Cataract Surgery in Patients with Ocular Surface Disease: An Update in Clinical Diagnosis and Treatment.

In this article we review essentials of diagnosis and management of ocular surface disease in patients who undergo cataract surgery. It is clearly shown that dry eye disease worsens following the cataract surgery in patients with prior history of ocular surface disease, Also new cases of dry eye might appear The current strategies for timely diagnosis and proper management of dry eye syndrome in the face of cataract surgery patients is mainly emphasized. To achieve the best outcome in cataract surgery, a healthy ocular surface is crucial. While ocular surface preparation is indispensable in patients with established ocular surface disease, it is also helpful in those with minimal signs or symptoms of surface disease. The current approach begins with early diagnosis and drastic management of ocular surface disease before cataract surgery using a stepwise regimen customized to the individual patient and disease severity. These considerations are typically sustained throughout and following the surgery

Medically Reversible Limbal Stem Cell Disease: Clinical Features and 1 Management Strategies

Purpose: To describe the clinical features and management strategies in patients whose limbal stem cell (LSC) disease reversed with medical therapy. Design: Retrospective case series. Subjects: 22 eyes of 15 patients seen at 3 tertiary referral centers between 2007 and 2011 with greater than 3 months follow-up. Methods: Medical records of patients with medically reversible LSC disease were reviewed. Demographic data, etiologies, location and duration of disease and medical inventions were analyzed. Main Outcome Measures: Primary outcomes assessed included resolution of 62 signs of LSC disease and improvement in visual acuity. Results: Etiologies of the LSC disease included contact lens wear only (13 eyes), contact lens wear in the setting of ocular rosacea (3 eyes), benzalkonium chloride toxicity (2 eyes) and idiopathic (4 eyes). Ophthalmologic findings included loss of limbal architecture, a whorl-like epitheliopathy or an opaque epithelium arising from the limbus with late fluorescein staining. The superior limbus was the most common site of involvement (95%).The corneal epithelial phenotype returned to normal with only conservative measures including lubrication and discontinuing contact lens wear in 4 patients (4 eyes) while in 11 patients (18 eyes) additional interventions were required after at least 3 months of conservative therapy. Medical interventions included topical corticosteroids, topical cyclosporine, topical vitamin A, oral doxycycline, and/or punctal occlusion. All eyes achieved a stable ocular surface over a mean follow-up of 15 months (range, 4-60 months). Visual acuity improved from a mean of 20/42 to 20/26 (P <0.0184). Conclusions: Disturbances to the LSC function and/or niche may be potentially reversible by medical therapy. These cases, which represent a subset of patients with LSC deficiency, may be considered to have LSC niche dysfunction. PRECIS We demonstrate the reversibility of limbal stem cell disease through medical treatment and withdrawal of toxic and traumatic insults. This reversibility suggests the limbal disease may result from dysfunction of the limbal stem niche

Decellularized Human Cornea for Reconstructing the Corneal Epithelium and Anterior Stroma

In this project, we strived to develop a decellularized human cornea to use as a scaffold for reconstructing the corneal epithelium and anterior stroma. Human cadaver corneas were decellularized by five different methods, including detergent- and nondetergent-based approaches. The success of each method on the removal of cells from the cornea was investigated. The structural integrity of decellularized corneas was compared with the native cornea by electron microscopy. The integrity of the basement membrane of the epithelium was analyzed by histology and by the expression of collagen type IV, laminin, and fibronectin. Finally, the ability of the decellularized corneas to support the growth of human corneal epithelial cells and fibroblasts was assessed in vitro. Corneas processed using Triton X-100, liquid nitrogen, and poly(ethylene glycol) resulted in incomplete removal of cellular material. Corneas processed with the use of sodium dodecyl sulfate (SDS) or with sodium chloride (NaCl) plus nucleases successfully removed all cellular material; however, only the NaCl plus nuclease treatment kept the epithelial basement membrane completely intact. Corneas processed with NaCl plus nuclease supported both fibroblast and epithelial cell growth in vitro, while corneas treated with SDS supported the growth of only fibroblasts and not epithelial cells. Decellularized human corneas provide a scaffold that can support the growth of corneal epithelial cells and stromal fibroblasts. This approach may be useful for reconstructing the anterior cornea and limbus using autologous cells

Medically Reversible Limbal Stem Cell Disease: Clinical Features and 1 Management Strategies

Purpose: To describe the clinical features and management strategies in patients whose limbal stem cell (LSC) disease reversed with medical therapy. Design: Retrospective case series. Subjects: 22 eyes of 15 patients seen at 3 tertiary referral centers between 2007 and 2011 with greater than 3 months follow-up. Methods: Medical records of patients with medically reversible LSC disease were reviewed. Demographic data, etiologies, location and duration of disease and medical inventions were analyzed. Main Outcome Measures: Primary outcomes assessed included resolution of signs of LSC disease and improvement in visual acuity. Results: Etiologies of the LSC disease included contact lens wear only (13 eyes), contact lens wear in the setting of ocular rosacea (3 eyes), benzalkonium chloride toxicity (2 eyes) and idiopathic (4 eyes). Ophthalmologic findings included loss of limbal architecture, a whorl-like epitheliopathy or an opaque epithelium arising from the limbus with late fluorescein staining. The superior limbus was the most common site of involvement (95%).The corneal epithelial phenotype returned to normal with only conservative measures includinglubrication and discontinuing contact lens wear in 4 patients (4 eyes) while in 11 patients (18 eyes) additional interventions were required after at least 3 months of conservative therapy. Medical interventions included topical corticosteroids, topical cyclosporine, topical vitamin A, oral doxycycline, and/or punctal occlusion. All eyes achieved a stable ocular surface over a mean follow-up of 15 months (range, 4-60 months). Visual acuity improved from a mean of 20/42 to 20/26 (P <0.0184)

Late Acute Rejection After Allograft Limbal Stem Cell Transplantation: Evidence for Long-Term Donor Survival.

Purpose: To describe the clinical presentation and management of late (>3.0 years) acute graft rejection in keratolimbal allograft (KLAL) recipients. Methods: This was a multicenter, retrospective observational case series. Six eyes of 6 patients with ocular surface transplant at a mean age of 36.2 years were seen at 3 tertiary referral centers for acute graft rejection between 2007 and 2013. Main outcome measures included strength of systemic immunosuppression (SI) at the time of rejection, time to rejection, and clinical presentation of rejection. Results: Preoperative diagnoses included total limbal stem cell deficiency because of aniridia (n = 2) or chemical injury (n = 4). After an initially successful outcome, patients experienced late acute graft rejection at a mean time of 67.8 ± 24.1 months (range: 41-98) after KLAL while receiving suboptimal levels of SI because of medication taper (n = 5) or noncompliance (n = 1). Objective findings included an epithelial rejection line (n = 6), edema (n = 2), corneal epithelial irregularities (n = 2), and neovascularization (n = 1). Antirejection management consisted of topical corticosteroids (n = 6) and augmentation of SI therapy (n = 5). Conclusions: These cases of late acute graft rejection in KLAL patients support the notion that allodonor cells can persist over the long run and remain at risk for immunologic rejection. It further underscores the fact that long-term success with KLAL may require extension of SI beyond the first few years, albeit at lower levels individualized to each patient

Relative quantitative reverse transcription polymerase chain reaction comparing the expression of Notch pathway genes between the limbal and central human corneal epithelium

All results are after normalization to 18S rRNA. Higher expression in the central cornea is noted for (1.4 fold) and (1.7 fold). The expression of (0.7 fold) and (0.8 fold) was lower in the central cornea compared to the limbus. The expression of , , and appeared slightly lower in the central cornea, but this did not reach statistical significance (*p<p><b>Copyright information:</b></p><p>Taken from "Down-regulation of Notch signaling during corneal epithelial proliferation"</p><p></p><p>Molecular Vision 2008;14():1041-1049.</p><p>Published online 05 Jun 2008</p><p>PMCID:PMC2426716.</p><p></p