RESUMO
PURPOSE: Scar contracture of the eyelid following facial burns often has adverse consequences. Total cicatricial contracture often makes adjustment flap translation challenging to implement. Previously used upper and lower eyelid adhesion methods are ineffective for patients with severe cicatricial contracture, and ectropion can easily recur. This study aimed to retrospectively examine upper and lower eyelid adhesions using an orbicularis oculi muscle flap and verify its stability. METHODS: In patients with ectropion caused by severe scar contracture following head and face burns, we employed a tunnel orbicularis oculi muscle flap technique, which involved creating a tunnel between the skin and the tarsal plate of the eyelid, mobilizing the orbicularis oculi muscle, and rotating it into this tunnel to provide stable adhesion of the upper and lower eyelids. Full-thickness skin grafting was then performed. The eyelids were examined postoperatively to determine whether reoperation was necessary and to monitor for any potential complications. RESULTS: This study included 26 patients and 46 eyes. No accidental disconnection occurred after eyelid adhesion, which lasted for an average of 21.87 ± 10.08 months before the eyelid adhesion was cut open. No complications or adverse reactions occurred, and the adhesions did not break unexpectedly. CONCLUSIONS: Repairing eyelid ectropion with the tunnel orbicularis oculi muscle flap is a simple procedure that immediately creates tension against upper and lower eyelid contractures, providing long-term stable adhesion. This method avoids structural disorders, such as eyelid margin scarring, minimally influences surrounding tissues, and has few postoperative complications. It holds great value for repairing eyelid tissue defects and warrants further study.
Assuntos
Ectrópio , Pálpebras , Músculos Oculomotores , Transplante de Pele , Retalhos Cirúrgicos , Humanos , Ectrópio/cirurgia , Ectrópio/etiologia , Masculino , Feminino , Estudos Retrospectivos , Adulto , Transplante de Pele/métodos , Pessoa de Meia-Idade , Músculos Oculomotores/cirurgia , Músculos Oculomotores/fisiopatologia , Adulto Jovem , Pálpebras/cirurgia , Blefaroplastia/métodos , Adolescente , Criança , Aderências Teciduais/cirurgia , Aderências Teciduais/etiologia , Queimaduras Oculares/cirurgia , Queimaduras Oculares/fisiopatologia , Queimaduras Oculares/diagnósticoRESUMO
Chemical burns of the ocular surface (CBOS) are emergencies of highest urgency. Therefore, an adequate emergency care is mandatory. Following a precise analysis of the initial damage, a staged therapeutic approach is used to prevent persistent impairment of the ocular surface. In the acute stage, the prevention of complications is targeted (symblepharon, conjunctival scarring, lacrimal stenosis, corneal ulceration, intraocular inflammation, elevated intraocular pressure, etc.). In later stages, if complications have developed, a secondary restoration of the ocular surface is focussed. Sometimes this requires several surgical interventions. Based on a review of international literature, this review highlights the pathophysiology according to different chemical agents, CBOS stages as well as main therapy strategies in early and advanced stages of CBOS. Acute treatment aims to lower inflammation, oxidative stress and tries to promote reepithelialisation. Besides conjunctival scarring, loss of goblet cells and corneal opacification a limbal stem cell insufficiency is the most harming complication. Several new techniques have been developed to recover the ocular surface with a sufficient and clear epithelial layer in order to avoid neovascularization of the cornea. The knowledge concerning the high risk potential for persistent visual impairment in CBOS patients and the ability for appropriate emergency care should be kept in every physician's mind dealing with CBOS.
Assuntos
Queimaduras Químicas , Queimaduras Oculares , Humanos , Queimaduras Oculares/terapia , Queimaduras Oculares/fisiopatologia , Queimaduras Químicas/terapia , Queimaduras Químicas/fisiopatologia , Queimaduras Químicas/etiologia , Resultado do Tratamento , Serviços Médicos de Emergência/métodos , Medicina Baseada em EvidênciasRESUMO
Limbal Stem Cell Deficiency (LSCD), caused due to corneal injury, primarily by chemical/alkali burns, leads to compromised vision. Recently, several animal models of corneal alkali burn injury have become available. The majority of the studies with these animal models start interventions soon after the injury. However, in the clinical setting, there is a considerable delay before the intervention is initiated. Detailed knowledge of the molecular, histopathological, and clinical parameters associated with the progression of the injury leading to LSCD is highly desirable. In this context, we set out to investigate clinical, histopathological parameters of ocular surface alkali burn over a long period of time, post-injury. Limbal stem cell-deficient animal models of rabbits were created by alkali burn using sodium hydroxide, which was then assessed for their progression towards LSCD by grading the alkali burn, corneal haze, and vascularization. Additionally, cells present on the corneal surface after the burn was investigated by histology and immunophenotyping. Grading of rabbit eyes post-alkali burn had shown complete conjunctivalization in 80% (n = 12/15) of the rabbits with the alkali burn grade score of 3.88 ± 0.29 in three months and remained stable at four months (4.12 ± 0.24). However, ocular surface showed self-healing in 20% (n = 3/15) of the rabbits with a score of 1.67 ± 0.34 in four months irrespective of similar alkali injury. These self-healing corneas exhibited decreased opacity score from 2.51 ± 0.39 to 0.66 ± 0.22 (p = 0.002) and regressed vascularity from 1.66 ± 0.41 to 0.66 ± 0.33 in one to nine months, respectively. Restoration of the corneal phenotype (CK3+) was observed in central and mid-peripheral regions of the self-healing corneas, and histology revealed the localization of inflammatory cells to the peripheral cornea when compared to conjunctivalized and scarred LSCD eyes. Our study shows the essentiality to consider the time required for surgical intervention after the corneal alkali injury in rabbit models as evident from their tendency to self-heal and restore corneal phenotype without therapy. Such information on the possibility of self-healing should be useful in further studies as well as determining interventional timings and strategy during clinical presentation of corneal alkali burns.
Assuntos
Queimaduras Químicas/fisiopatologia , Lesões da Córnea/fisiopatologia , Neovascularização da Córnea/fisiopatologia , Opacidade da Córnea/fisiopatologia , Queimaduras Oculares/induzido quimicamente , Recuperação de Função Fisiológica/fisiologia , Hidróxido de Sódio/toxicidade , Animais , Cáusticos/toxicidade , Túnica Conjuntiva/fisiopatologia , Córnea/fisiopatologia , Modelos Animais de Doenças , Queimaduras Oculares/fisiopatologia , Seguimentos , Limbo da Córnea/citologia , Coelhos , Transplante de Células-Tronco , Cicatrização/fisiologiaRESUMO
Stevens-Johnson syndrome, ocular cicatricial pemphigoid, and severe thermal or chemical injury are considered severe ocular surface disorders (OSDs) because they affect the entire ocular surface, including corneal and conjunctival epithelial stem cells. In patients with severe OSDs, the long-term prognosis for limbal transplantation is poor, and the related corneal opacity and cicatrization lead to devastating visual impairment. To date, there is no standardized treatment to improve vision in cases with severe OSD. Investigating novel treatment methods for severe OSDs, our group began cultivated oral mucosal epithelial transplantation in 2002 and developed a limbal-supported rigid-type contact lens that can be applied as a nonsurgical treatment. When used in combination, these treatment methods make it possible to successfully restore vision in cases with severe OSDs.
Assuntos
Queimaduras Químicas/terapia , Lentes de Contato , Células Epiteliais/transplante , Queimaduras Oculares/induzido quimicamente , Mucosa Bucal/citologia , Penfigoide Mucomembranoso Benigno/terapia , Síndrome de Stevens-Johnson/terapia , Queimaduras Químicas/fisiopatologia , Células Cultivadas , Terapia Combinada , Doenças da Córnea/fisiopatologia , Doenças da Córnea/terapia , Epitélio Corneano/citologia , Epitélio Corneano/transplante , Queimaduras Oculares/fisiopatologia , Humanos , Penfigoide Mucomembranoso Benigno/fisiopatologia , Transplante de Células-Tronco , Síndrome de Stevens-Johnson/fisiopatologia , Transtornos da Visão/reabilitação , Acuidade Visual/fisiologiaRESUMO
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.
Assuntos
Cílios/efeitos dos fármacos , Queimaduras Oculares/prevenção & controle , Inibidores de Poli(ADP-Ribose) Polimerases/farmacologia , Acuidade Visual/efeitos dos fármacos , Animais , Cílios/efeitos da radiação , Queimaduras Oculares/diagnóstico por imagem , Queimaduras Oculares/fisiopatologia , Humanos , Luz/efeitos adversos , Acuidade Visual/efeitos da radiaçãoRESUMO
INTRODUCTION: Choking agent exposure, among them chlorine gas, occurs in household or industrial accidents, chemical warfare and terrorist attacks. AIMS: Review of published animal and human data regarding the history, pathophysiology, clinical effects and management of chlorine exposure. PATHOPHYSIOLOGY: Highly soluble agents cause quick upper respiratory tract symptoms. Chlorine gas has a medium solubility, also causing delayed lower airway symptoms, mainly due to its oxidizing potential by releasing hypochlorous and hydrochloric acid, but also by interacting with Transient Receptor Potential channels. SYMPTOMS: Eyes may show conjunctival injection, abrasions and corrosions. Burns of the oronasal mucosa and trachea can occur. Dyspnea, bronchospasm and possible retrosternal pain occur frequently. Glottis edema or laryngospasm are acute life-threatening emergencies. Chlorine gas can cause toxic pneumonitis, lung edema and acute respiratory distress syndrome (ARDS). MANAGEMENT: General management includes physical examination, pulse oximetry and arterial blood gases. Eyes should be irrigated, humidified oxygen and inhalative bronchodilators administered. An EKG, cardiac enzymes and complete-blood-count should be obtained if there is retrosternal pain. Routine chest x-ray is not recommended - except if pulmonary edema is suspected. Laryngoscopy should be performed if glottis edema is suspected. Sodium bicarbonate inhalation after chlorine gas inhalation is discussed controversially. Mechanical ventilation with continuous-positive-airway-pressure or intubation/tracheotomy with high positive-end-expiratory-pressure may be necessary. Glucocorticoids for prevention of pulmonary edema should be applied restrictively. Prophylactic antibiotics are not recommended. In severe ARDS, extracorporeal membrane oxygenation (ECMO) can be considered. CONCLUSION: Treatment is mainly symptom oriented. New and promising therapies are in development.
Assuntos
Acidentes Domésticos , Acidentes de Trabalho , Queimaduras Químicas/terapia , Substâncias para a Guerra Química/intoxicação , Cloro/intoxicação , Queimaduras Oculares/terapia , Doenças Respiratórias/terapia , Animais , Queimaduras Químicas/etiologia , Queimaduras Químicas/história , Queimaduras Químicas/fisiopatologia , Substâncias para a Guerra Química/história , Cloro/história , Queimaduras Oculares/induzido quimicamente , Queimaduras Oculares/história , Queimaduras Oculares/fisiopatologia , História do Século XX , História do Século XXI , Humanos , Exposição por Inalação/efeitos adversos , Exposição Ocupacional/efeitos adversos , Prognóstico , Doenças Respiratórias/induzido quimicamente , Doenças Respiratórias/história , Doenças Respiratórias/fisiopatologia , Medição de RiscoRESUMO
Wound healing differs significantly between men and women in a tissue-dependent manner. Dermal wounds heal faster in women whereas mucosal wounds heal faster in men. However, the effect of sex as a variable in corneal wound healing is largely unknown. The primary objective of this study was to test whether sex is a biological variable in corneal wound healing activated by the trauma or injury using an established in vivo rabbit model with male and female New Zealand White rabbits. Corneal wounds in rabbits were produced by a single topical alkali (0.5N Sodium hydroxide) application. Serial slit-lamp, stereo biomicroscopy, and applanation tonometry evaluated corneal opacity, anterior segment ocular health, and intraocular pressure (IOP), respectively, at various times during the study. Fourteen days after alkali-wound, corneal tissues were collected after humane euthanasia to examine cellular and molecular wound healing parameters. Quantitative PCR (qPCR) and immunofluorescence were used to quantify changes in the extracellular modeling protein levels of alpha-smooth muscle actin (α-SMA), Fibronectin (FN), Collagen-I (Col-I), and Transforming growth factor beta 1 (TGFß1) involved in corneal healing. Hematoxylin and Eosin (H&E) staining was used to study histopathological changes in morphology and TUNEL assay to evaluate levels of apoptotic cell death. Male and female rabbits showed no significant differences in corneal opacity (Fantes score) or intraocular pressure (IOP) values (9.5⯱â¯0.5â¯mm Hg) in live animals. Likewise, no statistically significant sex-based differences in the mRNA levels of α-SMA (maleâ¯=â¯5.95⯱â¯0.21 fold vs. femaleâ¯=â¯5.32⯱â¯0.043), FN (maleâ¯=â¯3.02⯱â¯0.24 fold vs. femaleâ¯=â¯3.23⯱â¯0.27), Col-I (maleâ¯=â¯3.12⯱â¯0.37 fold vs. femaleâ¯=â¯3.31⯱â¯0.24), TGFß1 (maleâ¯=â¯1.65⯱â¯0.06 fold vs. femaleâ¯=â¯1.59⯱â¯0.053); and protein levels of α-SMA (maleâ¯=â¯74.16⯱â¯4.6 vs. femaleâ¯=â¯71.58⯱â¯7.1), FN (maleâ¯=â¯60.11⯱â¯4.6 vs. femaleâ¯=â¯57.41⯱â¯8.3), Col-I (maleâ¯=â¯84.11⯱â¯2.8 vs. femaleâ¯=â¯84.55⯱â¯3.6), TGFß1 (maleâ¯=â¯11.61⯱â¯2.8 vs. femaleâ¯=â¯9.5⯱â¯3.04) were observed. Furthermore, H&E and TUNEL analyses found no statistically significant differences in cellular structures and apoptosis, respectively, in male vs. female corneas. Consistent with earlier reports, wounded corneas showed significantly increased levels of these parameters compared to the unwounded corneas. Our data suggest that sex is not a major biological variable during active early stages of corneal wound healing in rabbits in vivo.
Assuntos
Queimaduras Químicas/fisiopatologia , Lesões da Córnea/fisiopatologia , Queimaduras Oculares/induzido quimicamente , Fatores Sexuais , Cicatrização/fisiologia , Actinas/genética , Animais , Queimaduras Químicas/genética , Colágeno Tipo I/genética , Lesões da Córnea/genética , Queimaduras Oculares/genética , Queimaduras Oculares/fisiopatologia , Fibronectinas/genética , Imunofluorescência , Marcação In Situ das Extremidades Cortadas , RNA Mensageiro/genética , Coelhos , Reação em Cadeia da Polimerase em Tempo Real , Hidróxido de Sódio/toxicidade , Fator de Crescimento Transformador beta1/genéticaRESUMO
OBJECTIVE: To determine the pattern of ocular injuries and their surgical management.. Methods: The retrospective study was conducted at the Chittagong Eye Infirmary and Training Complex, Chittagong, Bangladesh, and comprised hospital data of patients with ocular injuries from October 1, 2016, to December 31, 2017. Information gathered related to type and cause of injuries, visual acuity, postoperative complications, follow-up visits, and outcome. SPSS version 22 was used for data analysis. Results: Of the total injuries, 370 (91%) were classified open globe and 36 (9%) as close globe. In terms of type of injury, 330 (81.4%) were penetrating, 30 (7.3%) ruptured globe, 29 (7.1%) lime burn and 17 (4.2%) injuries were traumatic hyphaema and chemical in nature. Open globe injuries were mostly found in subjects aged 18 years or below. Surgery was the main mode of management in 388 (95.5%) patients. Conclusion: Preventive measures along with high-quality management should receive priority for reducing monocular blindness.
Assuntos
Traumatismos Oculares/epidemiologia , Procedimentos Cirúrgicos Oftalmológicos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Bangladesh/epidemiologia , Queimaduras Químicas/epidemiologia , Queimaduras Químicas/fisiopatologia , Queimaduras Químicas/cirurgia , Criança , Pré-Escolar , Queimaduras Oculares/induzido quimicamente , Queimaduras Oculares/epidemiologia , Queimaduras Oculares/fisiopatologia , Queimaduras Oculares/cirurgia , Enucleação Ocular , Evisceração do Olho , Corpos Estranhos no Olho/epidemiologia , Corpos Estranhos no Olho/fisiopatologia , Corpos Estranhos no Olho/cirurgia , Traumatismos Oculares/fisiopatologia , Traumatismos Oculares/cirurgia , Ferimentos Oculares Penetrantes/epidemiologia , Ferimentos Oculares Penetrantes/fisiopatologia , Ferimentos Oculares Penetrantes/cirurgia , Feminino , Humanos , Hifema/epidemiologia , Hifema/fisiopatologia , Hifema/cirurgia , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ruptura/epidemiologia , Ruptura/fisiopatologia , Ruptura/cirurgia , Distribuição por Sexo , Fatores Sexuais , Tempo para o Tratamento , Acuidade Visual , Vitrectomia , Adulto JovemRESUMO
PURPOSE: The purpose of this study was to investigate the thermal injuries caused by ultrasonic pars plana phacoemulsification and aspiration (PPPEA) using pig eyes. METHOD: Using a 20-gauge (G) vitrectomy system (Accurus®, Fragmatome; Alcon Laboratories) in both the 'open-tip' and 'closed-tip' techniques, PPPEA was performed in pig eyes and the subsequent thermal injuries generated around the scleral wound were measured by infrared thermal imaging (thermography). Post surgery, the state of the scleral wound was observed under a microscope, and a tissue slice containing the scleral wound was then prepared and observed under an optical microscope. RESULTS: Thermography measurements revealed a slight temperature rise around the scleral wound in the open-tip case, yet a marked temperature rise in the closed-tip case. The scleral wound incision produced by the open tip was linear, while that produced by the closed tip was expanded. Histological examination revealed mild degeneration of the sclera around the wound in the open-tip case, yet marked tissue degeneration by thermal injuries in the closed-tip case. CONCLUSION: Our findings showed that in PPPEA, the temperature of the tip of a 20G vitrectomy system rapidly increases due to the closed-tip technique, thus producing obvious thermal damage to the scleral wound. In order to prevent thermal injuries to the scleral wound during PPPEA, it is important to shorten the time of ultrasonic oscillation during surgery as much as possible while the tip is occluded with nuclear fragments.
Assuntos
Queimaduras Oculares/diagnóstico , Paracentese/efeitos adversos , Facoemulsificação/efeitos adversos , Esclera/diagnóstico por imagem , Doenças da Esclera/diagnóstico , Animais , Modelos Animais de Doenças , Queimaduras Oculares/complicações , Queimaduras Oculares/fisiopatologia , Complicações Pós-Operatórias , Esclera/lesões , Doenças da Esclera/etiologia , Doenças da Esclera/fisiopatologia , Suínos , Termografia , Índices de Gravidade do Trauma , Procedimentos Cirúrgicos Ultrassônicos/efeitos adversosRESUMO
PURPOSE: To compare the outcomes of conventional medical treatment vs combined medical treatment and amniotic membrane transplantation (AMT) in the management of patients with Roper-Hall grade IV ocular chemical injury. DESIGN: Randomized, parallel-controlled clinical trial. METHODS: Setting: Single tertiary referral hospital. PATIENTS: Sixty eyes of 60 patients with Roper-Hall grade IV ocular chemical injury with a minimum follow-up of 12 months were enrolled in the study. INTERVENTION: Patients were randomly assigned to 2 groups: Group 1 (30 eyes) received topical preservative-free lubricating gel and drops, chloramphenicol, betamethasone, homatropine, oral vitamin C, and doxycycline; Group 2 (30 eyes) received amniotic membrane transplant (AMT) on the entire ocular surface in addition to the medical treatment provided in Group 1. OUTCOME MEASURES: The main outcome measure was time to complete corneal epithelialization. Secondary outcome measures were best-corrected visual acuity (BCVA) and neovascularization in the central 5 mm of the cornea. RESULTS: Mean follow-up time was 20.3 ± 2.5 months (range 13-24 months). Corneal epithelial defects healed within 72.6 ± 30.4 (21-180) days in Group 1 vs 75.8 ± 29.8 (46-170) days in Group 2 (P = .610). Mean BCVA was 2.06 ± 0.67 (0.4-2.6) logMAR vs 2.06 ± 0.57 (1-2.9) logMAR in Groups 1 and 2, respectively (P = .85). Group 1 developed more central corneal neovascularization (22 eyes; 73.3%) compared to Group 2 (16 eyes; 53.3%); however, it was not statistically significant (P = .108). CONCLUSIONS: In comparison to conventional medical therapy, combined amniotic membrane transplantation and medical therapy does not accelerate corneal epithelialization or affect final visual acuity in severe chemical injuries.
Assuntos
Âmnio/transplante , Queimaduras Químicas/terapia , Doenças da Córnea/terapia , Queimaduras Oculares/induzido quimicamente , Administração Oftálmica , Adolescente , Adulto , Antibacterianos/uso terapêutico , Ácido Ascórbico/administração & dosagem , Queimaduras Químicas/tratamento farmacológico , Queimaduras Químicas/fisiopatologia , Queimaduras Químicas/cirurgia , Criança , Doenças da Córnea/tratamento farmacológico , Doenças da Córnea/fisiopatologia , Doenças da Córnea/cirurgia , Epitélio Corneano/fisiologia , Queimaduras Oculares/fisiopatologia , Queimaduras Oculares/terapia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Lubrificantes Oftálmicos/administração & dosagem , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Estudos Prospectivos , Reepitelização/fisiologia , Acuidade Visual/fisiologia , Cicatrização/fisiologia , Adulto JovemRESUMO
AIMS: Cultivated limbal epithelial transplantation (CLET) fails in around 20%-30% of cases. This study aimed to report the clinical outcomes of autologous simple limbal epithelial transplantation (SLET) in eyes with recurrent unilateral limbal stem cell deficiency (LSCD) due to failure of CLET. METHODS: This was a prospective case series which included 30 eyes of 30 patients who underwent SLET between 2010 and 2016 after failure of one (n=24) or two (n=6) previous CLET procedures for chronic unilateral ocular burns. The primary outcome measure was success of SLET defined on the basis of relative improvement in five objective criteria: best corrected visual acuity (BCVA), and grades of symblepharon, corneal conjunctivalisation, vascularisation and opacification. RESULTS: At a mean follow-up of 2.3 years, 24 (80%) of the 30 eyes maintained a successful outcome. Kaplan-Meier analysis showed a 5-year survival probability of 77%±8%. At 1 year postoperatively statistically significant improvement was noted in BCVA (logarithm of the minimum angle of resolution of 3 to 1) and in the median grades of corneal conjunctivalisation (2 to 0), vascularisation (2 to 0) and opacification (2 to 1) (P≤0.0026). In 62.5% of successful cases, BCVA improved to 20/200 or better. The success rate of SLET in failed CLET was better than that of repeat CLET (53.5%, P=0.011). None of the donor eyes developed any complications. CONCLUSION: SLET is an effective alternative to CLET in eyes with recurrence of LSCD after previously failed CLET procedures. Since SLET is single-staged and less expensive, it is probably preferable to repeating CLET.
Assuntos
Queimaduras Químicas/cirurgia , Doenças da Córnea/cirurgia , Epitélio Corneano/transplante , Queimaduras Oculares/induzido quimicamente , Limbo da Córnea/citologia , Células-Tronco/patologia , Adulto , Idoso , Queimaduras Químicas/fisiopatologia , Células Cultivadas , Doença Crônica , Doenças da Córnea/fisiopatologia , Queimaduras Oculares/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Prognóstico , Estudos Prospectivos , Recidiva , Reoperação , Transplante Autólogo , Falha de Tratamento , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To describe the technique and present 2 cases of a combined conjunctival limbal autograft (CLAU) and living-related conjunctival limbal allograft (lr-CLAL) procedure for treatment of severe unilateral ocular surface failure. METHODS: Interventional case series of 2 eyes of 2 patients sustaining severe thermal/chemical injuries from firework explosions. They both underwent the combined CLAU/lr-CLAL procedure followed by penetrating keratoplasty. Systemic immunosuppression consisted of oral tacrolimus and mycophenolate mofetil. RESULTS: Preoperative vision was counting fingers for both patients, whereas visual acuity at last follow-up ranged between 20/40 and 20/50. Both patients maintained a stable surface at last follow-up without any episodes of rejection. Patients tolerated systemic immunosuppression well without any persistent adverse reactions. CONCLUSIONS: Certain etiologies of limbal stem cell deficiency also lead to significant conjunctival (and goblet cell) deficiency. Combined CLAU and lr-CLAL procedures maximize the amount of healthy limbal stem cells with conjunctiva while also minimizing the antigenic burden as all transplanted tissue potentially can be a complete (or near-complete), compatible HLA and crossmatch.
Assuntos
Queimaduras Químicas/terapia , Túnica Conjuntiva/citologia , Doenças da Córnea/terapia , Células Epiteliais/transplante , Queimaduras Oculares/induzido quimicamente , Limbo da Córnea/citologia , Doadores Vivos , Transplante de Células-Tronco , Aloenxertos , Autoenxertos , Queimaduras Químicas/fisiopatologia , Criança , Doenças da Córnea/fisiopatologia , Queimaduras Oculares/fisiopatologia , Feminino , Humanos , Masculino , Acuidade Visual/fisiologia , Adulto JovemAssuntos
Utensílios de Alimentação e Culinária , Epitélio Corneano/fisiologia , Queimaduras Oculares/fisiopatologia , Temperatura Alta/efeitos adversos , Reepitelização/fisiologia , Adolescente , Queimaduras Oculares/tratamento farmacológico , Humanos , Masculino , Midriáticos/administração & dosagem , Indução de Remissão , Tobramicina/administração & dosagem , TogoRESUMO
PURPOSE: To explore whether alkali burn causes corneal neuropathic pain and activates the neuropathic pain matrix in the central nervous system in mice. METHODS: A corneal alkali burn mouse model (grade II) was used. The mechanical threshold in the cauterized area was tested using Von Frey hairs. Spontaneous pain behavior was investigated with conditioned place preference. Phosphor extracellular signal-regulated kinase (ERK), which is a marker for neuronal activation in chronic pain processing, was investigated in several representative areas of the neuropathic pain matrix: the 2 regions of the spinal trigeminal nucleus (subnucleus interpolaris/caudalis, Vi/Vc; subnucleus caudalis/upper cervical cord, Vc/C1), insular cortex, anterior cingulated cortex (ACC), and the rostroventral medulla (RVM). Furthermore, pharmacologically blocking pERK activation in the ACC of alkali burn mice was performed in a separate study. RESULTS: Corneal alkali burn caused long-lasting damage to the corneal subbasal nerve fibers, and mice exhibited spontaneous pain behavior. By testing in several representative areas of the neuropathic pain matrix in the higher nervous system, phosphor ERK was significantly activated in Vc/C1, but not in Vi/Vc. Also, ERK was activated in the insular cortex, ACC, and RVM. Furthermore, pharmacologically blocking ERK activation in the ACC abolished alkali burn induced corneal spontaneous pain. CONCLUSIONS: Alkali burn could cause corneal spontaneous pain and activate the neuropathic pain matrix in the central nervous system. Furthermore, activation of ERK in the ACC is required for alkali burn induced corneal spontaneous pain.
Assuntos
Queimaduras Químicas/fisiopatologia , Doenças do Sistema Nervoso Central/fisiopatologia , Doenças da Córnea/fisiopatologia , Queimaduras Oculares/induzido quimicamente , Dor Ocular/fisiopatologia , Neuralgia/fisiopatologia , Hidróxido de Sódio/toxicidade , Animais , Queimaduras Químicas/enzimologia , Cáusticos/toxicidade , Doenças do Sistema Nervoso Central/enzimologia , Córnea/inervação , Doenças da Córnea/enzimologia , Modelos Animais de Doenças , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Queimaduras Oculares/enzimologia , Queimaduras Oculares/fisiopatologia , Dor Ocular/enzimologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Neuralgia/enzimologia , Medição da Dor , Limiar da Dor , FosforilaçãoRESUMO
SIGNIFICANCE: Ocular chemical injury is a medical emergency in which immediate treatment is critical to prevent visual morbidity. We report a severe ocular burn case that illustrates in-office management to promote rapid re-epithelialization and reduce inflammation to restore ocular surface integrity. PURPOSE: To report a case of severe acid burn that was managed successfully with self-retained cryopreserved amniotic membrane (AM). METHODS: A 43-year-old man presented with complaints of pain, light sensitivity, and blurred vision in both eyes 1 day after ocular exposure to acid. Symptoms and signs were more severe in the left eye. Examination revealed diffuse conjunctival inflammation and extensive corneal, conjunctival, and limbal epithelial defects in the left eye; hence, application of cryopreserved AM was performed. RESULTS: Placement of three self-retained AMs over a 10-day period resulted in resolution of symptoms, reduction in inflammation, complete re-epithelialization of corneal and limbal defects, and improvement of visual acuity from 20/50 to 20/20. Intriguingly, areas of conjunctival inflammation not covered by the AM remained inflamed. CONCLUSIONS: In this case of acute chemical burn, application of self-retained AM 24 hours after injury was effective in promoting ocular surface healing, reducing inflammation, and restoring visual acuity.
Assuntos
Âmnio/transplante , Queimaduras Químicas/cirurgia , Criopreservação , Queimaduras Oculares/cirurgia , Acuidade Visual , Doença Aguda , Adulto , Queimaduras Químicas/fisiopatologia , Queimaduras Oculares/fisiopatologia , Humanos , Masculino , CicatrizaçãoRESUMO
Although the wound healing effects of nitric oxide (NO) are known, the mechanism by which NO modulates corneal wound healing remains unclear. In this study, we investigated the effect of exogenous NO donor (NaNO2) on corneal wound healing. We found that NaNO2 (0.1 µM to 100 µM) increased human corneal epithelial cell (HCEC) viability and migration. It also modulated the phosphorylation of mitogen-activated protein kinases (MAPKs) in a time- dependent manner in those HCECs. Further, p38 MAPK phosphorylation increased at 6 h and normalized at 24 h, while the phosphorylation of extracellular signal regulated kinase (ERK) was increased both at 6 h and 24 h. Topical treatment with NaNO2 (10 µM) enhanced corneal epithelial healing and decreased corneal opacity in murine corneal alkali burn model by modulating inflammatory cytokines. Our findings suggest that NO increased HCEC proliferation and migration via time-dependent MAPK activation and eventually enhanced corneal recovery from the alkali burn.
Assuntos
Sobrevivência Celular/fisiologia , Lesões da Córnea/metabolismo , Células Epiteliais/metabolismo , Epitélio Corneano/metabolismo , Óxido Nítrico/metabolismo , Cicatrização/fisiologia , Animais , Queimaduras Químicas/metabolismo , Queimaduras Químicas/fisiopatologia , Movimento Celular/fisiologia , Proliferação de Células/fisiologia , Células Cultivadas , Córnea/metabolismo , Córnea/fisiopatologia , Lesões da Córnea/fisiopatologia , Células Epiteliais/fisiologia , Epitélio Corneano/fisiopatologia , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Queimaduras Oculares/metabolismo , Queimaduras Oculares/fisiopatologia , Humanos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Fosforilação/fisiologia , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismoRESUMO
The paper presents an atypical case of solar retinopathy after short-term exposure to reflected focused sunbeams. An ophthalmoscopic peculiarity was the presence of intraretinal hemorrhage. The basis for establishing the diagnosis were spectral optical coherence tomography and fluorescein angiography findings.
Assuntos
Queimaduras Oculares , Retina , Doenças Retinianas , Hemorragia Retiniana/diagnóstico , Queimadura Solar/complicações , Adulto , Diagnóstico Diferencial , Gerenciamento Clínico , Queimaduras Oculares/diagnóstico , Queimaduras Oculares/etiologia , Queimaduras Oculares/fisiopatologia , Angiofluoresceinografia/métodos , Humanos , Masculino , Oftalmoscopia/métodos , Retina/diagnóstico por imagem , Retina/lesões , Doenças Retinianas/diagnóstico , Doenças Retinianas/etiologia , Doenças Retinianas/fisiopatologia , Hemorragia Retiniana/etiologia , Tomografia de Coerência Óptica/métodos , Acuidade VisualRESUMO
PURPOSE: To evaluate the influence of somatostatin (SST) and its analog octreotid (Oct) on corneal wound healing processes. METHODS: The wound healing rate in C57BL/6 mice eyes under SST and Oct treatment was analyzed using an alkali-induced corneal wounding model. Effects of SST and Oct on cell proliferation, migration and quantified protein expression of vascular endothelial growth factor (VEGF) on human corneal epithelial cells (HCE, cell line) were evaluated by means of electric cell-substrate impedance sensing, scratch migration assays and ELISA. ERK1/2 and p38 phosphorylation was investigated by semi-quantitative western blot analysis. RESULTS: Ten nanograms per microliters of SST significantly accelerated the wound closure rate of corneal defects in vivo. SST and Oct had no influence on HCE cell proliferation and migration and did not activate ERK1/2 or p38 signaling in HCE cells. However, there was increased VEGF protein expression in cytosolic proteins and medium supernatants of HCE upon Oct stimulation for 24h. One and 10ng/ml Oct led to a 2.5-fold and 100ng/ml Oct to a 4-fold upregulation of VEGF protein expression. CONCLUSION: The data implicate that SST promotes corneal wound healing in a mouse model. However, using a HCE cell line in vitro, the wound healing mechanism does not seem to be supported by proliferation and migration processes or by activation of ERK1/2 and p38 signaling pathways. Other possible mechanisms could be the activation of other pathways and the induction of growth factors such as VEGF that modulate the observed corneal wound healing process.
Assuntos
Queimaduras Químicas/tratamento farmacológico , Queimaduras Químicas/fisiopatologia , Queimaduras Oculares/tratamento farmacológico , Queimaduras Oculares/fisiopatologia , Somatostatina/administração & dosagem , Fator A de Crescimento do Endotélio Vascular/metabolismo , Animais , Queimaduras Químicas/etiologia , Movimento Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Relação Dose-Resposta a Droga , Queimaduras Oculares/induzido quimicamente , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos C57BL , Octreotida/administração & dosagem , Hidróxido de Sódio , Cicatrização/efeitos dos fármacos , Cicatrização/fisiologiaRESUMO
PURPOSE: To report the clinical course of a patient sustaining a ocular laser injury from 1,064-nm Nd:YAG cosmetic laser machine. METHOD AND PATIENT: A 31-year-old beauty parlor aesthetician was operating an Nd:YAG cosmetic laser machine of 1,064 nm wavelength. However, the probe was held in the opposite direction, and on firing, the laser shot fired into her left eye. The patient heard a "pop" sound followed by immediate floaters and blurring of vision. Her clinical course was followed for 6 weeks, with investigations including optical coherence tomography, fluorescein angiogram, and Humphrey's visual field examination performed. RESULTS: Optical coherence tomography taken over the injured area showed thickened retina and preretinal hyperreflectivities. Fluorescein angiogram showed hypofluorescence superonasal to the disk with late staining of vessels. Humphrey's visual field showed a dense scotoma emanating from the blind spot. The lesion eventually scarred down, and the patient's vision recovered. DISCUSSION: The eye is the most susceptible body part to laser light injury. A review of reported laser accidents revealed the majority to be ocular injuries. The retina is particularly vulnerable, as laser light with wavelength between 400 nm and 1,400 nm is focused by the cornea and lens onto the retina, increasing the retinal irradiance as a result. Most injuries were parafoveal, suggesting that most injuries occurred during laser beam alignment. The prognosis is generally favorable. As laser use becomes more widespread and its application increasingly heterogeneous, regulation of laser use and monitoring of laser safety are crucial but at the same time challenging.
Assuntos
Técnicas Cosméticas/instrumentação , Queimaduras Oculares/diagnóstico , Angiofluoresceinografia/métodos , Lasers de Estado Sólido/efeitos adversos , Retina/patologia , Tomografia de Coerência Óptica/métodos , Campos Visuais/fisiologia , Adulto , Técnicas Cosméticas/efeitos adversos , Queimaduras Oculares/fisiopatologia , Feminino , Fundo de Olho , Humanos , Retina/lesõesRESUMO
OBJECTIVE: The aim of this study was to evaluate the clinical outcomes of the implantation of MICOF keratoprosthesis (Kpro) in patients with alkaline, acid and thermal ocular burns. METHODS: This is a retrospective, non-competitive, interventional case series. Ninety eyes of 90 patients with ocular burns underwent MICOF KPro surgery at the Chinese People's Liberation Army General Hospital between April 2000 and December 2012. Preoperative and postoperative findings were recorded. Retention of the prostheses and the treatment for postoperative complications were investigated. RESULTS: The mean age of patients was 40.26±12.18â years (range: 8-64â years), and the mean duration after ocular trauma was 4.8±6.2â years (range: 1.5-12â years). The mean follow-up period was 58.22±36.28â months (range: 1-145â months). Eighty patients were followed for ≥1â year and 73 eyes (81.11%) achieved the best-corrected visual acuity of 20/200 or better and 39 eyes (43.33%) achieved best-corrected visual acuity of ≥20/40. The common complications were glaucoma, corneal melt and conjunctiva overgrowth, and the incidences of these complications were 59.99%, 40% and 31.11%, respectively. One patient experienced KPro extrusion, and two patients exhibited leakage from the area of the implant. Seven with endophthalmitis eyes had final visual acuities of light perception. There was no significant difference in the effectiveness of the implants among the different causes of injuries, including acid, alkali and thermal burns. CONCLUSIONS: MICOF Kpro is an effective alternative for patients with ocular burn with corneal blindness. Glaucoma and endophthalmitis were identified as significant risk factors for visual loss.