Architectural analysis of subconjunctival oblique limbus incision techniques in manual cataract extraction surgery by optical coherence tomography imaging

The purpose was to assess the profile of subconjunctival oblique limbus incision (SCOLI) design by using anterior-segment optical coherence tomography (AS-OCT) and try to emphasize the proper technique of wound construction. The structural dimensions and integrity of the wound were acquired from the patients, who had undergone manual small-incision cataract surgery with SCOLI techniques, using a Canon OCT anterior-segment imaging system on the first postoperative day. The use of AS-OCT allowed for an in vivo evaluation of SCOLI in high definition. The radial OCT scan image showed three staggered incisions, including conjunctiva incision, scleral entrance, and inner corneal lip. A tangential scan demonstrated that the internal lip is parallel to the curvature of the peripheral cornea. The en face image showed an asymmetric 4 arc-shaped configuration rather than a symmetrical one. In conclusion, AS-OCT could be used to analyze SCOLI to determine optimal wound construction and geometry. The results of this study indicated that an asymmetric 4 arc-shaped limbus tunnel incision was superior to the conventional linear equivalent in stability and nucleus delivery.

Countering choroid prolapse in corneo scleral repair

Background: The video shows the meticulous repair of the corneoscleral tear along with management of the choroidal prolapse. Purpose: The video demonstrates the steps to establish the anatomical integrity of the globe and tips to avoid suture bites through the choroid in a corneo-scleral tear repair. Synopsis: Identification of important landmarks helps in the establishment of anatomical integrity. Therefore, the limbal area of tear is first sutured with 10-O nylon. The extent of wound onto the sclera is checked on the other end of the tear. Second limbal suture at the opposite end of the tear is taken, followed by dividing the corneal extent of tear by rule of half and segmental suturing with 10-O nylon. Then conjunctival peritomy is done to explore the scleral extent and the uveal tissue prolapse. Blunt and atraumatic back tip of Weckel sponge is used perpendicular to the plane of the sclera to push the choroid back aiding the scleral bite. Sclera is sutured with 9-O nylon suture taking care not to include the choroidal tissue. Air injection is done to check for any wound leak. Side port is hydrated, and corneal sutures are buried. The conjunctiva is secured with fibrin glue. Anterior chamber is formed with air bubble. Povidone iodine is instilled and BCL placed. Highlights: 1. Suturing the landmark areas first; 2. Exploring the extent of wound; 3. Segmental suturing of the cornea; 4. Pushing the choroid back to avoid bites through it while suturing sclera; 5. Air injection to check for wound leaks; 6. Anterior chamber formation with air at the end.

Efficacy and safety of trabeculectomy at the inferior limbus for patients of intraocular pressure after failed glaucoma filtration / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the efficacy and safety of trabeculectomy at the inferior limbus for patients of intraocular pressure(IOP)after failed glaucoma filtration.METHODS: A retrospective analysis was conducted to identify 51 glaucoma patients with 61 eyes that had undergone trabeculectomy at the inferior limbus for patients of IOP after failed glaucoma filtration. The preoperative and postoperative IOP, visual acuity and number of IOP-lowering drugs, as well as intraoperative and postoperative complications were extracted. Surgical success rates were calculated using Kaplan-Meier survival analysis.RESULTS: The postoperative follow-up time ranged from 6-76(mean 30.15±14.10)mo. The preoperative IOP of 61 eyes was 35.98±10.01mmHg, the IOP after the surgery at 1wk, 1, 3, 6mo, 1a and the IOP of last follow-up visit were 9.62±4.90, 13.15±4.51, 16.05±7.37, 16.48±6.81, 16.68±6.42, 16.77±7.56 mmHg respectively, all of these were different compared to the preoperative IOP(P<0.001). The postoperative complete success rates at 6mo, 1 and 2a were 62%, 49% and 36%, respectively and the partial success rates were 93%, 85% and 81%, respectively. There were 34 eyes(56%)formed functional filtration blebs. There were 3.33±0.77 kinds of IOP-lowering eye drops used before surgery, and it was decreased to 1.41±1.44 kinds of eye drops(t=9.86, P<0.001)at 3mo after surgery. There was no severe complication observed such as filtering bleb infection and endophthalmitis.CONCLUSION: Trabeculectomy at the inferior limbus offers the opportunity for patients with uncontrolled IOP after failed glaucoma filtration, and it can still be used as a safe and effective treatment for patients, although it is relatively difficult to operate.

Application of limbal protection technique in epithelium-on corneal collagen cross-linking / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the clinical effect of a limbus protection technique during epithelium-on corneal collagen cross-linking(Epi-on CXL)for keratoconus treatment.<p>METHODS: Prospectively clinical study. A total of 15 patients(30 eyes)with diagnosed binocular progressive keratoconus were selected and treated with Epi-on CXL in my hospital from Jan. to Dec. 2019, and divided into 2 groups, Limbus-protecting Group and Control Group. The differences in corrected distance visual acuity, astigmatism, Km, thickness at the thinnest point of cornea, postoperative discomfort score, corneal epithelium healing time, and tear breakup time were compared between the two groups pre- and postoperatively.<p>RESULTS: The corrected distance visual acuity and astigmatism were improved at 3mo postoperatively(<i>P</i><0.05). The thickness at the thinnest point of cornea and the tear breakup time decreased after Epi-on CXL surgeries(<i>P</i><0.05). No difference was found in parameters of corrected distance visual acuity, astigmatism, Km, thickness at the thinnest point of cornea, tear break up time, and postoperative discomfort sore between the two groups(<i>P</i>>0.05). However, the postoperative corneal epithelium healing time in Limbus-protecting Group was shorter than in Control Group(3.20±0.56d <i>vs</i> 3.73±0.96d, <i>P</i>=0.041).<p>CONCLUSION:This limbal protection technique can reduce the corneal epithelium healing time after Epi-on CXL surgery, which preliminarily shows the feasibility of this technique.

Severe corneal burn due to the accidental application of salicylic acid packed in a plastic dropper bottle / Quemadura corneal grave debida a la aplicación accidental de ácido salicílico envasado en un frasco gotero plástico

Eye burns due to the accidental application of pharmacological or nonpharmacological substances packaged in plastic dropper bottles have been described for more than three decades and continue to occur. These burns can cause potentially serious corneal injuries. We report the case of a patient who mistakenly applied salicylic acid to the right eye after confusing it with an eye lubricant, which caused him a severe corneal burn. Fortunately, after aggressive medical and surgical management (including oxygen therapy and amniotic membrane grafting), the visual results were good. We suggest conducting educational campaigns and taking legislative measures in our country to avoid packaging corrosive substances in this type of dropper bottle to reduce the risk of accidental burns.

Las quemaduras oculares por aplicación accidental de sustancias farmacológicas o no farmacológicas envasadas en frascos goteros plásticos, se han descrito desde hace más de tres décadas y siguen ocurriendo. Estas quemaduras pueden causar lesiones potencialmente graves de la córnea. Se presenta el caso de un paciente que se aplicó ácido salicílico en el ojo derecho al confundir el envase con el de un lubricante ocular, lo que le causó una grave quemadura corneal. Afortunadamente, tras un manejo médico y quirúrgico agresivo (incluida oxigenoterapia e injerto de membrana amniótica) los resultados visuales fueron buenos. Se sugiere hacer campañas educativas y adoptar normas en el país para evitar el envase de sustancias corrosivas en este tipo de frascos goteros, con el fin de disminuir el riesgo de quemaduras accidentales.

Limbus Sparing Limbal Incision - A New Modified Conjunctival Incision Technique in Strabismus Surgery

The aim of the study is to introduce a newer technique of conjunctival incision called ‘Limbus Sparing Limbal Incision (LSLI)’ for horizontal rectus muscle strabismus surgeries. Methods: 20 patients were randomly divided into two groups of 10 each. In group 1, the conventional limbal incision was given in the conjunctiva and in group 2, a modified limbal incision, Limbus Sparing Limbal Incision (LSLI) was given. Each patient was followed post operatively on 1st, 7th and end of six weeks. Symptoms like pain, discharge, FB sensation, conjunctival congestion, excessive watering and lid swelling were noted. A record was also made of the conjunctival hyperaemia/chemosis, gaping in conjunctival incision, conjunctival retraction/coiling, thickened conjunctival flap, suture granuloma, corneal abrasion, dellen formation, other signs of ocular surface disorders, need for suture removal and need for resuturing. Results: The mean pain score in group 1 was 1.30 ± 0.68 and 2.10 ± 0.57 in group 2 (p=0.010). Mean foreign body sensation score in group 1 was 1.10 ± 0.32, and 2.30 ± 0.68 in group 2 (p<0.001). In 20% of patients in group 2, re-suturing of the wound had to be done. Dellen formation was seen in 10% of patients in group 1 and none in group 2 (p=1.0). Conclusion: Though, the new modified conj incision spares the damage to perilimbal tissue and stem cells, the post op discomfort and delayed healing limited its use. However, large scale studies are needed which can compare the two techniques in terms of outcomes, complication rates, and patient satisfaction.

Amniotic membrane as a biological scaffold for dental pulp stem cell transplantation in ocular surface reconstruction / Membrana amniótica como substrato biológico para o transplante de células-tronco da polpa do dente de leite na reconstrução da superfície ocular

ABSTRACT Purpose: To evaluate the ability of human immature dental pulp stem cells, which are mesenchymal stem cells of neural crest origin, to differentiate into the corneal epithelium for purposes of corneal transplantation and tissue engineering when cultured on de-epithelized amniotic membranes. Methods: We compared the immunophenotypes (ABCG2, K3/12, and vimentin) of cells grown on amniotic membranes or plastic surfaces under serum-free conditions or in culture media containing serum or serum replacement components. Results: Immature dental pulp stem cells grown on amniotic membranes under basal conditions are able to maintain their undifferentiated state. Our data also suggest that the culture medium used in the present work can modulate the expression of immature dental pulp stem cell markers, thus inducing epithelial differentiation of these cells in vitro. Conclusions: Our results suggest that the amniotic membrane is a good choice for the growth and transplantation of mesenchymal stem cells, particularly immature dental pulp stem cells, in clinical ocular surface reconstruction.

RESUMO Objetivos: Avaliar a capacidade das células-tronco imaturas da polpa do dente de leite que são células-tronco mesenquimais de origem da crista neural, de se diferenciarem no epitélio corneano para fins de transplante de córnea e engenharia de tecidos quando cultivadas em membrana amnióticas desepitelizadas. Métodos: Foram comparamos so imunofenótipo (ABCG2, CK3/12 e vimentina) de células cultivadas em membranas amnióticas ou em superfícies plásticas sob condições livres de soro ou em meios de cultura contendo soro ou componentes de substituição de soro. Resultados: Células-tronco imaturas da polpa do dente de leite cultivadas sobre membrana amniótica em condições basais são capazes de manter seu estado indiferenciado. Nossos dados também sugerem que o meio de cultura utilizado no presente trabalho pode modular a expressão de marcadores de células-tronco imaturas da polpa do dente de leite, induzindo a diferenciação epitelial destas células in vitro. Conclusão: Nossos resultados sugerem que a membrana amniótica é uma boa escolha para o crescimento e transplante de células-tronco mesenquimais, particularmente as células-tronco imaturas da polpa do dente de leite, na reconstrução da superfície ocular.

Limbal ischemia: Reliability of clinical assessment and implications in the management of ocular burns

Purpose: Limbal ischemia is an important prognostic factor in the management of ocular burns. In this study, we evaluated the reliability of clinically assessing limbal ischemia among ophthalmic professionals. Methods: This study included 111 ophthalmic professionals who were shown 12 diffuse illumination color slit-lamp photographs of eyes with recent chemical injuries. Respondents were asked whether the photos were assessable and if yes, then to indicate the presence, location, and grade of limbal ischemia in each case. The responses were collected using a standard data collection sheet and the inter-observer agreement was calculated. Results: All participants responded to every question. Of the 1,332 responses, images were deemed assessable in 1,222 (91.7%) instances. The overall agreement (Fleiss' kappa) for the presence of limbal ischemia and severity of limbal ischemia was 0.106 and 0.139, respectively (P < 0.012). Among the four groups of observers, practicing cornea specialists displayed significantly (P < 0.003) higher kappa values (0.201–0.203) when compared to residents (0.131–0.185), fellows (0.086–0.127), and optometrists (0.077–0.102). All indicated a poor level of inter-rater consistency. Conclusion: The results indicate that clinical assessment of limbal ischemia is highly subjective and there is lack of reliability even among cornea specialists who regularly manage patients with ocular burns. A non-invasive, standardized, objective, accurate, and reliable modality for ocular surface angiography is desperately needed for proper assessment and prognostication of ocular burns.

Latest progresses of limbal stem cell / 国际眼科杂志(Guoji Yanke Zazhi)

@#The corneal epithelial cells are the outermost layer of the cornea. When they are turnover or trauma, the corneal epithelial cells are supplemented by continuous self-renewal of stem cells located in the basal epithelium at the corneoscleral limbus. If limbal stem cells are deficient(LSCD), this balance would be broken, resulting in corneal diseases. Currently, transplantation of cultured limbal stem cells is one of the best curative option of reconstruction of the ocular surface. This article reviews the recent progress on identification, different sources of stem cells, and expansion of limbal stem cells.

Comparison of the efficacy of phacoemulsification with corneoscleral limbus incision and corneal incision in the treatment of age-related cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To analyze the effects of corneoscleral limbus incision phacoemulsification and corneal incision phacoemulsification on postoperative rehabilitation of elderly cataract patients.<p>METHODS: Totally 98 elderly cataract patients(132 eyes)who underwent phacoemulsification in our hospital during the period from January 2015 to January 2017 were enrolled. According to surgical incision sites, they were divided into corneoscleral limbus incision group(group A, <i>n</i>=52 cases, 74 eyes)and corneal incision group(group B, <i>n</i>=46 cases, 58 eyes). The changes of uncorrected visual acuity, best corrected visual acuity(BCVA)and corneal astigmatism in both groups were measured at different time points before and after operation. The epithelial repair time and incision repair time in both groups were statistically analyzed. The changes of tear break-up time(BUT), tear secretion and corneal staining score were recorded at different time points before and after treatment. The incidence of postoperative complications was statistically analyzed.<p>RESULTS: There were significant differences in uncorrected visual acuity, corneal astigmatism, surgery induced corneal astigmatism, BCVA, BUT, tear secretion and corneal staining scores between the two groups and within the same group at different time points(<i>P</i><0.05). The uncorrected visual acuity and BCVA in group A were superior than those in group B at different time points after operation. The corneal astigmatism and surgery induced corneal astigmatism were lower than those in group B. BUT was longer than that of group B. And tear secretion was higher than that in group, and corneal staining score was lower than that in group B(<i>P</i><0.05).The epithelial repair time and incision repair time in group A were shorter than those in group B after operation(<i>P</i><0.05).There was no significant difference in the incidence of postoperative complications between the two groups(<i>P</i>>0.05).<p>CONCLUSION:The phacoemulsification under corneoscleral limbus incision can improve postoperative visual acuity of elderly cataract patients, reduce the corneal astigmatism, reduce the influence on the tear film function, and promote postoperative rehabilitation.

Clinical features and corneal optical anisotropies in a rabbit model of limbal stem cell deficiency / Fenótipos clínicos e anisotropias ópticas da córnea em coelhos com deficiência de células tronco limbais

ABSTRACT Purposes: To investigate the intra-laboratory reproducibility of clinical features and to evaluate corneal optical anisotropies in a rabbit model of limbal stem cell deficiency. Methods: Limbal injury was induced in the right eye of 23 adult New Zealand White rabbits using a highly aggressive protocol that combined 360 degrees limbal peritomy, keratolimbectomy, alkaline chemical burn, and mechanical removal of the epithelium. Clinical evaluation of the injured eyes was performed for 28 days and included corneal impression cytology. Corneas with a severe clinical outcome set typical of limbal stem cell deficiency were then collected, subjected to a histopathological examination, and examined for optical anisotropies. Corneas from healthy rabbit eyes were used as controls. Differences in optical path due to stromal collagen birefringence, as well as linear dichroism related to the expression and spatial orientation of glycosaminoglycan chains from proteoglycans, were measured from cross-sections under a quantitative polarized light microscope. Results: One eye showed signs of hypopyon and was excluded. Signs of ocular inflammation were observed in all eyes studied (n=22). Corneal impression cytology did not detect goblet cells. Twelve of the 22 corneas presented a clinical outcome set typical of limbal stem cell deficiency, which is characterized by the presence of epithelial defects, inflammatory cells, moderate-to-severe opacity, and neovascularization. Microscopic studies under polarized light revealed that relative to controls, limbal stem cell deficiency caused a 24.4% increase in corneal optical path differences. Further, corneas with limbal stem cell deficiency were less dichroic than controls. Conclusions: These results suggest that rabbit models of limbal stem cell deficiency must be rigorously screened for use in preclinical studies to ensure experimental homogeneity because protocols used to create limbal stem cell deficiency could be not associated with good intra-laboratory reproducibility of clinical features. Limbal stem cell deficiency, as induced herein, altered the optical anisotropic properties of the corneal stroma. Such alterations are indicative of changes in collagen packing and the spatial orientation of glycosaminoglycan chains from proteoglycans. Knowledge of these changes is important to potentiate strategies aimed at restoring the morphofunctional integrity of the corneal stroma affected by limbal stem cell deficiency.

RESUMO Objetivos: Investigar a reprodutibilidade intra-la­boratorial dos fenótipos clínicos e avaliar anisotropias ópticas em córneas de coelhos com deficiência de células tronco limbais. Métodos: Lesões ao limbo foram feitas no olho direito de 23 coelhos adultos da Nova Zelândia Branco, usando um protocolo altamente agressivo, que envolveu peritomia limbal em 360 graus, ceratolimbectomia, cauterização por álcali, e remoção mecânica de epitélio remanescente. Os olhos foram clinicamente avaliados por 28 dias, inclusive por citologia de impressão corneal. As córneas que manifestaram um conjunto de alterações típicas de deficiência de células tronco limbais foram coletadas e submetidas à estudos em histopatologia e em anisotropias ópticas. Córneas saudáveis foram usadas como controles. Diferenças de caminho óptico de birrefringência relacionada à organização do colágeno estromal, e dicroísmo linear relacionado à expressão e à orientação das cadeias de glicosaminoglicanos dos proteoglicanos estromais, foram quantificados por microscopia de luz polarizada. Resultados: Um olho apresentou hipópio e foi excluído do estudo. Todos os olhos estudados (n=22) apresentaram sinais de inflamação ocular. A citologia de impressão não detectou células caliciformes na superfície corneal. Doze de 22 córneas manifestaram alterações clínicas típicas de deficiência de células tronco limbais, caracterizado por defeitos epiteliais, infiltrados inflamatórios, opacidade de moderada à severa, e neovascularização. Estudos por microscopia de luz polarizada mostraram que a deficiência de células tronco limbais aumentou a diferenças de caminho óptico corneal em 24,4% (versus controles). As cór­neas com deficiência de células tronco limbais foram menos dicroicas do que as córneas controle. Conclusões: Coelhos com deficiência de células tronco limbais, para aplicações em estudos pré-clínicos, devem ser rigorosamente selecionados para assegurar homogeneidade experimental, pois há evidências de que protocolos utilizados para indução de deficiência de células tronco limbais não estão associados com boa reprodutibilidade intra-laboratorial de fenótipos clínicos. A deficiência de células tronco limbais, como induzida aqui, alterou as propriedades ópticas anisotrópicas do estroma corneal. Tais alterações são indicativas de mudanças no empacotamento de colágeno e na orientação das cadeias de glicosaminoglicanos dos proteoglicanos. Conhecimentos nessas alterações são importantes para potencializar estratégias que visam a restabelecer a integridade morfofuncional do estromal corneal acometido pela deficiência de células tronco limbais.

Corneal fibroma: An uncommon stromal tumor

A 56-year-old male patient presented with a slow-growing, elevated, smooth, white corneal mass. The mass was excised by performing an alcohol-assisted keratoepitheliectomy and sent for histopathological examination. Subepithelially, closely packed spindle cells in 揻eather-stitched� or storiform pattern were seen. Immunohistochemically, the cells stained negatively for CD-34 and S-100 and focal positivity was seen for vimentin. Based on the morphology and immunochemical staining, a diagnosis of corneal fibroma was made. No recurrence was seen. Corneal fibroma is an exceedingly rare, benign tumor and possibly lies on the same spectrum as corneal keloid and hypertrophic cicatrix. Surgical resection is usually curative.

Research progress of ocular surface reconstruction with ex vivo cultured tissue engineered cell sheet / 中华实验眼科杂志

Limbal stem cells (LSCs),the source of corneal epithelial cells,play an important role in the ocular surface. In recent years, with the development of somatic stem cell application and tissue engineering, biomaterials and cell culture technology,progress has been made on the basic researches and clinical applications of ocular surface reconstruction with ex vivo cultured limbal epithelial and oral mucosal epithelial cell sheet transplantation. However, there are several issues, including the successful clinical outcomes for ocular surface reconstruction,and the in vivo tracking of donor stem cells,remained indefinitive. This article introduced and compared recent advancements of tissue engineering techniques ex vivo cultured autologous or allogeneic limbal,oral mucosal epithelial cells in ocular surface reconstruction,so as to provide a useful direction for the future research of ocular surface reconstruction.

Preliminary exploration of rabbit corneal limbus stem cells cultured with tissue block and enzyme digestion method / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM:To establish a simple and efficient method for the primary culture of rabbit corneal limbus stem cells. ·METHODS:Obtained the limbal tissues from rabbits, used tissue block and enzyme digestion method to culture the corneal limbus stem cells in vitro. The growth characteristics of the cultured cells in vitro were observed under inverted microscope. By means of HE, the morphology and construction features of cells were observed.And immunohistochemical method was used to identify the cultured cells. ·RESULTS:Rabbit corneal limbus stem cells could be fast and simply cultured by using tissue block and enzyme digestion method. The dynamic observation under microscope showed that rabbit corneal limbus stem cells grew well with a higher proliferative capacity. In HE staining, the morphology and structure of cells were normal.AE5 and P63 cellular immune identification were positive. · CONCLUSION: Tissue block and enzyme digestion method could be a simple and efficient mode for the primary culture of rabbit corneal limbus stem cells.

A supramolecular look at microenvironmental regulation of limbal epithelial stem cells and the differentiation of their progeny / Uma visão supramolecular sobre a regulação microambiental de células tronco epiteliais limbais e a diferenciação de sua progênie

ABSTRACT Various approaches have been taken to improve our knowledge of the microenvironmental regulation of limbal epithelial stem cells. Researchers have extensively investigated the roles of growth factors, survival factors, cytokines, enzymes, and permeable molecules secreted by the limbal cells. However, recent evidence suggests that stem cell fate (i.e., self-renewal or differentiation) can also be influenced by biophysical and mechanical cues related to the supramolecular organization and the liquid crystalline (mesophase) nature of the stromal extracellular matrix. These cues can be sensed by stem cells and transduced into intracellular biochemical and functional responses, a process known as mechanotransduction. The objective of this review is to offer perspectives on the supramolecular microenvironmental regulation of limbal epithelial stem cells and the differentiation of their progeny.

RESUMO Muitas abordagens têm sido utilizadas para ampliar entendimentos sobre a regulação microambiental das células tronco epiteliais limbais. Neste contexto, pesquisadores têm exaustivamente investigado a participação de fatores de crescimento, fatores de sobrevida, citocinas, enzimas e moléculas permeáveis secretadas pelas células limbais. Entretanto, evidências recentes sugerem que o destino (ie. autorrenovação ou recrutamento para a via de diferenciação) das células tronco também sofre influência de estímulos biofísicos ou mecânicos relacionados à organização supramolecular e à natureza liquido-cristalina (mesofases) da matriz extracelular estromal. Esses estímulos podem ser percebidos e traduzidos pelas células tronco em sinais bioquímicos que geram respostas funcionais, através de um processo designado de mecanotransdução. Objetiva-se, com a presente revisão, oferecer ao leitor perspectivas supramoleculares sobre a regulação microambiental das células tronco epiteliais limbais e a diferenciação de sua progênie.

Comparison of improved phacoemulsification through limbus tunnel incision versus manual small-incision cataract surgery on ophthalmic operation vehicle / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To compare the clinical effects of improved phacoemulsification through limbus tunnel incision versus manual small-incision cataract surgery on ophthalmic operation vehicle.METHODS:Totally 261 patients (261 eyes) were enrolled in non-randomized controlled retrospective study.There were 160 eyes of Group A were treated with improved phacoemulsification through limbus tunnel incision;101 eyes of Group B were treated with manual small-incision cataract extracapsular extraction.Both of the two groups were implanted PMMA IOL during the surgery and were follow-up for postoperative 30d.The surgical operation time and surgical complications of the two groups were compared.Uncorrected visual acuity (UCVA) and surgery induced astigmatism (SIA) were recorded at postoperative 1,7 and 30d.RESULTS:The operation time of improved phacoemulsification through limbus tunnel incision was shorter than that of manual small incision cataract extraction (t=-6.419,P＜0.001).UCVA greater than or equal to 0.5 of Group A were 110 (68.8％),115 (71.9％) and 121 (75.6％) at postoperative 1d,7d and 30d,and that of Group B were 55 (54.5％),63 (62.4％) and 68 (67.3％).UCVA of Group A was better at postoperative 1d (x2 =5.441,P=0.020).The differences of UCVA greater than or equal to 0.5 between the two groups were not statistically significant at postoperative 7d and 30d.The overall difference of SIA between the two groups was not statistically significant (F=2.135,P =0.145).The difference of SIA within the two groups was statistically significant (P ＜ 0.001) in different point time.The difference in the methods of improved phacoemulsification through limbus tunnel incision and manual small incision cataract extraction was not sifnificant on SIA in different time points (F=1.314,P=0.264).There was no statistically significant difference between the two groups in posterior capsular rupture and corneal edema (P＞ 0.05),but the difference in the anterior chamber reaction between the two groups was statistically significant at postoperative 1d (x2 =5.293,P＜0.05).CONCLUSION:Improved phacoemulsification through limbus tunnel incision has advantages over shorter operation time,better visual recovery,few syndromes and is worth promoting on ophthalmic operation vehicle.

Expression changes and significance of ATP-binding cassette transporter B5 in pterygium / 中华实验眼科杂志

Background Limbal stem cells (LSCs) deficiency leads to many ocular surface diseases,such as pterygium and so on.ATP-binding cassette transporter B5 (ABCB5) is a recently discovered marker of LSCs.Understanding the expression changes of ABCB5 in pterygium tissue has an important clinical significance for pterygium.Objective This study was to investigate the expression changes of ABCB5 in pterygium tissue.Methods Thirty-seven pterygium tissue specimens were collected from primary pterygium patients who received pterygium surgery,and 22 normal conjunctival tissue specimens were obtained from the strabismus patients and retinal detachment patients during surgery in 474 Hospital of Chinese PLA from January 2015 to November 2015.Immunochemistry was employed to detect the cxpression and location of ABCB5 in the specimens,and the protein and mRNA expressions of ABCB5 were detected by Western blot and real-time fluorescence quantitative PCR,respectively.The results were compared between normal conjunctival tissues and pterygium tissue.Results ABCB5 protein was expressed in the cytoplasm and nuclei of stratified squamous epithelium of 22 normal counjunctival tissue specimens,especially in the basal layer cells,and showed obvious polarity in normal conjunctiva.In pterygium group,ABCB5 protein was positively expressed in 91.89％ specimens (34/37) and the expression was absent in 8.11％ specimens (3/37).The relative expression levels of ABCB5 protein were 0.90±0.31 and 0.59±0.41,and those of ABCB5 mRNA were 1.01±0.26 and 0.65±0.32 in the normal conjunctival tissues and pterygium tissue,respectively,showing significant differences between them (protein:t =-0.266,P =0.011;mRNA:t =-4.560,P =0.000).Conclusions Down-regulation of ABCB5 in pterygium indicates the decreasing and losing of LSCs,which may play an important role in the development of pterygium.ABCB5 may be a useful indicator for the prediction of development and recurrence of pterygium and has an important implication for treating evaluation,and it may also be a target for the management of pterygium.

Application value of corneal limbus stem cells transplantation to treat pterygium / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the application value of corneal limbus stem cells transplantation in the treatment of pterygium. <p>METHODS: Totally 300 patients(318 eyes)with pterygium were divided into 2 groups according to treatment methods. Patients of the control group(70 patients with 77 eyes)were given simple surgical resection, while patients of the observation group(230 patients with 241 eyes)were given corneal limbus stem cells transplantation after surgical resection. The postoperative recurrent rate, corneal epithelium incision healing time, corneal epithelium healing degree, pain score and tear film break-up time were observed. <p>RESULTS: The corneal epithelium incision healing time of the observation group and control group were respectively 5.2±1.9d and 6.4±1.7d, and the difference had statistical significance(<i>P</i><0.05). There was no patient recurred in the observation group, while there were 7 eyes(9.1%)recurred in the control group, and the difference between groups had statistical significance(<i>P</i><0.05). At 1wk after treatment, there was no significant difference in corneal epithelium healing degree and pain score between groups(<i>P</i>>0.05). At 2wk after treatment, the corneal epithelium healing degree of the observation group was better, and the pain score of the observation group was lower than those of the control group, the differences between groups had statistical significance(<i>P</i><0.05). Before treatment, there was no significant difference in tear film break-up time between groups(<i>P</i>>0.05). At 1 and 2wk after treatment, the tear film break-up time of the observation group was longer than that of the control group(<i>P</i><0.05). <p>CONCLUSION: Corneal limbus stem cell transplantation can prevent postoperative recurrence of pterygium effectively, and its postoperative tissue repair effect is superior to simple surgery.

Autologous limbus conjunctival flap transplantation for pterygium accompaniedwith conjunctival cyst / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe the efficacy of surgical excision combined with autologous limbus conjunctival flap transplantation in the treatment of pterygium accompanied with conjunctival cyst.METHODS: Totally 126 patients 188 eyes with pterygium were hospitalized in Department of Ophthalmology of Tongji Hospital of Huazhong University of Science and Technology during August 2013 and August 2015.The patients were divided into two groups: observation group (11 eyes of 11 patients) with pterygium accompanied with conjunctival cyst and control group (177 eyes of 115 patients) with primary pterygium.All patients underwent slit lamp microscope examination, anterior segment photography, and anterior segment optical coherence tomography(OCT).The size of pterygium was calculated by multiplying neck width and length of the covered corneal.All patients underwent excision combined with autologous conjunctival flap transplantation, and the resections were performed pathological section with hematoxylin and eosin staining.All patients were followed up postoperatively for 4-28mo.RESULTS: All cases in the observation group were confirmed by postoperative pathological examination.All cyst walls were complete, and containing single layer of epithelial cells.The mean size of pterygium of the observation group was 6.9±1.7mm2, and 6.3±1.8mm2 for the control group.There was no significant difference between the two groups (P>0.05).The mean postoperative healing time of observation group was 2.1±0.9d, and 1.9±0.8d for the control group.There was no significant difference between the two groups (P>0.05).Recurrence was seen in two eyes within the follow-up period in the control group, and no recurrence in the observation group.CONCLUSION: Surgical excision combined with autologous limbus conjunctival flap transplantation is a safe and effective treatment for pterygium accompanied with conjunctival cyst.

Assessment of surgical outcomes of limbal transplantation using simple limbal epithelial transplantation technique in patients with total unilateral limbal deficiency / Avaliação dos resultados cirúrgicos do transplante de limbo utilizando a técnica SLET (simple limbal epithelial transplantation), em pacientes com deficiência límbica total unilateral

ABSTRACT This study aimed to evaluate the effectiveness of the novel simple limbal epithelial transplantation (SLET) technique, which reduces the risk of iatrogenic limbal stem cell deficiency in the donor eye. Four patients with total unilateral limbal stem cell deficiency received a limbal graft, measuring 4 mm × 2 mm, from the contralateral healthy eye in a single surgical procedure. The graft was divided into 10-20 pieces and distributed on the corneal surface. At 6-month follow-up, a completely avascular corneal epithelial surface was obtained in two patients, and there was improvement in visual acuity in one patient. The limbal grafts did not adhere to the cornea in one patient. No serious complications related to the surgery were observed in this study.

RESUMO Este trabalho tem como objetivo avaliar a eficácia de uma nova técnica cirúrgica denominada SLET (simple limbal epithelial transplantation), um procedimento promissor que reduz os riscos de indução de deficiência límbica iatrogênica no olho doador. Quatro pacientes com deficiência límbica total unilateral, secundária a queimadura química, receberam um enxerto de células límbicas, medindo 4 mm x 2 mm, do olho contralateral sadio, em apenas um tempo cirúrgico. Este foi divido em 10 a 20 fragmentos e distribuído sobre a superfície da córnea. Após 6 meses de cirurgia, superfície corneana totalmente epitelizada e avascular foi obtida em dois pacientes. Houve melhora da acuidade visual em um paciente. Não houve aderência dos enxertos de limbo na córnea em um paciente. Nenhum paciente apresentou efeitos colaterais graves decorrentes do procedimento cirúrgico.