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Scheffer C G Tseng - One of the best experts on this subject based on the ideXlab platform.
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sealing of the gap between the conjunctiva and tenon capsule to improve Symblepharon surgery
American Journal of Ophthalmology, 2015Co-Authors: Dandan Zhao, Han Y Yin, Anny M S Cheng, Rendian Chen, Hosam Sheha, Scheffer C G TsengAbstract:Purpose To report the surgical outcome of “sealing the gap” in treating Symblepharon caused by various etiologies other than recurrent pterygium. Design Retrospective, interventional case series. Methods Sixteen eyes of 14 patients with pathogenic Symblepharon were consecutively operated by conjunctival recession, sealing the gap between recessed conjunctiva and Tenon capsule with a running 9-0 nylon suture, and covering of the bare sclera with amniotic membrane. For severe Symblepharon where there was conjunctival shortening, oral mucosa graft was added. Outcome measures include ocular surface inflammation, fornix reformation, and restoration of ocular motility. Results The underlying causes of Symblepharon included Stevens-Johnson syndrome (n = 6), chemical burn (n = 5), ocular cicatricial pemphigoid (n = 1), thermal burn (n = 1), following excision of conjunctival squamous cell carcinoma (n = 1), conjunctival scarring following exposed buckle (n = 1), and immune dysregulation (n = 1). Twelve eyes (75%) had an average of 1.6 ± 0.9 previous surgeries. Before surgery, ocular motility restriction was significantly correlated with the severity of Symblepharon. During the follow-up period of 17.1 ± 13.6 months, 13 eyes (81.3%) achieved complete success, 2 eyes (12.5%) achieved partial success, and 1 eye with immune dysregulation had failure (6.3%). There was no correlation between the success rate and the severity of Symblepharon. After surgery, the ocular motility and inflammation were significantly improved. Visual acuity had improved in 2 of 15 eyes. Conclusions Sealing the gap between the conjunctiva and Tenon capsule is an important step in the surgical management of pathogenic Symblepharon. This method not only avoids the use of mitomycin C, but also creates a strong barrier to prevent recurrence, restore ocular surface integrity, reform a deep fornix, and regain full ocular motility.
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mitomycin c amniotic membrane transplantation and limbal conjunctival autograft for treating multirecurrent pterygia with Symblepharon and motility restriction
Graefes Archive for Clinical and Experimental Ophthalmology, 2006Co-Authors: Yongming Zhang, Scheffer C G TsengAbstract:Background Treatment of eyes with multirecurrent pterygia associated with severe Symblepharon and motility restriction is challenging. A combined surgical procedure of intraoperative mitomycin C, amniotic membrane transplantation and conjunctival limbal autograft was applied for treating such eyes.
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correlation of corneal complications with eyelid cicatricial pathologies in patients with stevens johnson syndrome and toxic epidermal necrolysis syndrome
Ophthalmology, 2005Co-Authors: Mario A Di Pascuale, Edgar M Espana, Daniel Tzongshyue Liu, Tetsuya Kawakita, Ying Y Gao, Alireza Baradaranrafii, Antonio Elizondo, V K Raju, Scheffer C G TsengAbstract:Purpose To look at the correlation between many factors (time of hospitalization, floppy eyelid syndrome, trichiasis, open lacrimal puncta, Symblepharon, and aqueous tear deficiency) and corneal complications in Stevens-Johnson syndrome (SJS). Design Observational cases series. Patients Clinical data were retrospectively reviewed from 38 patients (32.7±20.1 years old) with SJS (n = 11) and with toxic epidermal necrolysis (TENS) (n = 27) from January 2002 to August 2004. One case report with SJS was included to verify the presence of tarsal/lid margin ulceration at the acute stage. Methods The medical history was retrieved regarding presumed causative medications used within 15 days and the duration of hospitalization. Data of the latest photographic documentation and eye examination were compared and correlated in a masked fashion. Main Outcome Measures Floppy eyelid, trichiasis, lid margin keratinization, meibomian gland orifice metaplasia, Symblepharon, tarsal scar, and corneal complications. Results Acute SJS/TENS was characterized by tarsal conjunctival ulceration. Keratinization of the eyelid margin with variable degrees of meibomian gland dysfunction was observed in all cases. Floppy eyelid, trichiasis, partially or totally opened lacrimal punctum, Symblepharon, and aqueous tear deficiency were not significantly correlated with corneal complications. In contrast, there was a strong correlation between the severity of eyelid margin and tarsal pathology and the extent of corneal complications (Spearman r , 0.54; P = 0.0005). A multivariable regression analysis also showed that the extent of eyelid and tarsal pathology had a significant effect on corneal complications (coefficient, 0.84; P = 0.006). Conclusions Patients with acute SJS/TENS are characterized by severe inflammation and ulceration of the tarsal conjunctiva and lid margins. If left unattended, lid margin keratinization and tarsal scar, together with lipid tear deficiency, contribute to corneal complications because of blink-related microtrauma. Attempts to suppress inflammation and scarring by amniotic membrane transplantation at the acute stage and to prevent microtrauma at the chronic stage are vital to avoid sight-threatening complications.
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amniotic membrane transplantation for reconstruction of the conjunctival fornices
Ophthalmology, 2003Co-Authors: Abraham Solomon, Edgar M Espana, Scheffer C G TsengAbstract:Abstract 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.
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amniotic membrane transplantation for conjunctival surface reconstruction
American Journal of Ophthalmology, 1997Co-Authors: Scheffer C G Tseng, Pinnita Prabhasawat, Shwuhuey LeeAbstract:Purpose To determine whether preserved human amniotic membrane can be used to reconstruct the conjunctival defect created during surgical removal of a large lesion or during Symblepharon lysis. Methods Amniotic membrane transplantation was performed in six consecutive patients (seven eyes) during removal of large conjunctival lesions and in nine patients (nine eyes) during removal of conjunctival scars or Symblepharon. Results During a mean follow-up period ± SD of 10.9 ± 9.1 months (range, 2.2 to 34.0 months), 10 patients (11 eyes) showed successful surface reconstruction without recurrence, five patients (five eyes) showed improved visual acuity, and one patient (one eye) showed epithelialization within 3 weeks and resolution of motility restriction. Two patients (two eyes) showed partial success, with surrounding conjunctival inflammation. Three cases (three eyes) failed and exhibited recurrent scarring: one patient had received mitomycin treatment and beta radiation, whereas the transplanted amniotic membrane of the second patient was partially, and of the third patient was completely, dissolved or replaced by the inflamed pseudopterygial tissue. Two patients (two eyes) had epithelial cyst formation. Conclusion Amniotic membrane transplantation can be considered an alternative substrate for conjunctival surface reconstruction during removal for large tumors, disfiguring scars, or Symblepharon, especially for those whose surrounding conjunctival tissue remains relatively normal.
Shigeru Kinoshita - One of the best experts on this subject based on the ideXlab platform.
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long term results of autologous cultivated oral mucosal epithelial transplantation in the scar phase of severe ocular surface disorders
British Journal of Ophthalmology, 2011Co-Authors: Takahiro Nakamura, Kazunori Takeda, Tsutomu Inatomi, Chie Sotozono, Shigeru KinoshitaAbstract:Purpose To investigate the long-term outcome of autologous cultivated oral mucosal epithelial transplantation (COMET) for the treatment of the scar phase of severe ocular surface disorders. Participants This study involved 19 eyes of 17 patients who received autologous COMET for total limbal stem-cell deficiency. Methods Autologous cultivated oral mucosal epithelial sheets were created using amniotic membrane as a substrate. Clinical efficacy was evaluated by best-corrected visual acuity and visual acuity at the postoperative 36th month. The clinical results (clinical conjunctivalisation, corneal opacification, corneal neovascularisation and Symblepharon formation) were evaluated and graded on a scale from 0 to 3 according to their severity. Clinical safety was evaluated by the presence of persistent epithelial defects, ocular hypertension and infections. Results Autologous cultivated oral mucosal epithelial sheets were successfully generated for all 17 patients. All patients were followed up for more than 36 months; the mean follow-up period was 55 months and the longest follow-up period was 90 months. During the long-term follow-up period, postoperative conjunctivalisation and Symblepharon were significantly inhibited. All eyes manifested various degrees of postoperative corneal neovascularisation, but it gradually abated and its activity was stable at 6 months after surgery. Best-corrected visual acuity was improved in 18 eyes (95%) during the follow-up periods, and visual acuity at the postoperative 36th month was improved in 10 eyes (53%). Conclusions These long-term clinical results strongly support the conclusion that tissue-engineered cultivated oral mucosal epithelial sheets are useful in reconstructing the ocular surface of the scar phase of severe ocular surface disorders.
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pathological keratinization of ocular surface epithelium
Advances in Experimental Medicine and Biology, 2002Co-Authors: Shigeru Kinoshita, Takahiro Nakamura, Kohji NishidaAbstract:The normal ocular surface is composed of corneal, limbal, and conjunctival epithelial cells, which maintain its integrity. Severe damage to limbal epithelial cells from Stevens-Johnson syndrome (SJS), ocular cicatricial pemphigoid (OCP) and chemical burns may lead to loss of the limbal epithelial cells.1 Such limbal cell deficiencies are some of the greatest challenges facing todays clinician.2–6 During the chronic cicatricial phase, most patients with ocular surface disease—experience numerous problems, including Symblepharon, persistent epithelial defects, conjunctivalization, and pathological keratinization. Some of these problems can be managed by antibiotics, corticosteroids and immunosuppressants. However, the pathological keratinization of ordinarily nonkeratinized corneal and conjunctival epithelium is a serious and potentially debilitating problem that is difficult to manage pharmacologically.
Takahiro Nakamura - One of the best experts on this subject based on the ideXlab platform.
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long term results of autologous cultivated oral mucosal epithelial transplantation in the scar phase of severe ocular surface disorders
British Journal of Ophthalmology, 2011Co-Authors: Takahiro Nakamura, Kazunori Takeda, Tsutomu Inatomi, Chie Sotozono, Shigeru KinoshitaAbstract:Purpose To investigate the long-term outcome of autologous cultivated oral mucosal epithelial transplantation (COMET) for the treatment of the scar phase of severe ocular surface disorders. Participants This study involved 19 eyes of 17 patients who received autologous COMET for total limbal stem-cell deficiency. Methods Autologous cultivated oral mucosal epithelial sheets were created using amniotic membrane as a substrate. Clinical efficacy was evaluated by best-corrected visual acuity and visual acuity at the postoperative 36th month. The clinical results (clinical conjunctivalisation, corneal opacification, corneal neovascularisation and Symblepharon formation) were evaluated and graded on a scale from 0 to 3 according to their severity. Clinical safety was evaluated by the presence of persistent epithelial defects, ocular hypertension and infections. Results Autologous cultivated oral mucosal epithelial sheets were successfully generated for all 17 patients. All patients were followed up for more than 36 months; the mean follow-up period was 55 months and the longest follow-up period was 90 months. During the long-term follow-up period, postoperative conjunctivalisation and Symblepharon were significantly inhibited. All eyes manifested various degrees of postoperative corneal neovascularisation, but it gradually abated and its activity was stable at 6 months after surgery. Best-corrected visual acuity was improved in 18 eyes (95%) during the follow-up periods, and visual acuity at the postoperative 36th month was improved in 10 eyes (53%). Conclusions These long-term clinical results strongly support the conclusion that tissue-engineered cultivated oral mucosal epithelial sheets are useful in reconstructing the ocular surface of the scar phase of severe ocular surface disorders.
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pathological keratinization of ocular surface epithelium
Advances in Experimental Medicine and Biology, 2002Co-Authors: Shigeru Kinoshita, Takahiro Nakamura, Kohji NishidaAbstract:The normal ocular surface is composed of corneal, limbal, and conjunctival epithelial cells, which maintain its integrity. Severe damage to limbal epithelial cells from Stevens-Johnson syndrome (SJS), ocular cicatricial pemphigoid (OCP) and chemical burns may lead to loss of the limbal epithelial cells.1 Such limbal cell deficiencies are some of the greatest challenges facing todays clinician.2–6 During the chronic cicatricial phase, most patients with ocular surface disease—experience numerous problems, including Symblepharon, persistent epithelial defects, conjunctivalization, and pathological keratinization. Some of these problems can be managed by antibiotics, corticosteroids and immunosuppressants. However, the pathological keratinization of ordinarily nonkeratinized corneal and conjunctival epithelium is a serious and potentially debilitating problem that is difficult to manage pharmacologically.
Rasik B Vajpayee - One of the best experts on this subject based on the ideXlab platform.
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adjuvant role of amniotic membrane transplantation in acute ocular stevens johnson syndrome a randomized control trial
Ophthalmology, 2016Co-Authors: Namrata Sharma, S A Thenarasun, Manpreet Kaur, Neelam Pushker, Neena Khanna, Tushar Agarwal, Rasik B VajpayeeAbstract:Purpose To evaluate the adjuvant role of amniotic membrane transplantation (AMT) in cases of acute ocular Stevens–Johnson syndrome (SJS). Design Prospective randomized controlled clinical trial. Participants Twenty-five patients (50 eyes) with acute ocular SJS who presented within 4 weeks of onset of symptoms were recruited. Methods The eyes were randomized into 2 groups that underwent either AMT with medical therapy (MT; n = 25) or standard MT alone (n = 25). The patients were evaluated at presentation and during follow-up at 1 week and 1, 3, and 6 months. The parameters evaluated were the best-corrected visual acuity (BCVA), Schirmer test, tear film breakup time (TBUT), conjunctival congestion, corneal haze, vascularization, conjunctivalization, and limbal stem cell involvement. Lid edema, Symblepharon, ankyloblepharon, ectropion, entropion, trichiasis, and metaplastic lashes also were analyzed. Main Outcome Measures Maintenance of BCVA and stable ocular surface. Results At the end of 6 months, the mean BCVA was significantly better in the AMT group (0.068±0.10 logMAR units) compared with the MT group (0.522±0.52 logMAR units; P = 0.042). The mean TBUT in the AMT and MT groups was 9.92±4.1 and 6.96±4.5 seconds, respectively ( P = 0.015). The mean Schirmer test results in the AMT and MT groups were 15.4±6.3 and 8.64±5.4 mm, respectively ( P P = 0.03) at the end of the 6-month follow-up. No case in the AMT group demonstrated corneal haze, limbal stem cell deficiency, Symblepharon, ankyloblepharon, or lid-related complications. Among eyes in the MT group, corneal haze occurred in 44% (11/25; P = 0.001), corneal vascularization and conjunctivalization in 24% (6/25; P = 0.03), Symblepharon in 16% (4/25; P = 0.12), ankyloblepharon in 4% (1/25; P = 1.00), ectropion and entropion in 8% (2/25; P = 0.47), and trichiasis and metaplastic lashes in 24% (6/25; P = 0.03) eyes. Conclusions Amniotic membrane transplantation is a useful adjunct to conventional MT in maintaining BCVA and a stable ocular surface in cases of acute ocular SJS. Furthermore, the adjunctive use of AMT also helps to prevent intermediate-term ocular cicatricial sequelae.
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evaluation of umbilical cord serum therapy in acute ocular chemical burns
Investigative Ophthalmology & Visual Science, 2011Co-Authors: Namrata Sharma, Rasik B Vajpayee, Jeewan S Titiyal, Thirumurthy Velpandian, Radhika Tandon, Manik GoelAbstract:PURPOSE To evaluate the role of umbilical cord serum therapy in cases of acute ocular chemical burns. METHODS In a double-blind prospective randomized controlled clinical study, 33 eyes of 32 patients with acute ocular chemical burns of grade III, IV, and V severity were randomized into three groups: umbilical cord serum (n = 12), autologous serum (n = 11), and artificial tears (0.5% HPMC+0.3% glycerin; n = 10). In addition, all eyes received standard medical therapy. The parameters evaluated were pain score, size, and area of epithelial defect, extent of limbal ischemia, corneal clarity, and Symblepharon formation. The patients were followed up at day 1, 3, 7, 14, and 21 and at the end of months 1, 2, and 3. RESULTS Mean time to complete epithelialization was 21.16 ± 26.81, 56.6 ± 35.5, and 40.13 ± 35.79 days in cord serum, autologous serum, and artificial tears groups respectively (P = 0.02). By day 21, the mean percentage decrease in epithelial defect diameter was 94.63 ± 11.99 with cord serum compared with 53.17 ± 34.81 and 64.22 ± 42.43 with autologous serum and artificial tears, respectively (P = 0.01). By month 3, the extent of limbal ischemia with cord serum showed a mean percentage decrease of 73.43 ± 25.51 compared with 35.64 ± 25.60 and 43.71 ± 28.71 with autologous serum and artificial tears, respectively (P = 0.008). More patients had clear corneas with cord serum compared with autologous serum and artificial tears (P = 0.048). No significant difference was seen between the groups with regard to Symblepharon formation (P = 0.07). CONCLUSIONS Umbilical cord serum therapy is more effective than autologous serum eye drops or artificial tears in ocular surface restoration after acute chemical injuries. (www.controlled-trials.com number, ISRCTN08131903.).
Daniel Meller - One of the best experts on this subject based on the ideXlab platform.
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ocular surface reconstruction with cultivated limbal epithelium in a patient with unilateral stem cell deficiency caused by epidermolysis bullosa dystrophica hallopeau siemens
Cornea, 2010Co-Authors: Melissa Thanos, M Pauklin, K P Steuhl, Daniel MellerAbstract:Purpose To report a case of partial limbal stem cell deficiency (LSCD) caused by epidermolysis bullosa dystrophica mutilans Hallopeau-Siemens treated by transplantation of autologous ex vivo expanded limbal epithelium. Methods Review of the clinical findings of an 11.5-year-old boy with unilateral LSCD and epidermolysis bullosa dystrophica who underwent ocular surface reconstruction in the right eye with autologous on intact human amniotic membrane cultivated limbal epithelial cells. Results Twenty-eight months after reconstruction, the corneal surface is clear, smooth, and stable showing no signs of LSCD recurrence. Three subconjunctival bevacizumab (Avastin) injections reduced the recurrent growth of Symblepharon and corneal vascularization. The visual acuity has increased from hand motion to 20/50. Conclusion Autologous transplantation of cultivated human limbal epithelial cells on intact human amniotic membrane can be a safe and effective method for corneal surface reconstruction in LSCD caused by recessive epidermolysis bullosa dystrophica.
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amniotic membrane transplantation for acute chemical or thermal burns
Ophthalmology, 2000Co-Authors: Daniel Meller, Pinnita Prabhasawat, Renato T F Pires, Robert J S Mack, Francisco C Figueiredo, Arnd Heiligenhaus, Woo Chan Park, Thomas John, Stephen D Mcleod, Klaus P SteuhlAbstract:Abstract In acute burns, amniotic membrane transplantation can be considered as an early, if not immediate, surgical procedure to promote epithelialization and suppress inflammation so that scarring-induced sequelae can be prevented in the chronic stage. % Purpose: To determine whether preserved human amniotic membrane (AM) can be used to treat ocular burns in the acute stage. Design Prospective, noncomparative, interventional case series. Participants Thirteen eyes from 11 patients with acute burns, 10 eyes with chemical burns and 3 with thermal burns of grades II–III (7 eyes) and grade IV (6 eyes), treated at 7 different facilities. Methods Patients received amniotic membrane transplantation (AMT) within 2 weeks after the injury. Main outcome measures Integrity of ocular surface epithelium and visual acuity during 9 months of follow-up. Results Ten patients were male and one patient was female; most were young (38.2 ± 10.6 years). For a follow-up of 8.8 + 4.7 months, 11 of 13 eyes (84.63%) showed epithelialization within 2 to 5 weeks (23.7 ± 9.8 days), and final visual acuity improved ≥6 lines (6 eyes), 4 to 5 lines (2 eyes), and 1 to 3 lines (2 eyes); only one eye experienced a Symblepharon. Eyes with burns of grade II to III showed more visual improvement (7.3 ± 3 lines) than those with burns of grade IV (2.3 ± 3.0 lines; P t test). In the group with grade II or III burns, none had limbal stem cell deficiency. All eyes in the group with grade IV burns did experience limbal stem cell deficiency. Conclusions Amniotic membrane transplantation is effective in promoting re-epithelialization and reducing inflammation, thus preventing scarring sequelae in the late stage. In mild to moderate burns, AMT alone rapidly restores both corneal and conjunctival surfaces. In severe burns, however, it restores the conjunctival ocular surface without debilitating Symblepharon and reduces limbal stromal inflammation, but does not prevent limbal stem cell deficiency, which requires further limbal stem cell transplantation. These results underscore the importance of immediate intervention in the acute stage of eyes with severely damaged ocular surface. Further prospective randomized studies including a control group are required to determine the effectiveness of AMT in acute chemical and thermal burns of the eye.
