Serial anterior segment optical coherence tomography post autologous simple limbal epithelial transplantation.

A 24-year-old young man presented to us with total limbal stem cell deficiency (LSCD) in the right eye 1 year post ocular chemical burn. The patient subsequently underwent limbal biopsy in the healthy contralateral eye and autologous simple limbal epithelial transplantation in the right eye. The patient was followed up with sequential imaging of the cornea with high-resolution anterior segment optical coherence tomography (HR-ASOCT) for 3 years. The serial HR-ASOCT imaging in the operated eye showed regeneration of the epithelium from the limbal transplant over the human amniotic membrane (hAM) with integration of the transplant within the cornea with subepithelial retention of the hAM. Over the long-term follow-up, thinning of the hAM and thickening of the epithelium was noted. At 3 years, the cornea maintained an intact epithelium with no signs of recurrence of LSCD.

Analysis from the perspective of cilia: the protective effect of PARP inhibitors on visual function during light-induced damage.

PURPOSE: To analyze the protective effect of PARP inhibitors on light-damaged retina and explore its possible mechanism from the perspective of ciliopathy. METHODS: A systematic review of the literature was performed to investigate the protection of PARP inhibition on light-damaged cilia. PubMed database was retrieved to find the relevant studies and 119 literatures were involved in the review. RESULTS: In retina, the outer segment of photoreceptor is regarded as a special type of primary cilium, so various retinal diseases actually belong to a type of ciliopathy. The retina is the only central nervous tissue exposed to light, but poly (ADP-ribose) polymerase (PARP), as a nuclear enzyme repairing DNA breaks, is overactivated during the light-induced DNA damage, and is involved in the cell death cascade. Studies show that both ATR and phosphorylated Akt colocalize with cilium and play an important role in regulating ciliary function. PARP may function at ATR or PI3K/Akt signal to exert protective effect on cilia. CONCLUSION: PARP inhibitors may protect the cilia/OS of photoreceptor during light-induced damage, which the possible mechanism may be involved in the activation of ATR and PI3K/Akt signal.

The ocular surface after simple limbal epithelial transplant (SLET): A high-resolution OCT study of the early postoperative period.

Simple limbal epithelial transplantation (SLET) is an emerging technique for treating unilateral limbal stem cell deficiency. We report the high-resolution, anterior segment optical coherence tomography (OCT) features of the first 2 weeks of a patient undergoing SLET for an old acid injury of the right eye, repeatedly from postoperative day 1 through day 14. Three out of 11 explants with the subjacent human amniotic membrane (hAM) and the overlaid bandage contact lens were imaged. The hAM was intact and of the same thickness throughout the study period; the sub-hAM space increased from day 3 to 9 and disappeared by day 10; the explants started thinning from day 3 with the fibrin around them starting to decrease from day 2 and completely disappeared by day 4. Epithelialization occurred between day 8 and 14 and proceeded more rapidly towards the limbus than centrally. There was no change of the corneal stromal thickness or reflectivity. This case report uses high-definition, spectral-domain OCT to document the events on the ocular surface after a successful SLET surgery and opens up an avenue to study epithelialization in a convenient and noninvasive manner.

Sclerocorneal graft and sequential removal of melted cornea after severe corneal burn with perforation.

Corneal burn grade IV usually leads to blindness. Several different surgical techniques remain challenging owing to the extensive tissue damage. Here, we introduce a novel technique with a 15 mm corneoscleral and limbal homologous graft combined with sequential autologous corneal removal ab interno, with a vitrectomy probe to save the anterior chamber angle. In vivo anatomy with optical coherence tomography is the surgical key. A large 15 mm sclerocorneal graft is sutured on top of the remainder of the destroyed cornea and sclera after removal of the epithelium and conjunctiva, with anterior synechiolysis if necessary, peripheral iridectomy and conjunctivoplasty. The recipient central corneal stroma is not removed, primarily to protect the anterior chamber angle. After three weeks, the collagenolytic central recipient corneal stroma can be removed with a small 23 g vitrectomy probe, respecting the lens and scleral spur. The corneoscleral graft remains clear under systemic and local immunosuppression. Intraocular pressure is well controlled because the anterior chamber angle is respected. Recurrent corneal erosions need close follow-up. Therapeutic soft contact lenses can support topical therapy. In cases of sclercorneal graft decompensation or rejection after 3-5 years, a new sclerocorneal graft (with limbal donation) seems to be superior to perforating keratoplasty without limbal stem cell transplantation. Repeated sclerocorneal grafts after severe corneal burn with limbal transplantation and maintenance of the complete anterior angle structure are a successful option for preventing blindness and achieving good visual acuity. Clin. Anat. 31:39-42, 2018. © 2017 Wiley Periodicals, Inc.

Analysis of Ocular Firework-Related Injuries and Common Eye Traumata: a 5-year Clinical Study.

Background A comparative study of eye injuries related to fireworks or acts of violence around New Year's Eve and the Swiss National Day on August 1st. The two groups were compared with respect to the overall numbers of eye accidents within the period of review. Patients and Methods Retrospective analysis of emergency consultations at the Department of Ophthalmology, University Hospital Zurich with eye accidents around the Swiss National Day on August 1st and New Year's Eve over the last 5 years. Two subgroups were formed: (1) Firework-related eye traumata, (2) Eye injuries due to acts of violence. The groups were analysed by age, gender, active participant or bystander, eye involved, severity of trauma (from clinical findings), surgical interventions, time of follow-up and visits, visual acuity and outcome. Results The study included 97 patients (100 eyes) with 74 male (76 %) and 23 female (24 %) victims. After filtering out 67 common traumata cases (all unilateral), 17 patients (18 eyes) with firework-related injuries and 13 patients (15 eyes) with damage due to an act of violence remained. Firework injuries accounted for 18 % of cases (65 % men); eye injuries caused by an act of violence accounted for 15 % of cases (92 % men). In the fireworks group, women were significantly older than men (mean age men 32 ± 14 years versus women 38 ± 16 years, p = 0.002). 65 % of cases were bystanders. The two subgroups contained 30 patients (33 eyes) with 22 left eyes (67 %, p < 0.001). The anterior segment was most frequently involved (79 %), significantly more often than the posterior part of the eye (p < 0.001). The posterior segment was injured more often in the fireworks group (28 %), than in the violence group (13 %). 87 % of the victims in the group of common traumata were mild trauma, 10 % moderate and 3 % severe. In the fireworks group the distribution was 53 % mild, 12 % moderate and 35 % severe, in the violence group 46 %, 23 % and 31 % respectively. Severe trauma cases occurred significantly more often around the New Year, with 36 % versus August 1st with 18 % (p = 0.0028). They are more often related to firework injuries than caused by violence (40 % versus 33 %). In summary, 7 victims (23 %) needed 8 interventions, with 3 having additional issues with their intraocular pressure. Full final visual acuity was noted in 88 %, which was alike in the two subgroups. On the contrary common traumata happened significantly more often around August 1st (66 %) than New Year (34 %; p < 0.001). Conclusions The number of injured eyes in the two subgroups of fireworks and violence was twice as high around New Year's Eve than around the Swiss National Day. If the two events were combined, eye injuries were caused by an act of violence in 45 % and by fireworks in 55 % of cases. Injuries from fireworks can be decreased by professional fireworks. Both types of accident can be decreased by public awareness.

Optical coherence tomography analysis of hydrofluoric acid decontamination of human cornea by mannitol solution.

PURPOSE: To evaluate the efficacy of mannitol solution as a decontamination agent on the chemical burn of the human corneas. METHODS: Eight donor corneas from an eye bank were exposed to 25µl of 2.5% hydrofluoric acid (HF) solution on a filter paper for 20s. Three eyes were rinsed with 1000ml of mannitol 20% for 15min immediately after removal of the filter paper, 3 other were rinsed with sodium chloride (NaCl) 0.9% (1000ml for 15min) and two eyes were not rinsed. Microstructural changes were monitored in the time domain by optical coherence tomography (OCT) imaging for 75min. RESULTS: NaCl reduced the penetration depth to approximately half the thickness of the cornea at 15min; scattering within the anterior cornea was higher than that for the unrinsed eye. With mannitol, no increased scattering was observed in the posterior part of the corneal stroma within a time period of 1h after rinsing. OCT images revealed low-scattering intensity within the anterior stroma at the end of the rinsing period. CONCLUSION: In eye bank human corneas, mannitol proved to be an efficient agent to decontaminate HF burn.

[Diagnostic accuracy of the immersion high-frequency B-scan ultrasonography in chemical injured eyes].

OBJECTIVE: To investigate the diagnostic accuracy of the immersion high-frequency B-scan ultrasonography, a noninvasive preoperative diagnosis method, in observing the anterior segment in chemical injured eyes. METHODS: It was a retrospective study. Sixty-three ocular chemical injury patients (63 eyes), who accepted the keratoplasty or the artificial cornea transplant in PLA General Hospital from May 2011 to May 2013, were included in this study. All the injured eyes were examined by ultrasound bio-microscopy (UBM) and immersion high-frequency B-scan ultrasonography, respectively. The images were analyzed and the results were compared with the intraoperative findings. The observation of lens was the main parameter. RESULTS: All the 63 patients were examined with the UBM and the immersion high-frequency B-scan ultrasonography before the surgery. The findings of the cornea, anterior chamber angle, iris from UBM were consistent with those from the immersion high-frequency B-scan ultrasonography. As for the lens observation, in 32 eyes in which the lens were not detected by UBM, the lens were not detected in only 16 eyes, while 3 eyes with normal lens and 13 eyes with lens pacifications (1 eye with pyknotic lens) by immersion high-frequency B-scan ultrasonography. In 17 eyes in which the lens were found normal by UBM, there were only 14 eyes with normal lens and the rest 3 eyes' lens were found intumescent by immersion high-frequency B-scan ultrasonography. In 6 eyes in which lens were detected with suspicious by UBM, 2 eyes' lens were pyknotic and 4 eyes' lens were intumescent or clouded by immersion high-frequency B-scan ultrasonography. The findings of immersion high-frequency B-scan ultrasonography were highly consistent with the intraoperative findings. CONCLUSIONS: The lens could be observed accurately by immersion high-frequency B-scan ultrasonography in chemical injured eyes.

Corneal oedemas: diagnosis and surgical planning with ultrasound biomicroscopy.

We used the Humphrey Ultrasound Biomicroscope (UBM System 840 by Zeiss-Humprey Instruments, San Leandro, Calif. USA) to study various corneal oedemas and leucomas. This UBM system, using a high-resolution probe of 50 Mhz, has an axial and lateral resolution of about 50 micrometer. We analysed 36 eyes divided into two groups, 27 (group A) affected by corneal oedema caused by traumatic-mechanic or phlogistic-toxic lesions, 9 (group B) affected by postsurgery oedema. Thanks to its high-resolution power, we could study their pathogenesis and their clinical evolution and so arrange a suitable therapy and perform an accurate follow-up of these pathologies.

[Massive foreign body reaction after intraocular penetration of hot, liquid plastic]. / Massive Fremdkörperreaktion nach intraokularer Einsprengung von heissem, flüssigem Kunststoff.

PATIENT: A 32-year-old male had an injury of his right eye by hot liquid plastic (Ultradur R). Intraoperatively, the eye was found broadly penetrated and filled up by more than 50% with ragged pieces of plastic. Computed tomography three days after wound closure revealed remaining foreign body material. As function was totally lost no further operation was considered. Seven weeks after the trauma, the eye was enucleated because of a painful phthisis. Histology showed numerous giant cells. CONCLUSIONS: Hot liquid plastic may perforate the eye and fill it up to a great extent. Due to intraocular cooling, pieces with sharp edges may develop, thus producing further (mechanical) tissue damage. Intraocular plastic is able to induce a massive foreign body reaction. It may be detected easily by computed tomography.

Electrical injury of the eye.

A 17-year-old male suffered superficial and deep facial burns after coming into contact with a high tension electrical cable with his head and right side of the face. The right eye sustained severe thermal coagulative injuries and subsequently was enucleated. Histopathological examination showed that the retinal neuropile was relatively intact although the retinal and choroidal circulations were severely compromised. The left eye was less affected but a dense cataract developed and required lensectomy. Visual acuity remained poor in the left eye due to retinal atrophy, retinal vascular attenuation and optic nerve degeneration. Electroretinographic tests and pseudo-random binary stimulus visually evoked responses were useful in predicting the visual outcome.

Retinal burns occurring at cataract extraction.

Paramacular changes presumably induced by operating microscope light have been described previously in six patients who had undergone extracapsular cataract extraction with posterior chamber lens implantation. Twelve additional patients are reported, including pseudophakes and nonpseudophakes, macular and paramacular burns, and no visual loss and severe visual loss. Burns occurred in spite of filters and light barriers used in some cases. Light sources were tungsten bulb or halogen/fiberoptic. Three cases had essentially normal preoperative angiography. Currently recommended safety measures have not eliminated this complication.