A new method using xenogeneicacellular dermal matrix in the reconstruction of lacrimal drainage.

AIMS: To prospectively evaluate the reliability and efficacy of a new treatment for the reconstruction of the lacrimal duct using a new histo-engineered material, xenogeneic (bovine) acellular dermal matrix. METHOD: Five patients (five eyes) with partial or total absence of the lacrimal duct were included in the study. Four patients (four eyes) suffered from traumatic injuries to the lacrimal duct and one patient (one eye) had congenital absence of the lacrimal drainage system. A pedal graft of conjunctiva was taken from the fornix area and rolled into a tube structure after being attached to the acellular dermal matrix. RESULTS: The average duration of follow-up for the patients was 7.2 months (ranging from 6 to 12 months). After surgery, the new duct in the nasal cavity could be observed above the middle turbinate by nasal endoscopy. Patency was confirmed by pressing in the area of the lacrimal sac and visualising air bubbles in the nasal cavity. Additionally, the meatus above the middle turbinate of the nasal cavity was stained and visualised after patients underwent Jones dye test 1 (JDT1). Five tear ducts proved to be effective through irrigation testing and epiphora symptoms were alleviated in all cases. CONCLUSIONS: The newly reconstructed lacrimal duct, formed by the shift of autogenous conjunctival petal and the attachment of acellular dermal matrix, was successful in all five cases and suggests a new solution for the complex lacrimal duct lesion and congenital anomalies of the lacrimal duct.

Effects of tobacco smoking on human corneal wound healing.

PURPOSE: To evaluate the effect of tobacco smoking on healing of corneal abrasions and keratitis in humans. METHODS: A retrospective chart review of patients diagnosed with corneal abrasions and corneal ulcers from 1990 to 2010 at the Dean McGee Eye Institute was performed. The primary outcome measured was time from initial examination to epithelial closure; tobacco smoking was the primary exposure variable. Comorbidity variables were also examined as potential confounding factors. The data were analyzed using Kaplan-Meier curves and Cox proportional hazards models. RESULTS: Eighty-seven patients met the inclusion criteria for corneal abrasion and 52 for keratitis. The mean healing time was 4.8 days in nonsmokers and 5.9 days in smokers in the abrasion arm, and 15.5 days in nonsmokers and 39.4 days in smokers in the keratitis arm. After controlling for comorbidities, treatment, and demographic variables, the healing time in both arms was significantly delayed in smokers when compared with nonsmokers (P = 0.01 and P = 0.03, respectively). The comorbidities were also studied after adjusting for smoking. A statistically significant delay was seen with previous keratoplasty and steroid treatment for the abrasion arm. In the keratitis arm, neurotrophic corneas and fungal infections were associated with a delay in healing after correcting for smoking. CONCLUSIONS: Epithelial healing is delayed by 1.1 days on average in smokers when compared with nonsmokers with corneal abrasions. Patients who had undergone a previous keratoplasty had delayed healing from corneal abrasions regardless of the smoking status. Epithelial healing is delayed by 23.9 days on average in patients with keratitis who report smoking. Neurotrophic corneas and fungal infections also had prolonged time to healing.