Amniotic membrane transplantation for symptomatic conjunctivochalasis refractory to medical treatments.

UNLABELLED: PURPOSE. To determine whether preserved human amniotic membrane can restore the large conjunctival defect created during surgical removal of conjunctivochalasis. METHODS: Amniotic membrane transplantation was performed at two facilities in 40 consecutive patients (47 eyes) with symptomatic conjunctivochalasis refractory to conventional treatments. RESULTS: The majority of patients were elderly (73.1 +/- 9.7 years) and women (75%). Over a follow-up period of 6.9 +/- 4.3 months, 46 (97.8%) eyes recovered smooth, quiet, and stable conjunctival surfaces. Epithelial defects healed in 16.5 +/- 7.3 days. Episodic epiphora was resolved in 24 of 30 (83.3%) eyes and improved in five other eyes. Notable relief was also noted for such symptoms as fullness or heaviness (19/19, 100%), sharp pain (6/6, 100%), redness (14/17, 88.2%), tiredness (17/20, 80.9%), itching (11/13, 78.6%), blurry or decreased vision (6/8, 75%), burning (8/13, 61.5%), foreign body sensation (8/13, 61.5%), and crust formation (1/2, 50%). Complications included focal inflammation of the host conjunctiva adjacent to the graft (six eyes), scar formation (five eyes), and suture-induced granuloma (one eye). CONCLUSION: Amniotic membrane transplantation can be considered as an effective means for conjunctival surface reconstruction during removal of conjunctivochalasis.

Amniotic membrane transplantation for symptomatic bullous keratopathy.

OBJECTIVE: To determine whether amniotic membrane transplantation can be used to treat symptomatic bullous keratopathy displaying poor visual potential. METHODS: Amniotic membrane transplantation was performed at 5 centers on 50 consecutive eyes (50 patients) with symptomatic bullous keratopathy and poor visual potential. The underlying causes of bullous keratopathy included aphakia (9 eyes), pseudophakia (19 eyes), failed grafts (9 eyes), and others (13 eyes). RESULTS: During the follow-up period of 33.8 weeks (3-96 weeks) after amniotic membrane transplantation, 43 (90%) of 48 eyes with intolerable pain preoperatively became pain free postoperatively. Among the 5 eyes with residual pain, 3 received repeated amniotic membrane transplantation, 1 required a conjunctival flap for pain relief, and 1 had reduced pain. Epithelial defects in 45 (90%) of 50 eyes created and covered by amniotic membrane healed rapidly within 3 weeks. Only 4 eyes (8%) showed recurrent surface breakdown. Epithelial edema or bullae recurred in a smaller area in 5 eyes (10%) and pseudopterygium developed in 1 eye. CONCLUSION: Amniotic membrane transplantation can be considered as an alternative to conjunctival flaps in alleviating pain, promoting epithelial healing, and preserving cosmetic appearance in patients with symptomatic bullous keratopathy and poor visual potential.

Clonal growth and differentiation of rabbit meibomian gland epithelium in serum-free culture: differential modulation by EGF and FGF.

We have established a serum-free clonal culture system to study the growth and differentiation of individual progenitor epithelial cells of the meibomian gland independent of other cell types and undefined serum factors. Single meibomian gland epithelial cells were obtained by subjecting whole meibomian glands to a brief EDTA treatment, needle aspiration, and nylon mesh filtration. The cells had been isolated by a previously described method using enzymatic and microsurgical techniques. Four to five hundred cells obtained were seeded on a 35 mm or 60 mm dish with serum-free MCDB 151 medium containing insulin, transferrin, selenium, ethanolamine, o-phosphorylethanolamine, dimethyl sulfoxide, and calcium. Control cultures with this basic medium did not show continuous clonal growth. Addition of epidermal growth factor (EGF) from 1 to 5 and 10 ng/ml enhanced clonal growth with a decreasing effect as measured by colony forming efficacy and colony size. Clonal growth was associated with the occurrence of two types of colony morphology and an increase in intracellular lipid production in the BrdU-labelled cells, shown by Nile red fluorescent staining. In contrast, the clonal growth stimulated by addition of acidic fibroblast growth factor (aFGF) from 1 to 100 ng/ml exhibited a pattern of an initial increase followed by a decrease, with the maximum noted at 10 ng/ml. Moreover, the aFGF-stimulated clonal growth was associated with a uniform colony morphology and minimal lipid synthesis even in the non-BrdU-labelled cells. These results indicate that clonal growth of meibomian gland epithelium can be achieved in a serum-free culture by adding either of these two peptide growth factors. Furthermore, the clonal growth stimulated by EGF was associated with progressive cellular differentiation more so than that of aFGF. Further exploration of such a differential regulation of proliferation and differentiation by EGF and aFGF may provide a better understanding of normal meibomian gland function and pathogenesis of various meibomian gland disorders.

Culture of rabbit meibomian gland using collagen gel.

Rabbit whole meibomian glands were isolated by microsurgical dissection and enzymatic digestion. Both ductal and acinar elements could be separated by subsequent microsurgical manipulation. Epithelial outgrowth could be derived from either the whole gland or the ductal/acinar elements using collagen gel in the serum-containing, growth factor-enriched medium. Two types of outgrowths were observed: a discontinuous spindle-shaped epithelial cell monolayer in which oil-red-O (ORO)-stained meibum containing single cells and cell aggregates were evenly distributed, and a continuous cuboidal epithelial monolayer in which oil-red-O-stained cells formed a gradient with single cells and cell aggregates preferentially distributed in the periphery of the outgrowth. Thus, meibum production and meibomian gland differentiation can be maintained in collagen gel culture and ductal elements may contain progenitor cells for acinar differentiation. This culture system will allow future exploration of the regulatory mechanism of meibomian gland differentiation at the cellular level.

Diagnostic impression cytology for external eye disease.

The authors describe their experience with the use of impression cytology (IC) as a diagnostic aid in the evaluation of external eye disorders. IC is shown to be useful for diagnosis of epithelial cell storage disorders, infectious diseases, and allergic disorders.

Primary mucinous sweat gland carcinoma of the eyelid.

A 76-year-old woman had a slowly enlarging lesion of the right lower eyelid. After obtaining incisional biopsy results consistent with adenocarcinoma, we removed the tumor and made a final diagnosis of primary mucinous adenocarcinoma of the sweat gland. The defect was repaired using ipsilateral upper lid transpositional tarso-conjunctival and skin-muscle flaps. No evidence of recurrence or metastasis was noted 42 months postoperatively. Consideration of such tumors is clinically important, since they have full metastatic potential. We therefore suggest consideration of sweat gland primary mucinous adenocarcinoma in the differential diagnosis of red or violaceous eyelid masses.

Therapeutic ultrasound for refractory glaucoma: a three-center study.

We present the results of therapeutic ultrasound for refractory glaucoma in a three-center study over 1 year. One hundred fifty-eight eyes were treated, with a mean follow-up of 8.0 months. The mean fall in intraocular pressure was 38.4%. Life table analysis for three success criteria are presented. Success varied between 66% and 72% at the mean follow-up time. Complications occurred in 11.4%, including phthisis bulbi in 0.6% and persistent hypotony in 2.5%. There was a mean loss of less than one line of visual acuity. Therapeutic ultrasound appears to be safe and effective for treatment of refractory glaucoma.

Bipolaris hawaiiensis-caused phaeohyphomycotic orbitopathy. A devastating fungal sinusitis in an apparently immunocompetent host.

The authors present a case report of a devastating bilateral optic neuropathy and orbitopathy initiated by a contiguous fungal sinusitis, in an apparently immunocompetent young man. The causative organism, Bipolaris hawaiiensis, and other species classified in the genus Bipolaris, are being recognized with increased frequency as causes of several ophthalmic and systemic disorders in both immunocompromised and normal hosts. A literature review demonstrates the variety of clinical presentations with emphasis on those cases which may present to the ophthalmologist.

Elevated tear IgG and conjunctival plasma cell infiltrate in a graft versus host disease patient.

Two patients developed graft versus host disease (GvHD) following allogeneic bone marrow transplantation for leukemia. One patient developed acute GvHD 12 days after transplantation, and the second developed chronic GvHD 100 days after transplantation. Tear analysis and conjunctival impression cytology were performed. The results were compared to a normal control and to another patient who was 18 months status post bone marrow transplantation with successfully treated GvHD. Tear sampling on the patient with chronic GvHD revealed greatly elevated IgG levels with an inverse IgG to IgA ratio, as compared with normals. In addition, two of three leukemia patients demonstrated decreased mucin levels in tears. Conjunctival impression cytology from the patient with chronic GvHD revealed an abundance of plasma cells.

Electron microscopy of impression-acquired conjunctival epithelial cells.

The authors describe a technique with which one can perform electron microscopy on conjunctival epithelial cells acquired by impression cytology. With adjacent excisional and impression biopsies of conjunctival epithelium in patients having mucopolysaccharidoses (MPS), typical fibrillo-granular inclusions are shown. This noninvasive procedure has potential for the study of subcellular, cellular, and intercellular morphology in diseases of the ocular surface.