Tenon's Capsule Research Articles

Transforming Growth Factor-β1–induced Human Subconjunctival Fibrosis is Mediated by MicroRNA 143/145 Expression

To investigate the roles and pathways of microRNAs 143 and 145 in transforming growth factor (TGF)-β1-induced human subconjunctival fibrosis. Human tenon's capsule fibroblasts (HTFs) were obtained from a healthy eye. After treating cultured HTFs with TGF-β1, the expression of microRNAs 143 and 145 was evaluated using polymerase chain reaction. To identify the pathways of TGF-β1-induced microRNA 143/145 expression, HTFs were treated with specific inhibitors of p38MAPK, PI3K/Akt, JNK, ERK, and with siRNAs for SMAD2 and SMAD4. Mutagenesis studies were performed to evaluate the role of the CArG box and SMAD-binding element (SBE). To investigate the role of microRNA 143/145 in TGF-β1-induced myofibroblast transdifferentiation, microRNA 143/145 mimics and microRNA 143/145 inhibitors were applied to the HTFs. Array analysis revealed that TGF-β1 induced the expression of microRNA 143/145 in a dose- and time-dependent manner. When inhibitors and siRNAs for p38MAPK, PI3K/Akt, ERK, and JNK were applied, the TGF-β1-induced expression of microRNA 143/145 was inhibited; however, SMAD2 and SMAD4 inhibition did not affect the TGF-β1-induced expression of these microRNAs. In the mutagenesis studies, both the CArG box and SBE were associated with TGF-β1-induced expression of microRNA 143/145. Mimics of microRNA 143/145 induced increased myofibroblast formation, whereas their inhibitors had the opposite effect. TGF-β1-induced human subconjunctival fibrosis was mediated by the expression of microRNA 143/145, mainly via SMAD-independent pathways. Inhibition of TGF-β1-induced microRNA 143/145 expression in HTFs might represent a novel strategy to prevent subconjunctival fibrosis.

Features of Tissue Reaction in the Tenon Capsule in Progressive Myopia

Background: Research actuality is determined by the first, the prevalence of refraction errors including progressive myopia among children secondly, high risk and tends to develop complications from the visual organ in refractive disorders.Aims: To investigate tissue reactions occurring in the Tenon’s capsule with anomalies of refraction, including with progressive myopia.Materials and methods: A one-step study of the Tenon’s capsule of 47 samples (25 with hyperopia and 22 with progressive myopia) was carried out. The material of the Tenon’s capsule was obtained during surgical treatment of strabismus and sclera strengthening operations with progressive myopia. The Tenon’s capsule was studied at different levels: tissue, cellular, subcellular. Fragments of Tenon’s capsule were stained with hematoxylin-eosin and picrofuchsin mixture by the method of van Gieson at the tissue level. This allowed obtaining a general picture of the morphology of Tenon’s capsule. Fragments of Tenon’s capsule were stained by toluidine blue in tetraborate sodium at the cellular level. This gave the opportunity to define the scope for ultratome and spend morphometry of cellular composition. A fragment of Tenon’s capsule was studied by transmission electron microscopy (TEM) at the subcellular level and was performed ultrastructural morphometry of fibroblasts, evaluation of the density of the collagen fibers.Results: Were evaluated by qualitative and quantitative characteristics of the structure of Tenon’s capsule with two anomalies of refractions: progressive myopia and hyperopia: with progressive myopia in Tenon’s capsule, in contrast to hyperopia, the following number of fibroblasts (1.56±0.12 per 104 µm2), mast cells (0.08±0.02 per 104 µm2), adipocytes (0.01±0.001 per 104 µm2) were observed; ultrastructural features of fibroblasts were represented by such quantitative characteristics: the area of the fibroblast nucleus was 1.60±0.82 in µm2, the length of the karyolemma was 6.99±0.189 µm, the number of nucleoli was 0.17±0.015 per 1 µm2, the number of mitochondria and lysosome -2.05±0.14 per 1 µm2; 0.64±0.08 per 1 µm2, respectively); the density of collagen fiber was 28.72±4.18%, fibrillar fibrillation and fragmentation were recorded.Conclusions: Hyperplasia of fibroblasts and their ultrastructures, mast cells, reduction in the level of adipocytes and the density of collagen fibrils ― these changes are features of the tissue reaction in the tenon capsule and reflect the adaptive nature of the processes occurring during progressive myopia.

Relationship between the location of the XEN® stent glaucoma implant (with respect to the Tenon capsule) and the intraocular pressure

Relationship between the location of the XEN® stent glaucoma implant (with respect to the Tenon capsule) and the intraocular pressure

Differential effects of dexamethasone and indomethacin on Tenon's capsule fibroblasts: Implications for glaucoma surgery

Dysregulated wound healing and subsequent fibrosis represents the most common cause of failure in glaucoma filtration surgery. Primary means to prevent this outcome are the anti-metabolite surgical adjuvants, however, topical corticosteroids are commonly used postoperatively to permit further control of wound healing and development of the filtration bleb. Unfortunately, they carry important side effects such as raised intraocular pressure, cataract and increased infection risk. Non-steroidal anti-inflammatory drugs (NSAIDs) show promising results in clinical trials as an alternative wound modulatory drug. NSAIDs exhibit non-inferiority to steroids in terms of post-operative intraocular pressure control and secondary IOP lowering interventions, however there is little known about the differing effects these drugs exert on human Tenon's capsule fibroblast (HTCF) mediated wound healing. The purpose of this study was to assess the individual effects of dexamethasone and indomethacin on the extracellular matrix modifying actions of HTCFs in vitro. To this end, HTCFs were cultured in 3D collagen matrices as well as in 2D monolayers and exposed to clinically relevant concentrations of dexamethasone or indomethacin for up to seven days. HTCF-mediated wound healing functions were assayed through collagen matrix contraction, extracellular matrix morphology, estimation of HCTF proliferation and differentiation into myofibroblasts within the collagen matrices, as well as western blot. Both drugs significantly reduced HTCF-mediated collagen contraction relative to control however there was a significant trend towards greater inhibition with indomethacin exposure compared to dexamethasone. Indomethacin exposure significantly reduced HTCF-mediated collagen remodelling activity compared vehicle control, whereas dexamethasone was unable to reduce remodelling activity at any of the studied exposures. Both drugs reduced myofibroblast differentiation, however indomethacin alone demonstrated an inhibitory effect on final cell number relative to control whereas dexamethasone had no significant effect at any studied exposure. These findings demonstrate that both steroidal and NSAID treatment can mitigate HTCF-mediated collagen contraction and αSMA expression. However, NSAIDs may function to better impede HTCF proliferation and remodelling activity. Taken in the context of previous glaucoma surgical trials, NSAIDs appear to be a viable alternative to steroids for post-operative wound modulation.

Investigation of Conjunctival Fibrosis Response Using a 3D Glaucoma Tenon's Capsule + Conjunctival Model.

Surgical techniques such as trabeculectomy aim to treat glaucoma by making an incision into the scleral tissue, to create an alternative drainage pathway for aqueous to flow into the sub-Tenon's/subconjunctival space. However, tissue fibrosis and wound healing occurring after the procedures can reduce the success rate. This study aims to investigate the synergistic effects of aqueous humor in combination with shear stress on the fibrosis response occurring in Tenon's capsule and conjunctival tissue (TCCT) after glaucoma surgery. Two-dimensional (2D) and 3D in vitro TCCT models were constructed by seeding porcine Tenon's capsule + conjunctival fibroblasts in collagen gel. These were used to investigate key growth factors (singular and natural form) with shear stress, which are believed to influence tissue fibrosis after glaucoma surgery. In addition to cell proliferation assessments, a nondestructive assay to quantify neocollagen synthesis in TCCT models, in response to these factors, has been applied up to 14 days. TCCT fibroblast proliferation increased significantly with doses of TGF-β, TNF-α, and VEGF, in comparison with the control. Furthermore, fibroblasts exposed to 50% aqueous humor had significantly increased proliferation and actin expression. Shear stress-induced mechanotransduction was also found to promote metabolic activity across experimental conditions. Neocollagen labeling cross validated the fibrosis process. Shear stress appeared to enhance the influence of key growth factors and further promoted fibrotic response within the model. These findings offer a useful insight for further study into the wound-healing response triggered by aqueous fluid outflow after glaucoma surgery.

The Smad2/3/4 complex binds miR-139 promoter to modulate TGFβ-induced proliferation and activation of human Tenon's capsule fibroblasts through the Wnt pathway.

The activation and proliferation of human Tenon's fibroblasts (HTFs) play a vital role in the fibrosis in the pathology of the scar formation after the glaucoma filtration surgery. Transforming growth factor β1 (TGFβ1)/Smads signaling has been reported to promote fibrosis. In our previous study, we revealed that TGFβ1-induced orbital fibroblast activation and proliferation through Wnt/β-catenin signaling. As microRNA (miR)-139 could target several factors in Wnt signaling to modulate fibrosis, here, the effect and mechanism of miR-139 in HTF activation and proliferation were investigated. miR-139 overexpression significantly reversed the TGFβ1-induced increase in collagen I and α-smooth muscle actin contents and proliferation in HTFs. CTNNB1 and CTNND1 were direct downstream of miR-139 and can significantly restore the suppressive effect of miR-139 on the activation and proliferation in HTFs under TGFβ1 stimulation. Smad2/3/4 complex inhibits the transcription activity of miR-139, most possibly by Smad4 binding to the miR-139 promoter. Taken together, we demonstrated a new mechanism of HTF activation and proliferation from the perspective of miRNA regulation, which may provide new strategies for improving the fibrosis after the glaucoma filtration surgery.

Involvement of ER Stress in Human Primary Pterygium

Purpose: The aim of this study was to investigate the ER stress activation in human primary pterygium. Methods and materials: Human primary pterygium or normal Tenon's capsule tissues were obtained from patients with primary pterygium following surgical excision or from normal human fresh cadaver eyes. The tissues were processed within 2 hours. The mRNA or protein specimens were extracted from those tissues for analysis, cryosections of those tissues were prepared for immunohistochemical staining. The mRNA levels of endoplasmic reticulum (ER) stress-related factors in those tissues were detected by qPCR analysis and the related proteins levels were detected by qPCR analysis and immunohistochemical staining or western blotting. Results: The ER stress-related gene transcription levels of GRP78，spliced XBP-1, ATF4 and ATF6 and the protein expression levels of GRP78, p-IRE1α, p-eIF2α and ATF6 were all increased in the human primary pterygium tissues when compared with the normal control tissues. Conclusion: The results in this study suggest that the three unfolded protein response pathways are all activated in the human primary pterygium tissues, which indicates that the ER stress is involved in the progression of pterygium, and also suggests a potential mechanism of ER stress-induced inflammation in the human primary pterygium tissues.

Inhibition of hepatocyte growth factor on proliferation and transdifferentiation of human Tenon capsule fibroblasts triggered by transforming growth factor-β1in vitro

Objective To investigate the effects of hepatocyte growth factor (HGF) on proliferation and transdifferentiation of human Tenon capsule fibroblasts induced by transforming growth factor -β1 (TGF-β1) in vitro. Methods Human Tenon capsule fibroblasts were cultured and divided into blank control group, TGF-β1 treated group and different concentrations HGF+ TGF-β1 groups.The TGF-β1 at 10 μg/L was added into culture medium of the TGF-β1 treated group, and different concentrations of HGF (25, 50, 100, 200 μg/L) and 10 μg/L TGF-β1 were added into culture medium of the HGF25 μg/L+ TGF-β1, HGF50 μg/L+ TGF-β1, HGF100 μg/L+ TGF-β1, HGF200 μg/L+ TGF-β1 group respectively, Methyl thiazolyl tetrazolium (MTT) was employed to measure the cell proliferation (absorbance at 560 nm). Immunofluorescence staining was used to evaluate and locate the expression of α-smooth muscle action (α-SMA) in the cells.The expression of α-SMA protein in the cells was detected by Western blot assay. Results Cultured cells showed fusiform in shape with the positive response for vimentin.The proliferation value of the cells was 0.203±0.025, 0.497±0.101, 0.426±0.062, 0.354±0.040, 0.272±0.084, 0.241±0.011 in the blank control group, TGF-β1 treated group, HGF25 μg/L+ TGF-β1 group, HGF50 μg/L+ TGF-β1 group, HGF100 μg/L+ TGF-β1 group and HGF200 μg/L+ TGF-β1 group, respectively, showing a significant difference among the groups (F=9.210, P=0.003). Compared with the TGF-β1 treated group, the proliferation values of the cells were significantly reduced in the blank control group and HGF+ TGF-β1 group (all at P<0.05). Immunofluorescence staining showed that α-SMA protein mainly located in cytoplasm with the strong red fluorescence in the cells of the TGF-β1 treated group and weak red fluorescence in HGF+ TGF-β1 group, and the expression of α-SMA was absent in the blank control group.The percentage of α-SMA-positive cells was (60.0±4.7)% in the TGF-β1 treated group and (14.3±3.1)% in the HGF+ TGF-β1 group, with significant difference between the two groups (t=19.856, P<0.001). The relative expression levels of the α-SMA protein in the cells were 0.642±0.032, 1.330±0.069 and 0.884±0.040 in the blank control group, TGF-β1 group and HGF100 μg/L+ TGF-β1 group, respectively, showing a significant difference among the groups (F=13.370, P<0.001), and relative expression levels of the α-SMA protein in the cells were significantly lower in the blank control group and HGF100 μg/L+ TGF-β1 group than that in the TGF-β1 treated group (all at P<0.05). Conclusions HGF can inhibit the proliferation of human Tenon capsule fibroblasts, down-regulate the expression of α-SMA protein induced by TGF-β1 and arrest the phenotype transformation of fibroblasts in vitro. Key words: Tenon capsule/cytology; Fibroblasts/metabolism; Hepatocyte growth factor/administration & dosage; Transforming growth factor beta type 1; Fibrosis/prevention & control; α-Smooth muscular actin; Humans; Cells, cultured

Anti-scarring effect of rapamycin in rabbits following glaucoma filtering surgery

To study the anti- scarring effect of rapamycin in rabbits receiving glaucoma filtering surgery. Ninety-six Chinchilla rabbits were randomized equally into 3 rapamycin treatment groups and one control group. All the rabbits underwent trabeculectomy, after which the rabbits in the 3 rapamycin groups were treated with eye drops containing 1%, 3%, or 5% rapamycin in the operated eyes, and those in the control groups were given castor oil 4 times a day. The intraocular pressure (IOP) and inflammatory reaction in the treated eyes were observed, and the PCNA-positive cells in the filtering bleb were detected using immunohistochemistry. RTFs isolated from the Tenon's capsule of the rabbits were cultured in vitro, and the expressions of caspase-3, caspase-8, and caspase-9 in the fibroblasts were detected after treatment with different concentrations of rapamycin. The IOP was significantly lower in rapamycin-treated group than in the control group after the surgery (P &lt; 0.05). The counts of the PCNA-positive cells were significantly lower in rapamycin-treated rabbits than in the control group (P &lt; 0.05). Rapamycin treatment dose-dependently increased the expressions of caspase-3 and caspase- 9 at both the mRNA (P &lt; 0.001) and protein (P &lt; 0.001) levels without causing significant changes in the expressions of caspase-8. Rapamycin can inhibit excessive proliferation of the fibroblasts in the filtering bleb to reduce scar formation after glaucoma filtration surgery in rabbits. Rapamycin also increases the expressions of caspase-3 and caspase-9 to induce apoptosis of the RTFs.

Comparison of 2-year-results of mitomycin C-augmented trabeculectomy with or without cataract extraction in glaucoma patients

PurposeComparison of the 2-year results of phacotrabeculectomy (CET) and trabeculectomy (TE), both augmented with mitomycin C. MethodsThis prospective study enclosed 246 eyes in 246 consecutive patients that had undergone trabeculectomy (n = 85) or phacotrabeculectomy (n = 161, hereof n = 10 phacoretrabeculectomy) augmented by mitomycin C. Endpoints were best corrected visual acuity (BCVA), intraocular pressure (IOP), and number of antiglaucomatous medications at baseline, 3 months, and 2 years postoperatively. Postoperative management involved local steroid application and laser suture lysis according to a standardized protocol. ResultsBoth interventions reduced IOP statistically significant and stable. In the phacotrabeculectomy group BCVA improved from 0.45 ± 0.47 logMAR units preoperatively to 0.28 ± 0.54 logMAR units at 2 years (p < 0.001) and remained unchanged in the trabeculectomy group. After 2 years IOP reduced from 22.5 ± 7.2 mm Hg preoperatively to 11.5 ± 3.1 mm Hg in the TE group and from 20.0 ± 5.4 mm Hg to 12.5 ± 4.8 mm Hg in the CET group (both p > 0.05). The mean number of antiglaucomatous medications was significantly reduced from 2 ± 1 in both groups to 0.3 in the trabeculectomy group and to 0.4 in the phacotrabeculectomy group. With this standardized surgical procedure and postoperative protocol, there was no need for local postoperative antimetabolites. No Tenon's capsule cysts developed. In the subgroup of patients with phacoretrabeculectomy BCVA and IOP improvements were comparable to the phacotrabeculectomy group outcomes. ConclusionsPhacotrabeculectomy is comparably as effective as trabeculectomy alone in reducing IOP and the need for antiglaucomatous medication over a time interval of 2 years. We found indications that this favourable therapeutic effect is also true for patients needing phacoretrabeculectomy treatment.

Analysis on the efficacy of different exsection range in pterygium

Objective To analyse the efficacy of different exsection range in pterygium excision combined with conjunctival limbal autograft transplantation. Methods The clinical data of 86 eyes of 86 patients with ptergium, from Jan. 2016 to Jan. 2017 were analyzed retrospectively.Among them 2 cases were recurrent pterygium. All cases were divided into 2 groups randomly.Group A, 44 cases, treated with pterygium extended excision combined with Tenon’s capsule excision.Group B, 42 cases, received obvious hyperplasia pterygium excision only.The follow-up time was 1 year.Postoperative recurrence rates, efficacy and complications between both groups were compared and analyzed. Results The difference of length, width of pterygium invaded the cornea and the age of onset were not statistically significant between the two groups (P=0.247, 0.185, 0.125). In group A, the conjunctival of grafting bed occurred persistent congestion in 3 eyes after surgery. At the end of follow up, no recurrent or scar exposure occured.In group B, there were 10 cases with repeated conjunctival congestion in grafting bed. The conjunctival fibrovascular tissue proliferation and significant scar tissue exposure occured in 5 eyes(11.9%). Conclusion Pterygium extended excision combined with Tenon’s capsule excision is an efficient method for pterygium.It may reduce recurrence and improve postoperative conjunctival congestion. Key words: Surgery; Pterygium; Exsection range; Recurrence

TGF-β2 induces proliferation and inhibits apoptosis of human Tenon capsule fibroblast by miR-26 and its targeting of CTGF

AimThe aim of this study was to research the effect of TGF-β2 on human enon capsule fibroblasts proliferation and apoptosis and its potential mechanism. MethodsHuman eyeball fascia tissues (n = 45) were derived from ocular fascia tissues of patients who were underwent glaucoma filtration surgery, and Tenon capsule fibroblasts were obtained from these tissues. Liposome-mediated transfection, CCK8 assay, Hoechst33258 staining, qRT-PCR detection, western blot, and luciferase reporter assay were performed. ResultsTGF-β2 promoted proliferation and inhibited apoptosis of human Tenon capsule fibroblasts in a dose-dependent manner. TGF-β2 induced down-regulation of miR-26 and up-regulation of CTGF in a dose-dependent manner. CTGF was the target gene of miR-26 and miR-26 had a negative regulatory effect on CTGF expression. miR-26 up-regulation could significantly decrease proliferation and increase apoptosis of human Tenon capsule fibroblasts after induced by TGF-β2 (P < 0.05). Down-regulation of CTGF could markly decrease proliferation and increase apoptosis of human Tenon capsule fibroblasts after induced by TGF-β2 (P < 0.05). ConclusionmiR-26 could inhibit proliferation and promote apoptosis of human Tenon capsule fibroblasts after they were induced by TGF-β2 through suppressing CTGF expression.

Tacrolimus inhibits proliferation and induces apoptosis by decreasing survivin in scar fibroblasts after glaucoma surgery.

To investigate the effect of tacrolimus on the proliferation of fibroblasts after glaucoma surgery. Biopsy was applied in this study. Under aseptic conditions, tissues were collected from rabbits, cut into small pieces and cultured. Morphology of fibroblasts was observed under a microscope. Features of fibroblasts were identified via immunocytochemistry and reverse transcription-polymerase chain reaction (RT-PCR). Western blotting and RT-PCR were performed to detect the expressions of related proteins after treatment. Flow cytometry and cell counting kit-8 (CCK-8) assay were employed to examine the proliferation of human Tenon's capsule fibroblasts (HTFs) after tacrolimus treatment. Tacrolimus decreased the levels of survivin and α-smooth muscle actin (α-SMA) after transforming growth factor-β (TGF-β) treatment. Besides, it inhibited proliferation and induced apoptosis of HTFs. Tacrolimus reduces proliferation and promotes apoptosis of HTFs by inhibiting the expression of survivin, which may be a strategy for treating hypertrophic scar after glaucoma surgery.

Is Autophagy Dysfunction a Key to Exfoliation Glaucoma?

In this short report we review previous work toward the identification of the protein and cellular sources of exfoliation glaucoma and described our recent finding on dysfunction of autophagy in Tenon capsule fibroblasts obtained from exfoliation syndrome glaucoma patients at the time of surgery and discuss the potential implications of these findings for understanding the cellular sources of the disease.

MR findings of the orbit in patients with Vogt-Koyanagi-Harada disease.

We aimed to evaluate the MR findings of the orbit in patients with Vogt-Koyanagi-Harada disease (VKHD). We included 14 patients with clinically diagnosed VKHD, who underwent orbital MR imaging before treatment between May 2011 and August 2017. The mean duration from initial symptom onset to MR imaging was 16days (range, 2-36days). Fat-suppressed gadolinium-enhanced T1-weighted images were obtained in six patients. We retrospectively assessed the choroids and Tenon's capsules for the presence of thickening on unenhanced images and abnormal enhancement on contrast-enhanced images. Bilateral choroidal thickening was observed in 14 patients (100%) on T1-weighted images and in 12 patients (85.7%) on T2-weighted images. Choroidal thickening showed posterior pole predominance in 11 patients (78.6%) and diffusely distributed in the remaining three patients (21.4%). Bilateral Tenon's capsule thickening was observed in five patients (35.7%) on T1-weighted images and in 14 patients (100%) on T2-weighted images. On contrast-enhanced images, the choroids and Tenon's capsules were abnormally enhanced in six patients (100%). MR imaging sensitively detected abnormalities of the choroids and Tenon's capsules in patients with VKHD. Bilaterality and predominant posterior pole distribution were characteristic of choroidal VKHD.

Induction of pluripotent stem cells by reprogramming human ocular fibroblasts under xeno-free conditions

To develop an efficient and xeno-free standard eye-derived induced pluripotent stem cell reprogramming protocol for use during induced pluripotent stem cell-based cell therapies in treating retinal degenerative diseases and to compare the relative effectiveness of both animal- and non-animal-derived culture systems in the generation of induced pluripotent stem cells. Primary cultured human pterygium fibroblasts and human Tenon's capsule fibroblasts were induced to induced pluripotent stem cells using a non-in-tegrated virus under two xeno-free systems; as part of this study, a traditional non-xeno-free reprogramming system was also assessed. Induced pluripotent stem cell clones were selected and counted by live staining. Reprogramming efficiencies were evaluated between the fibroblasts and among different culture systems. In a series of experiments, such as PCR and immunofluorescence staining, the induced pluripotent stem cells were characterized. Human pterygium fibroblast- and human Tenon's capsule fibroblast-derived induced pluripotent stem cells were successfully established using different reprogramming systems, under which they exhibited properties of induced pluripotent stem cells. Reprogramming efficiencies of induced pluripotent stem cells using the cell therapy system, the traditional system, and the E6/E8 system were 0.014%, 0.028%, and 0.001%, respectively, and those of human pterygium fibroblast- and human Tenon's capsule fibroblast-derived induced pluripotent stem cells-using the aforementioned systems-were 0.018% and 0.017%, respectively. Sendai virus facilitates induced pluripotent stem cell reprogramming of ocular fibroblasts-both human pterygium and human Tenon's capsule fibroblasts being safe and efficient for induced pluripotent stem cell reprogramming. Although the reprogramming efficiencies of ocular-derived induced pluripotent stem cells under xeno-free conditions were not superior to those observed using the traditional reprogramming system, the cell therapy system reprogramming system is a good option when induced pluripotent stem cells are to be induced under xeno-free conditions.

Penetrating Orbitocranial Injury

SUMMARY – A case of a 37-year-old female patient is presented. The patient was admitted to the Surgical Emergency Unit after accidental fall on a metal rod when she had sustained stab injury of the right orbit with penetration into the right frontal brain lobe. Multi-slice computed tomography (MSCT) showed penetrating injury and fracture of the right orbital roof without eyeball damage and endocranial impressed bone fragments into the right frontal brain lobe. Urgent surgical intervention was performed by a maxillofacial surgeon and neurosurgeon, including reposition of bone fragments of the orbital roof and cranioplasty. Reconstruction of Tenon’s capsule of the right eyeball was performed by an ophthalmologist. From the intraoperative wound swab of the orbit, Bacillus cereus was isolated, therefore the patient was administered ciprofloxacin and rifampicin as recommended by an infectious disease (ID) specialist. Follow up brain MSCT at 15 days and magnetic resonance imaging of the brain at 25 days showed brain edema in the right frontal area and signs of local brain abscess. Intravenous administration of the ciprofloxacin and metronidazole antibiotics with corticosteroids for edema suppression were ordered by the ID physician. Fourteen weeks after this therapy, brain MSCT showed complete abscess regression and no neurologic deficit with only mild psychomotor changes.

The Anti-fibrotic Effect of Nilotinib on Tenon's Capsule Fibroblastsin Vitro

The Anti-fibrotic Effect of Nilotinib on Tenon's Capsule Fibroblasts<i>in Vitro</i>

Advanced Subconjunctival Anesthesia for Cataract Surgery.

Ocular regional blocks generally require blind instrumentation to the posterior orbit, leading to rare but serious complications. However, topical anesthesia does not suppress eye or lid movements and may lead to more surgical complications. Advanced subconjunctival anesthesia (ASCAN) is a technique developed to provide reliable akinesia and anesthesia without anterior dissection or blind intrusion into the posterior orbit, while allowing visualization of the needle-tip position. Nonrandomized case series at a rural health service. Advanced subconjunctival anaesthesia was performed on 60 elective adult patients undergoing phacoemulsification surgery. The technique involves piercing the conjunctiva and Tenon's capsule in the superior outer quadrant of the globe with a 25-gauge, 16 mm needle, using either lignocaine 2% plain or in equal mix with bupivicaine 0.5%. Up to 10 mL of anesthetic with hyaluronidase 30 IU/mL is injected in a posterior direction into the sub-Tenon's space. Ocular motor functions were assessed 10 minutes after ASCAN using a Brahma scale. Pain was assessed during surgery and at the end of surgery after subconjunctival injection of antibiotic and steroid using a verbal Numeric Rating Scale. All patients completed surgery without needing supplemental anesthesia. Fifty-eight patients (97%) were pain free, whereas 2 patients experienced transient mild pain. Adequate globe akinesia and reliable lid paralysis was achieved comparable to other studies, with no major surgical or anesthetic complications. Advanced subconjunctival anesthesia is a visually guided, minimally invasive technique, achieving satisfactory analgesia and akinesia for phacoemulsification surgery.

Involvement of Rho-associated coiled-coil kinase signaling inhibition in TGF-β1/Smad2, 3 signal transduction in vitro.

To research the effect of Y-27632, a selective Rho-associated coiled-coil kinase (ROCK) inhibitor, on TGF-β1/Smad2, 3 signal transduction in ocular Tenon's capsule fibroblasts (OTFs). Primary ocular Tenon's capsule fibroblasts had been cultured in vitro. The effect of Y27632 on proliferation of OTF stimulated by lysophosphatidic acid (LPA) was evaluated by MTT colorimetric assay so as to sift out the proper concentrations range of Y-27632 for the next experiment. Real time-polymerase chain reactor (RT-PCR) was to analyze the changes of Smad2 and Smad3 genes of cells affected by Y-27632, though unaffected by transforming growth factor-beta1 (TGF-β1). Proteins of Smad2, Smad3, phosphorylated Smad2 (Ser245/250/255), and phosphorylated Smad3 (Ser423/425/203) were respectively quantified by Western blot after OTFs were successively incubated by TGF-β1 and Y-27632. Meanwhile, α-smooth muscular actin (α-SMA) protein was also quantified after the small intervening gene fragments of human Smad2 and Smad3 were designed, synthesized, and then transfected to OTFs. Y-27632 significantly inhibited OTFs proliferation stimulated by LPA. Also Y-27632 significantly suppressed the expressions of Smad2 mRNA, Smad2, 3 proteins expressions, Smad3 phosphorylation at the carboxylic terminals of Ser423/425/203 which had been radically promoted by TGF-β1. SiRNA-Smad2, 3 suppressed α-SMA expressions, but less effectively than Y-27632. The inhibition of ROCK signaling may be a potential therapeutic candidate for the treatment of the filtration channel fibrosis.