characterization of the neoplastic cells was aided by the use of cytochemical and immunohistochemical techniques.

Outcome of surgery for recurrent pterygium using intraoperative application of mitomycin C and amniotic membrane transplantation

Purpose Preserved human amniotic membrane has been used in reconstruction of the ocular surface. In this paper, we report our method of amniotic membrane transplantation (AMT) for recurrent pterygium. Methods Twenty-six eyes of 26 patients with recurrent pterygium are reported. All subjects were operated on with an extensive excision of the subconjunctival fibrous tissues followed by application of mitomycin C(0.04%, 3∼5 min) during the operation. Amniotic membrane transplantation was performed with implantation of conjunctival autograft in cases with a large excision. Results The mean follow-up time was 17.3±9.3 (mean±standard deviation) months. Twelve eyes showed severe symblepharon and 14 patients had suffered from double vision before the operation. There were only three mild recurrences (12%), 11 patients recovered from double vision, and no major complications such as sclermalacia performans were noted during the follow-up period. Conclusion AMT with application of mitomycin C is effective in preventing pterygium recurrence and for improved ocular movement. The cosmetic outcome of our methods has also been satisfactory.

A Case Of A Uniocular Pterygium Related To An Unusual Occupation

Introduction is a characteristic triangular shaped fibrovascular growth of conjunctival and subconjunctival tissue, which invades the cornea between the epithelium and Bowman’s layer at its apex. Pterygia occur within the...

New surgical treatment for superior limbic keratoconjunctivitis and its association with conjunctivochalasis

PurposeTo introduce a new surgical procedure for treating superior limbic keratoconjunctivitis (SLK) and to suggest the association of SLK with conjunctivochalasis. DesignInterventional case series. MethodsSix eyes of five patients with long-standing severe ocular irritation unresponsive to treatment with topical steroid and artificial tears were operated on using our new procedure. This technique consists of four steps as follows: (1) Rose bengal (RB) staining is used to localize the abnormal conjunctival area; (2) an arc-like conjunctival incision is placed from the 2 to the 10 o’clock position adjacent and distal to the RB-stained area; (3) the conjunctiva is resected to form a crescent using the arc-like incision as the base; the size of the resection is determined by conjunctival redundancy after removal of the subconjunctival connective tissue; and (4) the crescent conjunctival opening is closed with interrupted sutures. In two eyes, the new surgical procedure was performed together with surgery for inferior bulbar conjunctivochalasis. ResultsIn all operated eyes, RB staining had disappeared by the end of the second postoperative week; recovery from symptoms and loss of inflammation were recorded by 1 month after treatment. In the case with the longest follow-up (14 months), there was cytologic evidence of goblet cell recovery at 3 months after the operation. In another, there was normalization of the nucleo/cytoplasmic ratio of conjunctival cells without the appearance of goblet cells. ConclusionsOur treatment very effectively resolved symptoms associated with SLK, even in eyes unresponsive to conventional therapy with eye drops. Considering that we did not address the diseased part of the conjunctiva but rather the adjacent conjunctival redundancy, we propose that superior bulbar conjunctivochalasis is involved in the pathogenesis of SLK.

Amniotic membrane transplantation for reconstruction of the conjunctival fornices

Purpose To describe the clinical outcome of amniotic membrane transplantation (AMT) for fornix reconstruction in a variety of ocular surface disorders. Design Noncomparative interventional case series. Participants Seventeen eyes in 15 patients with symblepharon. Four eyes had ocular-cicatricial pemphigoid, two eyes had symblepharon after pterygium excision, four eyes had chemical or mechanical trauma, two eyes had strabismus surgery, two eyes (one patient) had Stevens-Johnson syndrome, one eye had toxic epidermal necrolysis, and two eyes (one patient) had chronic allergic conjunctivitis. Intervention The subconjunctival scar tissue was dissected from the episclera, and the freed conjunctival flap was recessed to the fornix. A layer of amniotic membrane (AM) was applied to cover the exposed episclera. The fornical edge of the membrane was anchored with sutures passing through the full thickness of the lid. Main outcome measures A deep conjunctival fornix, lack of motility restriction. Results The mean follow-up period was 37 ± 24 months (range, 9–84 months). Complete fornix reconstruction was demonstrated in 12 of 17 eyes (70.6%), whereas 2 eyes had a partial success, and 3 eyes (3 patients) had recurrence of symblepharon with restricted motility. In eyes that demonstrated partial success or failure, the underlying etiology was either an autoimmune disorder or a recurrent pterygium. The most successful outcome was observed in eyes with symblepharon associated with trauma. Conclusions AMT is an effective method of fornix reconstruction for the repair of symblepharon in a variety of ocular surface disorders. Future modifications, including an epithelial cellular component on the AM (conjunctival autograft or ex vivo expanded epithelial stem cells) may improve the outcome of this surgical procedure.

Partial Excision With A Conjunctival Advancement Flap After A Relaxing Incision for A Dissecting Glaucoma Filtering Bleb

A 65-year-old male patient developed dissecting glaucoma filtration bleb following trabeculectomy with mitomycin-C (MMC). Surgical partial excision of the bleb was performed and the tissue was subjected to histopathological evaluation. The bleb area was covered by a conjunctival flap that was advanced with the help of a relaxing incision in the superior conjunctiva fornix. The dissecting bleb was successfully managed by controlling intraocular pressure, and the patient became asymptomatic without any medication. The light microscopic examination of the bleb showed irregularly arranged collagen bundles and hypocellularity of the subconjunctival tissue with places of nodular configuration of the fibroblast in the periphery. Surgical partial excision of the dissecting glaucoma filtering bleb is a reliable, simple, and precise method. Advancing the conjunctival flap by a superior conjunctival relaxing incision facilitates easy mobilization of the flap, ensures healthy resurfacing of the bleb, and prevents postoperative transconjunctival leakage. Histopathology of the bleb is compatible with the use of MMC during original filtering surgery.

Apoptosis in the cornea in response to epithelial injury: significance to wound healing and dry eye.

Chronic ocular surface injury is a hallmark of dry eye disease. The extent of objective surface abnormality is highly variable between patients, and roughly correlates with the severity of the disease. These surface changes extend from mild conjunctival rose bengal staining to diffuse conjunctival and corneal rose bengal and fluorescein staining. Previous studies have demonstrated that corneal surface injury triggers keratocyte apoptosis and a subsequent wound healing response in the stroma. However, the majority of patients with mild to moderate surface abnormalities from dry eye have no evidence of stromal haze, unstable refractive error, or other changes that would be expected if significant ongoing stromal wound healing were triggered by the surface changes. Superficial injury to the corneal or conjunctival epithelium probably does not induce stromal wound healing because of the intact barrier function of the epithelium and lack of penetration of proapoptotic cytokines into the corneal stroma and subconjunctival tissues. New data suggest in response to IL-1 or tumor necrosis factor (TNF) alpha is monocyte chemotactic and activating factor (MCAF)18 (also Hong, Liu, and Wilson, unpublished data, 2000). This upregulation of MCAF in response to IL-1 or TNF alpha stimulation was confirmed by RNAse protection assay (mRNA) and western blotting (protein). MCAF has chemotactic effects on monocyte and macrophage cells. This observation has led us to formulate a model to explain factors attracting inflammatory cells into corneal stroma or subconjunctival connective tissue in response to epithelial injury. This hypothesis holds that: 1) Significant injury to the epithelium (mechanical or other) results in the release of IL-1 and TNF alpha from the epithelial cells. 2) If the injury to the epithelium is sufficient to break down the epithelial barrier function, then IL-1 and TNF alpha penetrate into the stroma or subconjunctival tissues. Some types of injury might directly trigger release of IL-1 or TNF alpha from the basal epithelial cells. 3) IL-1 or TNF alpha that penetrates into the subepithelial tissues binds to receptors expressed by keratocytes or conjunctival fibroblasts, and triggers MCAF production. 4) MCAF attracts and activates macrophages. Work is in progress to characterize the effects of MCAF. We also hope to identify other cytokines released by keratocytes or conjunctival fibroblasts that attract T cells and polymorphonuclear cells in response to epithelial injury or other pathophysiological triggers.

Chymase and angiotensin converting enzyme activities in a hamster model of glaucoma filtering surgery

Purpose. Two pathways for the formation of angiotensin II (Ang II) in local tissues are known to exist, one involving angiotensin-converting enzyme (ACE), and the other in which chymase plays a role. It has been shown that chymase activity is present in monkey, dog, and hamster eyes. Because chymase activates various cytokines by increasing Ang II formation, thereby promoting the production of extracellular matrix, the role of Ang II in wound healing has attracted much interest. In this work, we created sclerocorneal wounds in hamster eyes and measured the levels of ACE and chymase activities in the eye during the wound healing process. Methods. Sclerocorneal wounds were made at 6 locations on the corneal limbus of one eye in each of 36 hamsters. Using the contralateral eyes as controls, we measured levels of chymase and ACE activities in the overall eye at 3, 7, and 21 days postoperatively. Histopathological evaluations of the sclerocorneal wounds in the treated eyes were also carried out for samples stained with toluidine blue. Results. Chymase activity in the treated eyes tended to be higher than that in the control at 21 days. ACE activity in the treated eyes was significantly higher than that in the control at 3, 7, and 21 days postoperatively. Histopathological examination revealed increased mast cells in the subconjunctival tissue and around the tunnel opening in the sclerocornea. Conclusions. These findings show that not only ACE but also chymase contributes to the formation of Ang II in the healing of sclerocorneal wounds in hamster eyes. This leads to the suggestion that ACE inhibitors or chymase inhibitors could potentially inhibit scarring in glaucoma filtering surgery.

Cultivated corneal epithelial stem cell transplantation in ocular surface disorders

Purpose To investigate the outcome of cultivated corneal epithelial transplantation for severe stem cell deficiencies using denuded amniotic membrane (AM) as a carrier. Design Retrospective, noncomparative case series. Participants Thirteen eyes of 11 patients were studied. These consisted of five eyes with acute Stevens-Johnson syndrome (SJS), two with chronic SJS, one with an acute chemical injury, two with chronic chemical injuries, two with ocular cicatricial pemphigoid, and one with drug-induced pseudopemphigoid. All of these eyes had total stem cell deficiencies. Main outcome measures Adaptation of the cultivated corneal epithelium onto the host corneal surface was confirmed 48 hours after surgery. The reconstruction of the ocular surface and visual acuity were measured. Methods Corneal limbal epithelium from donor corneas was cultivated for 4 weeks on a denuded AM carrier, with 3T3 fibroblast coculture and air lifting. The cultivated corneal epithelium showed four to five layers of stratification and was well differentiated. After conjunctival tissue removal from the cornea up to 3 mm outside the limbus and subconjunctival tissue treatment with 0.04% mitomycin C, cultivated allocorneal epithelium, including the AM carrier, was transplanted onto the corneal surface up to the limbus. Lamellar keratoplasty, using preserved donor graft without epithelium, was performed simultaneously for five chronic-phase patients showing corneal stromal scarring. Systemic immunosuppression was used to prevent allograft rejection. Results In all 13 eyes, the entire corneal surface, on which cultivated allocorneal epithelium had been placed, was free from epithelial defects 48 hours after surgery, indicating complete survival of the transplanted corneal epithelium. Visual acuity improved in all eyes after surgery, and 10 of the 13 eyes were restored to good vision (postoperative visual acuity improved two or more lines) 6 months after the operation. During the follow-up period (mean ± standard deviation, 11.2 ± 1.3 months), the corneal surfaces were clear, although three eyes experienced epithelial rejection. Conclusions Cultivated corneal epithelial transplantation using denuded AM as a carrier can be used for severe stem cell deficiencies.

Bindehautzyste: Subkonjunktivale Linsenluxation durch Bulbusprellung - Kasuistik1

Presentation of a 75-year-old female with subconjunctival lens luxation, that was initially misdiagnosed as conjunctival cyst. Initial examination had been difficult due to vascularized stromal corneal scars and a large hyphema. The ocular history revealed an ocular contusion 11 months ago. Aphakia with subconjunctival lens luxation, iris incarceration, iridodialysis and covered scleral rupture were diagnosed by inspection, palpation, slit-lamp biomicroscopy, gonioscopy and ultrasound biomicroscopy. The lens and incarcerated iris tissue were removed, the scleral wound was sutured and a penetrating keratoplasty was performed in combination with anterior vitrectomy and implantation of a transclerally sutured posterior chamber lens. The histologic investigation of the subconjunctival tissue showed the complete lens with intact lens capsule and surrounding subconjunctival connective tissue. Hyphemas following ocular contusion are frequent findings. A large hyphema may masquerade alterations of other ocular structures. The differential diagnosis of posttraumatic prominent conjunctival "tumors" should include subconjunctival luxation of the lens.