Dry eye and ocular surface disease dry eye disease: a review of diagnostic approaches and treatments

Dry eye [DE] is a common ocular disease that results in eye discomfort, visual disturbance and substantially affects the quality of life. It has a multifactorial etiology involving tear film instability, increased osmolarity of the tear film and inflammation of the ocular surface with potential damage to the ocular surface. This review discusses the classification, diagnostic approaches and treatments of DE

Stem cell-based therapy for treating limbal stem cells deficiency a review of different strategies

The self renewal capability of limbal epithelial stem [LEST] cells is fundamental to the maintenance and healing of corneal epithelium. Limbal stem cell deficiency [LSCD], due to dysfunction or loss of LEST cells, therefore presents as persistent epithelial defects, corneal vascularization, conjunctivalization etc. Stem cell-based therapy, in its simplest form - limbal autograft, has been used successfully for more than a decade. For bilateral LSCD, similar approaches with limbal allografts have been unsuccessful largely due to strong immune rejection. Therefore, as an alternate strategy for treating bilateral LSCD, ex vivo expansion of the remaining LEST cells or autologous stem cells sourced from other potential sites is being explored. Different culture systems [with and without xenobiotic supplements] using substrates like amniotic membrane or fibrin gels have been used successfully for ex vivo LEST cell maintenance and reproduction by imitating the stem cell niche. This paper is organized into sections reviewing the LEST cells, LSCD and various stem cell-based approaches for treating LSCD and discussing future direction and challenges

Ocular surface rehabilitation Application of human amniotic membrane in high-risk penetrating keratoplasties

Human amniotic membrane is a versatile tool for management of ocular surface disorders. This study evaluates the effect of cryopreserved human amniotic membrane [hAM] on one-year survival of penetrating keratoplasties [PKP] in high-risk recipients. This is a retrospective noncomparative cohort study of 58 consecutive eyes undergoing PKP with concurrent placement of a self-retained cryopreserved hAM [PROKERA®] at a tertiary care center from January 2009 to July 2010. Mean patient age was 66.7 +/- 17.2 years and 30 [54%] were males. 51 eyes were pseudophakic and one aphakic. 27 eyes were glaucomatous; 24 had glaucoma drainage device and 2 had previous endocyclophotocoagulation. 12 patients had PKP for the first time and 46 had repeat PKP [average number of prior PKP = 1.63 +/- 1.1, range: 1-5]. Risk factors for graft failure included repeat PKP [79.3%], corneal neovascularization [51.7%], preexisting glaucoma [46.6%], and presence of anterior synechiae [37.9%]. Both First Transplant and Repeat Transplant groups had similar survival rates until 6 months after transplant [75% vs 74%, odds ratio = 1.06, p = 1.00]. At 12 months, First Transplant group showed a better survival rate [67% vs 43%, odds ratio = 2.60, p = 0.20]. Eyes with >3 risk factors had a higher graft failure rate [odds ratio = 5.81, p = 0.003]. Survey of the literature suggests that high-risk PKP with concurrent hAM placement demonstrate comparable graft survival. Presence of multiple risk factors is associated with poor survival

Descemet stripping with automated endothelial keratoplasty: a comparative study of outcome in patients with preexisting glaucoma

To compare postoperative complications after Descemet stripping with automated endothelial keratoplasty [DSAEK] in patients with and without glaucoma. For this retrospective study a series of 298 DSAEK cases performed at the Doheny Eye Institute were taken, we compared postoperative complications in eyes with glaucoma on medication [55] or with previous glaucoma surgeries [64] with a time-matched group of all other DSAEK cases [179, control]. With a mean follow-up of 1.85 +/- 1.12 years, the complication rates were 12.8%, 11.1%, and 26.8% for postoperative graft detachment, graft failure, and IOP elevation, respectively. Graft detachment was an independent risk factor for graft failure [odds ratio OR = 12.35, 95% confidence interval CI [5.46-27.90], P < 0.001]. Graft detachment was not associated with either history of glaucoma or glaucoma surgery [P > 0.05]. Glaucoma on medication had no increased risks of graft failure compared to normal eyes [P = 0.38]. However, increased risk of failure was seen in eyes with prior incisional glaucoma surgeries [OR = 4.26, 95% CI [1.87-9.71], P < 0.001]. Medically managed glaucoma has increased risks of postoperative IOP elevation [OR = 2.39, 95% CI [1.25-4.57], P = 0.013], whereas surgically managed glaucoma has no significant elevation [P = 0.23]. Elevation of IOP was not significantly correlated with graft failure [P = 0.21]. DSAEK is the preferred treatment for corneal endothelial dystrophy. We observed that having glaucoma or glaucoma surgery is not associated with graft detachment. A history of glaucoma surgery and postoperative graft detachment appeared to be important risk factors for graft failure. And more studies are indicated to study long-term IOP evolution in post-DSAEK patients and its association with graft survival

Acute hydrops in the donor cornea graft in non-keratoconus patients

A 44-year-old Hispanic male and 91-year-old Caucasian male presented to the clinic with acute vision loss and pain years after penetrating keratoplasty [PKP]. Neither patient had a history of keratoconus. Both patients had a history of eye rubbing and intraocular device present in the anterior chamber. The first patient had a history of a glaucoma drainage tube and the second patient had an anterior chamber intraocular lens implanted. Anterior segment ocular coherence tomography showed deep stromal cystic cavities. Both patients exhibited breaks in the endothelium by ultrasound biomicroscopy and the histopathologic examination after repeat PKP. Those findings were most consistent with acute corneal hydrops in the donor graft

Strategies for local gene therapy of corneal allograft rejection

Penetrating keratoplasty is the most common type of tissue transplant in humans. Irreversible immune rejection leads to loss of vision and graft failure. This complex immune response further predisposes future corneal transplants to rejection and failure. A diverse armamentarium of surgical and pharmacologic tools is available to improve graft survival. In this review, we will discuss the various gene therapeutic strategies aimed at potentiating the anterior chamber-associated immune deviation to extend graft survival

Imaging studies in a case of infectious scleritis after pterygium excision

A 44-year-old woman presented with a painful red eye for 2 weeks. Ultrasound biomicroscopy and optical coherence tomography were instrumental in the diagnosis and management of this case of infectious scleritis associated with previous pterygium excision complicated by choroidal and retinal detachments