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Clinical ophthalmology (Auckland, N.Z.) 01/2013; 7:243-6.
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ABSTRACT: Tissue retraction is implicated in the pathogenesis of various ophthalmic disorders. Here we describe the clinical characteristics, epidemiology and pathophysiology of a form of retraction syndrome which - to the best of our knowledge - has not been reported in the ophthalmic literature so far. We have termed this condition - consisting of a slowly progressive pseudovertical shortening of tie length due to a horizontal extension of girth length - the "Tie retraction syndrome" (TRS). Other pathognomonic features include an increased tie tip to belt buckle distance and a prolapse of the subumbilical fat pad (SUFP). The syndrome has a clear male to female preponderance and shows an increasing incidence with age and income before tax. Based on a newly proposed grading scheme we discuss and illustrate the diagnosis as well as the medical and surgical management options of this abundant, but often undiagnosed condition. The authors have no explanation for the apparent lack of awareness for this widely preponderant syndrome and its severe cosmetically disfiguring potential. We thus would like to invite all fellow colleagues with expertise in the field to comment or present their views.
Orbit (Amsterdam, Netherlands) 10/2012;
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ABSTRACT: The disadvantages of human amniotic membrane (hAM), used for ocular surface reconstruction, necessitate the development of standardized alternatives. Keratin-derived-films (KF) have been indicated as transferable substrate for cell cultivation and tissue engineering. The impact of different sterilization procedures on KF and surgical feasibility were investigated. Human hair KF were prepared and sterilized; optical, biomechanical properties, in vitro cell seeding efficiency and proliferation of human corneal epithelial cells were studied and compared with hAM. Surgical feasibility was tested on enucleated porcine eye. Sterilized KF showed higher light transmission and significantly higher E-modulus than hAM; cell-seeding-efficiency and proliferation rate were not affected. Although KF could be surgically handled, suture placement was more difficult compared to hAM. Plasma treatment seems the best sterilization method for KF; it does not affect cell biology or optical and biomechanical properties. However material modifications are requested before KF may represent a feasible alternative for ocular surface reconstruction.
Journal of Materials Science Materials in Medicine 09/2012; · 2.32 Impact Factor
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ABSTRACT: Purpose: Aim of this study was to evaluate the efficiency of human MRC-5 cells to act as a feeder layer for conjunctival epithelial cells in order to develop a complete xenobiotic-free culture system for the expansion of conjunctival epithelial progenitor cells for clinical applications. Methods: Human conjunctival epithelial cells were expanded from a bulbar biopsy, in a completely xenobiotic free culture system using growth arrested MRC-5 cells as a feeder layer, without (MRC-5/No Serum) and in the presence of 5% (MRC-5/HS 5%) or 10% (MRC-5/HS 10%) human serum. The total cell count, the surface area as well as the total colony-forming efficiency (CFE), the percentage of aborted colonies and the expression of putative progenitor cell markers p63α, ABCG2, CK15 was compared to the gold standard culture system (GS) in which growth arrested 3T3 feeder cells and feotal calf serum were used. Results: The epithelial cell count revealed significantly less proliferation in the MRC-5/No Serum group compared to the GS conditions. All groups showed immunoreactivity to CK19; however, more differentiated epithelial cells were observed in the MRC-5/No Serum- and MRC-5/HS 10%-group and less immunoreactivity to p63 α and ABCG2 was found in these groups compared to GS and MRC-5/HS 5% conditions. This was in accordance with CFE results, were the MRC-5/HS 5% group showed similar CFE results compared to the GS group, while in the MRC-5/No Serum- and MRC-5/HS 10%-group significantly lower CFE's were observed. Conclusions: Our results indicate that a completely xenobiotic-free culture system using MRC-5 cells as a feeder layer in combination with human serum can be successfully used to expand conjunctival epithelial cells with progenitor cell characteristics and might be a useful tool for the safe expansion of these cells for clinical use.
Current eye research 08/2012; · 1.51 Impact Factor
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ABSTRACT: Retraction of the lower eyelid can be consequence of medical and surgical conditions. Various kinds of allotransplants and biomaterial have been used to correct it; we report on the surgical correction of lower lid retraction with a decellularized porcine derived membrane (Tarsys(®)). A 49-year-old patient with a history of adenoid cystic carcinoma in the pterygo-palatine fossa, requiring extensive surgery and repeated radiotherapy, presented with 6 mm lagophthalmus and exposure keratopathy secondary to facial nerve palsy. The lower lid malposition was corrected with a Tarsys(®) implant. Three months after surgery no lagophthalmos was present and substantial relief of signs and symptoms of ocular surface disease and good symmetry between right and left eye was achieved. If general condition or morbidity in potential donor sites hamper harvesting autologous graft material to support the lower lid, bioengineered xenografts can be used successfully to correct eyelid malpositions such as lower lid retraction.
Orbit (Amsterdam, Netherlands) 06/2012; 31(3):187-9.
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ABSTRACT: West Indian punctate keratopathy (WIPK) is characterized by stable, asymptomatic, white superficial corneal opacities. We examined this patient's lesions with in vivo confocal microscopy.
A 47-year-old North American male patient presented with bilateral, dense, punctate, white opacities of the corneal epithelium. Confocal microscopy was performed using the Heidelberg Retina Tomograph II/Rostock Cornea Module.
The patient was of Afro-Caribbean descent. In vivo confocal microscopy showed hyporeflective areas with multiple small hyperreflective dots inside at the level of the basal corneal epithelium with an unaffected Bowman layer. There was no round cell infiltration.
West Indian punctate keratopathy should be considered in the differential diagnosis of scattered spot-like opacities with a history of residence in the endemic West Indies. Inflammatory entities can be excluded by in vivo confocal microscopy.
Cornea 09/2011; 30(11):1270-2. · 1.73 Impact Factor
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ABSTRACT: We performed a comparative study using Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT) to measure intraocular pressure (IOP) in eyes with keratoconus.
IOP was measured in 114 eyes of 75 patients with keratoconus (51 men and 24 women; mean age, 36.1 ± 11.2 years) using GAT and DCT in randomized order. Central corneal thickness (CCT), minimal corneal thickness (MCT), and corneal topography were recorded using the Pentacam. Four groups according to Amsler's keratoconus classification were composed and analyzed for significant differences of CCT, MCT, GAT, and DCT results.
Mean CCT in the 114 keratoconus eyes was 481.1 ± 46.2 μm (range, 334-601 μm). Mean MCT was 453.3 ± 56.3 μm (range, 239-573 μm). Mean IOP measured using GAT was 13.1 ± 2.9 mm Hg, whereas mean IOP measured using DCT was 14.8 ± 2.6 mm Hg. Neither the results for GAT nor those for DCT showed a significant correlation with CCT (Pearson correlation: P < 0.05). Multifactorial analysis revealed that CCT and MCT, but not GAT and DCT, results were significantly different in corneas of varying curvatures.
This study shows that DCT measures IOP higher than GAT in eyes with keratoconus. In keratoconus, both methods seem to be independent of CCT and therefore are equally, but not interchangeably, applicable when monitoring IOP. Further analysis revealed that CCT and MCT are significantly different in corneas of varying Amsler grade.
Cornea 06/2011; 30(10):1078-82. · 1.73 Impact Factor
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ABSTRACT: Orbital leiomyolipoma is a rare benign tumor characterized by a mixture of mature smooth muscle cells and adipocytes. The authors present a case which, to the best of their knowledge, is the second case of leiomyolipoma of the orbit reported in the ophthalmic literature. A 65-year-old patient presented with a painful and swollen left eye, the symptoms having been present for 1 week. Imaging (CT, MRI follow up) confirmed the presence of a nearly 2-cm lesion medial to the lacrimal gland. A biopsy was planned, and 3 specimens were taken for histologic examination. Histology showed diffusely intermingling smooth muscle cells and mature adipocytes; immunohistochemistry demonstrated positive staining for smooth muscle actin and negativity for HMB45, MART-1, and Cytokeratin AE1/3. Although it is very rare, ophthalmologists should consider leiomyolipoma in the differential diagnosis of orbital tumors. The long-term prognosis for patients affected by this benign tumor is good.
Ophthalmic plastic and reconstructive surgery 04/2011; 28(1):e21-3. · 0.69 Impact Factor
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ABSTRACT: Human amniotic membrane (AM) is frequently used as a substrate for ocular surface reconstruction. Its disadvantages (e.g., reduced transparency and biomechanical strength, heterogeneity depending on donor) create the need for standardized alternatives. Keratin from hair or wool has been proposed as an appropriate material for producing films or cell cultivation scaffolds. The current study was performed to develop transparent, stable and transferable films based on human hair keratin that support cellular adhesion and proliferation. The films were engineered by a multi-step procedure including keratin extraction, neutral and alkaline dialysis, drying and a curing process. Keratin films were investigated by SDS-PAGE, SEM and X-ray analyses. Furthermore, swelling and water absorption of the films were studied, as were tensile strength and light transmission (UV/VIS). Finally, the growth behavior of corneal epithelial cells on the keratin films and AM was estimated in proliferation studies. In addition, we assessed the seeding efficiency and cell detachment behavior during trypsinization. The film-forming process resulted in transparent films composed of nanoparticulate keratin structures. The film characteristics could be varied by changing the protein composition, adding softening agents or varying the curing temperature and duration. Based on these findings, an optimized protocol was developed. The films showed improved light transmission and biomechanical strength in comparison to AM. Furthermore, cell behavior on the films was similar to that found on AM. We conclude that keratin films may represent a new, promising alternative for ocular surface reconstruction.
Biomaterials 02/2011; 32(13):3375-86. · 7.40 Impact Factor
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Current eye research 11/2010; 35(11):1040-1; author reply 1042-3. · 1.51 Impact Factor
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ABSTRACT: To investigate therapeutic ocular surface medium (TOSM), a potential physiological tear replacement therapy, for moderate to severe dry eye.
Forty-six patients with symptoms of moderate to severe dry eye despite maximal standard therapy were enrolled in a prospective pilot study of TOSM over 1 month (n = 10) and a randomized, double-masked, controlled trial of TOSM versus saline (placebo) over 2 months (n = 36). The primary outcome measure was conjunctival rose bengal staining.
An improvement in conjunctival rose bengal staining by ≥3 points occurred in 7 of 10 patients receiving TOSM in the pilot study (P = 0.017) and in 8 of 18 patients (44%) in the randomized trial (P = 0.982). In the pilot study, subjective dry eye symptoms significantly improved (P = 0.005). TOSM significantly improved the blepharitis score (P = 0.002) and conjunctival impression cytology (P = 0.028) in the randomized controlled trial. There were no serious or irreversible side effects with TOSM.
TOSM is a physiological tear replacement for dry eye that, unlike autologous serum, can be easily manufactured, could be widely available, and may also be beneficial for blepharitis.
Cornea 11/2010; 29(11):1241-6. · 1.73 Impact Factor
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ABSTRACT: To evaluate a serum-free system where mitotically active subconjunctival fibroblasts were co-cultured with conjunctival epithelial cells to mimic a niche environment for conjunctival progenitor cells.
Human conjunctival epithelial cells were expanded in vitro and evaluated for their colony-forming efficiency and clonal ability. The cells were then transferred to a serum-free co-culture system and cultured in the presence of mitotically active subconjunctival fibroblasts (human conjunctival epithelial cells and human bulbar subconjunctival fibroblasts [HCEC-HCF]). Cells were evaluated by Ki67 staining, total colony-forming efficiency and the number of colonies with a surface area of more than 10 mm(2). The expression of putative progenitor cell markers p63α, ABCG2 and CK15, and the presence of MUC5AC- and periodic acid-Schiff-positive cells was compared with standard culture conditions (HCEC-3T3).
Conjunctival epithelial cells cultured under HCEC-HCF and HCEC-3T3 conditions demonstrated strong immunoreactivity to p63α and ABCG2. Co-localization of CK15 and p63α revealed a subpopulation of CK15-positive cells under HCEC-3T3 conditions compared with only a few CK15-positive cells found under HCEC-HCF conditions. MUC5AC- and periodic acid-Schiff-positive cells were much more common under HCEC-3T3 conditions than under HCEC-HCF conditions. These results were confirmed by reverse transcription-PCR. Cells in HCEC-HCF conditions demonstrated a significantly higher total colony-forming efficiency and a significantly higher percentage of colonies with holoclone-like morphology.
The simulation of a niche environment in vitro by co-culturing mitotically active subconjunctival fibroblasts with conjunctival epithelial cells supports the maintenance of conjunctival cells with progenitor cell characteristics and therefore might be a useful tool to expand conjunctival epithelial progenitor cells in vitro for clinical use.
Regenerative Medicine 11/2010; 5(6):877-89. · 3.72 Impact Factor
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ABSTRACT: To report a case of Descemet stripping endothelial keratoplasty (DSEK) with a large posterior lamellar graft for the treatment of bullous keratopathy secondary to congenital glaucoma.
Bullous keratopathy secondary to unilateral congenital glaucoma with buphthalmos in a 36-year-old man was treated with DSEK. A Descemet endothelium lamella of 10-mm diameter was excised by descemetorhexis. A regular sclerocorneal donor button of 12-mm diameter was manually split using the Melles technique, and a 10-mm diameter donor graft was punched. The graft was implanted as a folded "Taco" into the anterior chamber using forceps and fixed to the host bed using an intracameral air bubble.
: Immediately after DSEK, the graft showed a small peripheral dehiscence of 1 × 3 mm, which resolved within 2 days. During 30 months of follow-up, the endothelial graft remained well centered, clear, and without any signs of graft rejection. Visual acuity improved from perception of hand movement before operation to 0.2 at 30 months after DSEK. Endothelial cell loss was 33% at 18 months, 44% at 24 months, and 47% at 30 months after operation. Maximum intraocular pressure was 15 mm Hg preoperatively and 16 mm Hg at the last follow-up.
DSEK using a corneal graft of 10.0-mm diameter obtained from a normal-sized donor button can be performed safely and effectively in cases of unilateral buphthalmos and secondary corneal decompensation, where a large recipient cornea requires an equivalently sized graft and transplantation of large amounts of donor endothelium.
Cornea 10/2010; 29(10):1195-8. · 1.73 Impact Factor
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Maria Borrelli,
Christina Schröder,
John K G Dart,
John Richard O Collin,
Peter Sieg,
Ian A Cree,
Melville A Matheson,
John M Tiffany,
Gordon Proctor,
Jaap van Best,
Nick Hyde, Gerd Geerling
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ABSTRACT: To evaluate the long-term results of autologous submandibular gland transplantation in eyes with cicatrizing conjunctivitis and to determine biomechanical and biochemical features of the resulting salivary tear film.
Prospective, observational case series.
Fifteen eyes with cicatrizing conjunctivitis with a viable autologous submandibular gland transplantation were compared with 10 eyes with cicatrizing conjunctivitis and a failed submandibular gland transplantation or no submandibular gland transplantation. Best-corrected visual acuity, frequency of tear substitute instillation, severity of dry eye discomfort, lid margin erythema, conjunctival hyperemia, corneal epithelial edema, tear film break-up time, Schirmer test results, and corneal fluorescein and conjunctival Rose Bengal staining were evaluated. In a subgroup central corneal thickness and sensitivity, corneal epithelial barrier function, conjunctival and lid margin flora, and conjunctival impression cytologic analysis results were evaluated. In 3 patients, preoperative and postoperative tear samples were analyzed for viscosity, surface tension, and presence of mucins.
Submandibular gland autotransplantation resulted in long-term improvement of subjective, objective, and some ocular surface parameters. Salivary mucins were detectable in salivary tears after submandibular gland transplantation. The viscosity of salivary tears was more similar to normal saliva and the surface tension was intermediate between the 2 original secretions.
Submandibular gland autotransplantation provides long-term relief from pain and reduces the need for frequent installation of lubricants.
American journal of ophthalmology 10/2010; 150(6):894-904. · 3.83 Impact Factor
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ABSTRACT: Riboflavin/ultraviolet A (UVA) cross-linking (CXL) of corneal collagen is a novel method of stabilizing corneal mechanical properties and preventing progression of keratectasias. This study was conducted to investigate whether CXL influences ablation rate, flap thickness, and refractive results of excimer laser procedures ex vivo.
Corneal epithelium was removed from enucleated porcine eyes, and CXL was performed with riboflavin 0.1% and UVA radiation (365 nm, 3 mW/cm(2)) for 30 minutes. Control eyes received epithelial abrasion only. Diffusion of riboflavin through the cornea was assessed by using infrared-excited, two-photon microscopy of riboflavin autofluorescence, combined with second-harmonic generation of fibrillar collagen. During phototherapeutic keratectomy, corneal thickness was measured by optical coherence pachymetry. During LASIK for myopia, the flap thickness of microkeratome cuts was measured and the induced refractive change assessed by Placido topography. Data were analyzed by Shapiro-Wilk test and Student's t-test.
Multiphoton imaging showed a rapid (30-minute) and even distribution of riboflavin throughout the corneal stroma. No difference in ablation rate was measured in treated and untreated corneas (P = 0.90). Mean flap thickness was increased by 44% in cross-linked corneas (P < 0.01). After LASIK for myopia of 4 to 25 D, the mean corneal refractive change was reduced in CXL-treated eyes by 20.1% (P < 0.05). This effect was less pronounced in thinner flaps.
CXL reduces the amount of refractive change after LASIK for myopia. Although the laser ablation rate is unaffected, CXL results in an increased flap thickness. This study suggests the need for adjustment of microkeratome and laser parameters for LASIK after CXL and indirectly endorses the theory of a direct stiffening effect of CXL.
Investigative ophthalmology & visual science 03/2010; 51(8):3929-34. · 3.43 Impact Factor
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ABSTRACT: Reconstruction of the conjunctiva is an essential part of ocular surface regeneration, especially if an extensive area or the whole ocular surface is affected, such as in patients with ocular cicatricial pemphigoid, Stevens-Johnson syndrome, toxic epidermal necrolysis, or chemical/thermal burns. In these situations, corneal reconstruction almost inevitably fails unless the conjunctival surface is first repaired and a deep fornix is restored. The growing field of tissue engineering and advances in stem cell research offer promising new alternatives for these challenges. This article reviews the present approaches for reconstruction of the conjunctival surface, considering the established strategies and new potential methodologies.
Current eye research 11/2009; 34(11):913-24. · 1.51 Impact Factor
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ABSTRACT: A rotary cell-culture system (RCCS) allows the creation of a microgravity environment of low shear force, high-mass transfer and three-dimensional cell culture of various cell types. The aim of the study was to evaluate the growth pattern and the secretory function of rabbit lacrimal gland acinar cells in a microgravity environment using an RCCS.
Lacrimal gland acinar cells from male New Zealand White rabbits were isolated and cultured in an RCCS up to 28 days. Cells were analysed by light and electron microscopy, and apoptosis was assessed by the TUNEL assay at days 7, 14, 21 and 28. Secretory function was tested by measuring the beta-hexosaminidase activity.
After 7 days of culture, spheroidal aggregates were found inside the RCCS. The spheroids consisted of acinus-like cell conglomerates. Apoptotic centres inside the spheroids were observed at all time points by means of the TUNEL assay. Evaluation of the secretory function revealed beta-hexosaminidase release after carbachol stimulation which decreased over the culture period.
A simulated microgravity environment promotes the development of three-dimensional cell spheroids containing viable acinar cells up to 28 days. Due to the evolving central apoptosis, it is unlikely that such simple three-dimensional cell communities can serve as tissue equivalents for clinical transplantation, but they promise opportunities for further applications in basic and applied cell research on lacrimal gland cells.
The British journal of ophthalmology 06/2009; 93(8):1121-5. · 2.92 Impact Factor
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ABSTRACT: Peeling of the internal limiting membrane is the treatment of choice for macular holes. Fresh platelet suspension (PS) is used to support wound healing in persistent macular holes. The concentration of growth factors in fresh, frozen, and thrombin-activated PSs were compared, to optimize their trophic potential and examine their capacity to support proliferation, migration, and contraction of human retinal Müller cells.
The concentration of various growth factors in frozen PS, thrombin-activated PS, and plasma were evaluated by ELISA. The effect of these preparations on proliferation, migration, and contraction of human Müller cells were evaluated with an ATP-assay, a colony-dispersion assay, and a detached collagen gel contraction assay respectively. Plasma was tested as a control.
Frozen and thrombin-activated PSs contained significantly more EGF, TGF-beta1, and PDGF than did plasma. The highest concentrations of EGF and FGF were found in frozen PS. All platelet preparations and plasma supported cell growth significantly better than the control, which was serum-free culture medium. Müller cells migrated better when incubated with thrombin-activated PS than with any other test solution. Contraction was extremely strong after incubation with fresh PS compared with plasma or thrombin-activated or frozen PSs.
Frozen and thrombin-activated PSs may be suitable alternatives to fresh PS for persisting macular holes, due to their superior effect on Müller cell migration.
Investigative ophthalmology & visual science 06/2009; 50(10):4881-6. · 3.43 Impact Factor
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The Laryngoscope 05/2009; 119(7):1445-6. · 1.75 Impact Factor
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ABSTRACT: The authors aimed to produce a new tear substitute capable of providing both lubrication and nutrition, based on a novel nutrient-containing therapeutic ocular surface medium (TOSM).
Viscous substances, including hypromellose (HPMC), carbopol, and sodium hyaluronate (SH) were added to the TOSM at various concentrations. Three commercial preservative-free artificial tear substitutes, Hypromellose (Pharmacy of Moorfields Eye Hospital, London, UK), Thilo-Tears (a carbomer; Alcon Pharma GmbH, Freiburg, Germany), and Vislube (a hyaluronate; Chemedica AG, Munich, Germany) were used as control preparations. Their viscosity and surface tension were measured. Human corneal (HCE-T) and conjunctival (IOBA-NHC) cell lines were used to investigate cell proliferation and viability in response to the formulations by means of a luminescence-based ATP assay and a calcein AM/EthD-1 assay.
HPMC, carbopol, and SH increased the viscosity of TOSM significantly. The surface tension of TOSM was reduced by HPMC, but not by carbopol or SH. TOSM-HPMC supported cell proliferation and viability better than TOSM-carbopol and TOSM-SH. TOSM-HPMC and TOSM-carbopol supported cell proliferation significantly better than the corresponding commercial artificial tears. However, TOSM-Vislube supported cell growth significantly better than TOSM-SH.
TOSM-HPMC showed superior lubricant and nutrient properties with moderate viscosity and little cytotoxicity. It thus could be an ideal nutrient and lubricant tear substitute for dry eyes and should be evaluated in a clinical study.
Investigative ophthalmology & visual science 01/2009; 50(6):2932-9. · 3.43 Impact Factor
