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Indian Journal of Ophthalmology Oct 2022Symblepharon occurs as chronic sequelae of severe chemical injuries. The risk of recurrence is high due to unpredictable wound healing of conjunctiva and tenons...
BACKGROUND
Symblepharon occurs as chronic sequelae of severe chemical injuries. The risk of recurrence is high due to unpredictable wound healing of conjunctiva and tenons following excision in young patients. Gore-tex aids in prevention of the recurrence of pterygium 1.
PURPOSE
To present a surgical video on role of Gore-tex in grade 4 Symblepharon lysis.
SYNOPSIS
A 28-year-old male with a previous history of Grade 4 chemical injury presented with symblepharon and total obliteration of both upper and lower fornices after one year in the right eye. He underwent symblepharon lysis, Living related conjunctival allograft, Amniotic membrane graft and Gore-tex. The video explains the surgical steps in detail. A 360-degree complete peritomy was done, Symblepharon was released from the corneal surface, and the fibrotic tissue was extensively dissected away from the corneal surface and released into the fornix. Further, cryopreserved AMG was placed over the entire raw ocular surface and sutured to the episclera with glue. Prepared Gore-tex was placed on the superior and inferior fornix and sutured with 10-0 nylon suture. Again, AMG was placed over the Gore-tex in the fornices and covered with glue. A small 2x2mm biopsy of limbal stem cells from the superior limbus was already excised from the fellow eye (CLAG) and then Lr-CLAL was prepared from the patient's mother. These two grafts were placed on the nasal and temporal bulbar surface over the AMG and sutured to the underlying AMG and the episclera with glue. The entire surface was then covered with the AMG to promote epithelisation. At one month postoperative period, patient had stable ocular surface with intact Limbal conjunctival graft with mild conjunctival recurrence of fibrosis superiorly.
HIGHLIGHTS
The video clearly explains the surgical steps of Symblepharon and the benefits of using Gore-tex.
ONLINE VIDEO LINK
https://youtu.be/aFfq2x9QBwA.
Topics: Adult; Burns, Chemical; Cicatrix; Conjunctiva; Eyelid Diseases; Humans; Male; Nylons; Polytetrafluoroethylene; Pterygium
PubMed: 36190104
DOI: 10.4103/ijo.IJO_515_22 -
Romanian Journal of Ophthalmology 2016Pterygium is characterized by the thickening of the bulbar conjunctiva and the invasion of the cornea from the sclerocorneal limbus to the central portion of the cornea....
Pterygium is characterized by the thickening of the bulbar conjunctiva and the invasion of the cornea from the sclerocorneal limbus to the central portion of the cornea. Pterygium produces corneal deformation, which extends toward the central portion of the cornea. The visual disorders depend on the corneal extent. The treatment goal is the removal of the corneal and conjunctival portion of the pterygium and the coverage of the resulting conjunctival defect. The association of the pterygium surgical excision was assessed with conjunctival autograft. For this purpose, a retrospective study was performed on 68 patients and was extended over 7 years (2009-2015). Patients with recurrent pterygium were excluded. The time for corneal re-epithelization and for the pain and photophobia disappearance was followed. The incidence of recurrence was also observed. Pain levels were assessed by using a 10-point visual analog linear scale (VAS). The mean time for ocular pain and photophobia disappearance was of 48 hours. The mean pain score was 3.38 at 24 hours after surgery. Corneal re-epithelialization was achieved in 60 hours after surgery. Recurrence occurred in 6 patients. It was concluded that pterygium surgical excision with conjunctival autograft is effective in pterygium surgery.
Topics: Adult; Autografts; Conjunctiva; Epithelium, Corneal; Female; Humans; Male; Middle Aged; Ophthalmologic Surgical Procedures; Pterygium; Re-Epithelialization; Retrospective Studies; Transplantation, Autologous; Treatment Outcome
PubMed: 29450343
DOI: No ID Found -
Investigative Ophthalmology & Visual... Oct 2019The purpose of this study was to investigate the inflammatory response of cornea and conjunctiva to topically applied lipopolysaccharide (LPS) in mice with and without...
PURPOSE
The purpose of this study was to investigate the inflammatory response of cornea and conjunctiva to topically applied lipopolysaccharide (LPS) in mice with and without antibiotic (antibiotic cocktail, ABX) induced dysbiosis.
METHODS
Dysbiosis was induced by oral antibiotics for 14 days in a group of conventional female C57BL/6J (B6) mice. 16S rRNA sequencing investigated microbiome composition. Intestinal microbiome differences were assessed using 16S rRNA sequencing of fecal pellet DNA. Blood was collected after euthanasia. CD86 expression in draining nodes was examined by flow cytometry. At day 15, a single dose of LPS or vehicle was topically applied to ABX and naïve mice. Corneal epithelium and conjunctiva were obtained after 4 hours and processed for gene expression analysis. A separate group of germ-free (GF) B6 mice was also topically challenged with LPS.
RESULTS
Antibiotic treatment significantly decreased intestinal diversity and increased serum levels of LPS. This was accompanied by a significant increase in CD86+MHC II+CD11c+CD11b+ cells in draining nodes. Compared to vehicle, topically applied LPS increased IL-1β, TNF-α, and CXCL10 mRNA transcripts in cornea and IL-1β, TNF-α, and CXCL10 in the conjunctiva in conventional and antibiotic-treated groups. However, there was higher TNF-α, CXCL10, and IL-12 expression in the cornea of LPS-treated ABX mice compared to LPS-treated mice with intact microbiota. LPS stimulation on GF conjunctiva mirrored the results in ABX mice, although greater IL-12 and IFN-γ expression was observed in GF conjunctiva compared to conventional LPS-treated mice.
CONCLUSIONS
Acute depletion of commensals through antibiotics or germ-free environment worsens the inflammatory response to LPS.
Topics: Animals; B7-2 Antigen; Conjunctiva; Cornea; Cytokines; Dysbiosis; Female; Lipopolysaccharides; Mice; Mice, Inbred C57BL
PubMed: 31618426
DOI: 10.1167/iovs.19-27939 -
Frontiers in Immunology 2021The glycocalyx is the main component of the transcellular barrier located at the interface between the ocular surface epithelia and the external environment. This... (Review)
Review
The glycocalyx is the main component of the transcellular barrier located at the interface between the ocular surface epithelia and the external environment. This barrier extends up to 500 nm from the plasma membrane and projects into the tear fluid bathing the surface of the eye. Under homeostatic conditions, defense molecules in the glycocalyx, such as transmembrane mucins, resist infection. However, many pathogenic microorganisms have evolved to exploit components of the glycocalyx in order to gain access to epithelial cells and consequently exert deleterious effects. This manuscript reviews the implications of the ocular surface epithelial glycocalyx to bacterial, viral, fungal and parasitic infection. Moreover, it presents some ongoing controversies surrounding the functional relevance of the epithelial glycocalyx to ocular infectious disease.
Topics: Animals; Conjunctiva; Epithelial Cells; Eye Infections; Glycocalyx; Host-Pathogen Interactions; Humans; Mucins; Signal Transduction
PubMed: 34497615
DOI: 10.3389/fimmu.2021.729260 -
International Journal of Environmental... Sep 2022The search for the "gold standard" in the surgical treatment of pterygium has been ongoing for over two decades. Despite the development of various surgical techniques,... (Review)
Review
The search for the "gold standard" in the surgical treatment of pterygium has been ongoing for over two decades. Despite the development of various surgical techniques, recurrence rates range from 6.7% to 88% depending on the method used. This review discusses the latest and most commonly used methods for the surgical removal of pterygium, primarily focusing on efficacy and safety. Moreover, this review includes articles that either evaluated or compared surgical methods and clinical trials for primary and recurrent pterygium. Limited data are available on combined methods as well as on the efficacy of adjuvant treatment. The use of adjuvant intraoperative mitomycin C (MMC) and conjunctival autografting (CAU) are the two most highly recommended options, as they have the lowest rates of postoperative recurrence.
Topics: Conjunctiva; Follow-Up Studies; Humans; Mitomycin; Pterygium; Recurrence; Treatment Outcome
PubMed: 36141628
DOI: 10.3390/ijerph191811357 -
Korean Journal of Ophthalmology : KJO Apr 2018Interleukin (IL)-22 is a cytokine involved in epithelial cell regeneration. Currently, no research studies have analyzed the distribution of the three distinct...
PURPOSE
Interleukin (IL)-22 is a cytokine involved in epithelial cell regeneration. Currently, no research studies have analyzed the distribution of the three distinct IL-22-secreting cell populations in human or mouse conjunctiva. This study investigated the distribution of the three main populations of IL-22-secreting immune cells, αβ Th cells, γδ T cells, or innate cells (innate lymphoid cells [ILCs] or natural killer cells), in conjunctival associated lymphoid tissues (CALTs) in human and mouse models.
METHODS
We collected discarded cadaveric bulbar conjunctival tissue specimens after preservation of the corneo-limbal tissue for keratoplasty from four enucleated eyes of the domestic donor. The bulbar conjunctiva tissue, including the cornea from normal (n = 27) or abraded (n = 4) B6 mice, were excised and pooled in RPMI 1640 media. After the lymphoid cells were gated in forward and side scattering, the αβ Th cells, γδ T cells, or innate lymphoid cells were positively or negatively gated using anti-CD3, anti-γδ TCR, and anti-IL-22 antibodies, with a FACSCanto flow cytometer.
RESULTS
In normal human conjunctiva, the percentage and number of cells were highest in αβ Th cells, followed by γδ T cells and CD3- γδ TCR- IL-22+ innate cells (presumed ILCs, pILCs) (Kruskal-Wallis test, p = 0.012). In normal mice keratoconjunctiva, the percentage and total number were highest in γδ T cells, followed by αβ Th cells and pILCs (Kruskal-Wallis test, p = 0.0004); in corneal abraded mice, the population of αβ Th cells and pILCs tended to increase.
CONCLUSIONS
This study suggests that three distinctive populations of IL-22-secreting immune cells are present in CALTs of both humans and mice, and the proportions of IL-22+αβ Th cells, γδ T cells, and pILCs in CALTs in humans might be differently distributed from those in normal mice.
Topics: Adult; Animals; Conjunctiva; Flow Cytometry; Humans; Interleukins; Intraepithelial Lymphocytes; Killer Cells, Natural; Lymphocytes; Mice; Mice, Inbred C57BL; Middle Aged; Receptors, Antigen, T-Cell, alpha-beta; Tissue Donors; Interleukin-22
PubMed: 29560621
DOI: 10.3341/kjo.2017.0068 -
The Ocular Surface Apr 2020Plasmacytoid dendritic cells (pDCs) constitute a unique population of bone marrow-derived cells that play a pivotal role in linking innate and adaptive immune responses....
Plasmacytoid dendritic cells (pDCs) constitute a unique population of bone marrow-derived cells that play a pivotal role in linking innate and adaptive immune responses. While peripheral tissues are typically devoid of pDCs during steady state, few tissues do host resident pDCs. In the current study, we aim to assess presence and distribution of pDCs in naïve murine limbus and bulbar conjunctiva. Immunofluorescence staining followed by confocal microscopy revealed that the naïve bulbar conjunctiva of wild-type mice hosts CD45 CD11c PDCA-1 pDCs. Flow cytometry confirmed the presence of resident pDCs in the bulbar conjunctiva through multiple additional markers, and showed that they express maturation markers, the T cell co-inhibitory molecules PD-L1 and B7-H3, and minor to negligible levels of T cell co-stimulatory molecules CD40, CD86, and ICAM-1. Epi-fluorescent microscopy of DPE-GFP×RAG1 transgenic mice with GFP-tagged pDCs indicated lower density of pDCs in the bulbar conjunctiva compared to the limbus. Further, intravital multiphoton microscopy revealed that resident pDCs accompany the limbal vessels and patrol the intravascular space. In vitro multiphoton microscopy showed that pDCs are attracted to human umbilical vein endothelial cells and interact with them during tube formation. In conclusion, our study shows that the limbus and bulbar conjunctiva are endowed with resident pDCs during steady state, which express maturation and classic T cell co-inhibitory molecules, engulf limbal vessels, and patrol intravascular spaces.
Topics: Animals; Conjunctiva; Dendritic Cells; Endothelial Cells; Mice; Mice, Inbred C57BL; Mice, Transgenic
PubMed: 32109562
DOI: 10.1016/j.jtos.2020.02.005 -
Frontiers in Immunology 2022The limbus is located at a 2-mm-wide area between the bulbar conjunctiva and the cornea and has been suggested to be the niche of corneal epithelial stem cells and...
BACKGROUND
The limbus is located at a 2-mm-wide area between the bulbar conjunctiva and the cornea and has been suggested to be the niche of corneal epithelial stem cells and immune cells. Like the skin and intestines, the cornea is also an important mucosal surface, and immune cells on the cornea play critical roles in immune surveillance to ensure barrier surface homeostasis and protection from various environmental damage and infections. Single-cell RNA sequencing (scRNA-seq) analysis of protein tyrosine phosphatase receptor type C positive (PTPRC) hematopoietic cells from the corneal limbus could provide a single cell atlas of all the immune cell subsets.
METHODS
We performed single-cell RNA sequencing to generate transcriptomic profile for 804 sort-purified hematopoietic cells from the corneal limbus of three healthy donors.
RESULTS
Our analysis identified a primary transcriptomic pattern for multiple immune cell subtypes, including naive T cells, antiviral effector CD8 T cells, and innate immune cells such as IDO1 mature regulatory dendritic cells (mregDCs), macrophages, monocytes, and basophils in the human corneal limbus.
CONCLUSION
Overall, single-cell transcriptomic analysis of limbal immune cells suggested the possible contribution of these cells on the adaptive and innate immune response of the human cornea.
Topics: Adult; CD8-Positive T-Lymphocytes; Conjunctiva; Cornea; Epithelium, Corneal; Humans; Limbus Corneae
PubMed: 35280984
DOI: 10.3389/fimmu.2022.798346 -
Middle East African Journal of... 2015The ocular surface is a component of the anterior segment of the eye and is covered by the tear film. Together, they protect the vital external components of the eye... (Review)
Review
The ocular surface is a component of the anterior segment of the eye and is covered by the tear film. Together, they protect the vital external components of the eye from the environment. Injuries, surgical trauma, and autoimmune diseases can damage this system, and in severe cases, tissue engineering strategies are necessary to ensure proper wound healing and recovery. Dry eye is another major concern and a complicated disease affecting the ocular surface. More effective and innovative therapies are required for better outcomes in treating dry eye. This review focuses on the regenerative medicine of the conjunctiva, which is an essential part of the ocular surface system. Features and advances of different types of biomolecular materials, and autologous and allogeneic tissue grafts are summarized and compared. Specifically, vitrigel, a collagen membrane and novel material for use on the ocular surface, offers significant advantages over other biomaterials. This review also discusses a breakthrough microfluidic technology, "organ-on-a-chip" and its potential application in investigating new therapies for dry eye.
Topics: Biocompatible Materials; Conjunctiva; Dry Eye Syndromes; Humans; Ophthalmologic Surgical Procedures; Plastic Surgery Procedures; Tissue Engineering
PubMed: 26692712
DOI: 10.4103/0974-9233.167818 -
American Journal of Ophthalmology Jul 2021To investigate the hypothesis that ocular surface epithelial thickness is correlated with tear osmolarity, conjunctivochalasis (CCh), and dry eye clinical tests.
PURPOSE
To investigate the hypothesis that ocular surface epithelial thickness is correlated with tear osmolarity, conjunctivochalasis (CCh), and dry eye clinical tests.
DESIGN
A case-control study.
METHODS
A total of 50 patients with different types of dry eye disease (DED) and 15 age- and sex-matched control subjects were enrolled in this study. We performed a detailed diagnostic assessment of tear film and ocular surface parameters, including Ocular Surface Disease Index questionnaire, visual analog scale questionnaire, topographic surface regularity and surface asymmetry indices, tear film break-up time, corneal and conjunctival dye staining, Schirmer I test, and tear osmolarity. The corneal and bulbar conjunctival epithelial thickness (CET) were obtained using the latest version of spectral domain optical coherence tomography (SDOCT).
RESULTS
Patients with aqueous-deficient DED (ADDED) had lower bulbar CET values, particularly in the temporal region, than those of normal subjects and patients with evaporative-type DED (EDED); however, the difference did not quite reach a statistically significant level. Patients with DED and CCh had lower bulbar CET values in temporal (38.52 ± 9.58 µm) and inferior regions (50.79 ± 9.10 µm) compared to those with DED without CCh (47.39 ± 11.71 µm, 60.38 ± 14.36 µm, respectively, P < .02). In the DED group, tear osmolarity was found to be negatively correlated with CET values in temporal bulbar region (P = .006 and r = -0.403) and central corneal epithelial thickness values (P = .029 and r = -0.325).
CONCLUSIONS
CCh and tear osmolarity are associated with reduced conjunctival epithelial thickness in DED.
Topics: Adult; Aged; Aged, 80 and over; Case-Control Studies; Conjunctiva; Conjunctival Diseases; Dry Eye Syndromes; Epithelial Cells; Epithelium, Corneal; Female; Humans; Male; Middle Aged; Organ Size; Osmolar Concentration; Surveys and Questionnaires; Tears; Tomography, Optical Coherence; Visual Acuity
PubMed: 33571473
DOI: 10.1016/j.ajo.2021.02.009