Cultivated oral mucosal epithelial transplantation (COMET) and penetrating keratoplasty in long-standing severe ocular surface injury.

Ocular chemical injury is a true ophthalmic emergency requiring immediate medical intervention. Damages can be devastating and potentially resulting in blindness, corneal perforation and phthisis bulbi. We describe here a successful treatment outcome in a patient who sustained Roper-Hall Grade 4 injury to both eyes. Patient received medical therapy followed by serial ocular surgeries with eventual visual recovery in one eye from counting finger to 6/15 after a decade. In conclusion, after maximum medical therapy, a carefully planned serial surgeries of cultivated oral mucosal epithelial transplantation (COMET) and PK has proven beneficial for this patient with advanced limbal stem cell deficiency (LSCD).

A CBCT Study to Evaluate the Root and Canal Morphology of Permanent Maxillary First Molars in Children.

Introduction: For the correct diagnosis and endodontic therapy, a complete understanding of root canal morphology is required. One of the causes of endodontic failure is the inability to identify every canal in the root canal system; the second mesiobuccal canal (MB2) in the permanent maxillary first molar is the most commonly missed canal. Studies examining the root canal differences in pediatric Indian populations' permanent maxillary first molars are somewhat uncommon. Aim: Cone-beam computed tomography (CBCT) will be used to assess the root and canal morphology of permanent maxillary first molars in the pediatric Indian population. Materials and methods: In the age range of 7-13 years, 25 children's CBCT pictures (50 images) were gathered from the institutional database and private diagnostic facilities. SCANORA® software was used to reconstruct the CBCT pictures, and Statistical Package for the Social Sciences (SPSS) for Windows was used to evaluate and analyze the data. Results: The roots of each permanent maxillary first molar were distinct. And all of the palatal and distobuccal roots were found to have a single root canal (100%), whereas the mesiobuccal roots were found to have a single root canal in 80% of cases and a double root canal in 20% of cases. The Vertucci type II structure, followed by types IV and V, was the most prevalent in roots with two channels. Conclusion: Within the constraints of this investigation, we came to the conclusion that the permanent maxillary first molar root canal configuration varied among the patients from the pediatric Indian population. How to cite this article: Krishnamurthy NH, Athira P, Umapathy T, et al. A CBCT Study to Evaluate the Root and Canal Morphology of Permanent Maxillary First Molars in Children. Int J Clin Pediatr Dent 2022;15(5):509-513.

Characterization and safety assessment of bioengineered limbal epithelium.

Transplantation of cultivated limbal epithelium on substrates such as amniotic membrane is an established treatment for severe ocular surface disease with limbal stem cell deficiency. In this study, we adapted an established method to generate sheets of limbal epithelium on amniotic membrane and characterized the cells contained in these sheets and tested them for safety with regard to microbial contamination. Human limbal biopsies were cultivated on denuded amniotic membranes. After three weeks of culture, the phenotypes of cultivated cells were analyzed by immunohistochemistry and real-time RT-PCR for the expression of a panel of specific markers. Cultivated limbal epithelial cell sheets were also analyzed by scanning (SEM) and transmission (TEM) electron microscopy. Sterility tests and mycoplasma assays were conducted for the safety of product. A confluent layer of polygonal cells was formed in 2 weeks and 1-3 stratified layer of cells were observed after three weeks of culture. Cultivated cells were positive for p63, K3, K19, and involucrin but negative for K14, integrin alpha9 and ABCG2 when analyzed by immunohistochemistry. Expression of molecular markers was detectable with real-time RT-PCR. SEM showed multilayer of flat squamous polygonal epithelial cells. Desmosomal and hemidesmosomal attachments were evident. Our study showed that cultivated limbal epithelium consists of limbal progenitors as well as differentiated corneal epithelial cells. SEM and TEM analysis showed cultivated cells demonstrated typical features of corneal epithelium. The risk of contamination is low and can be prevented by culturing the cells in a clean room facility complying to Good Manufacturing Practice standard.

Vitreous cavity length in keratoconus: implications for keratoplasty.

PurposeTo compare axial length (AL) with vitreous cavity length (VCL) in patients with keratoconus and to ascertain whether graft size can be tailored to reduce myopic refractive error in patients with keratoconus undergoing penetrating keratoplasty (PK).Patients and methodsThe AL and VCL were measured prospectively in patients with keratoconus not undergoing PK (Group 1) and in normal phakic, emmetropic individuals (Group 2). A retrospective analysis of these measurements in patients with keratoconus who had undergone PK (Group 3) was also performed. The postoperative spherical equivalent (SE) was then correlated to size of donor buttons.ResultsKeratoconus patients tended to have a longer mean VCL than emmetropic normal individuals. The mean VCL of these patients (Group 1) was 16.49 mm±SD 1.13 compared to the mean VCL of 15.94 mm±SD 0.56 in normals (Group 2, P<0.0001). Patients with keratoconus who had an undersized graft showed reduced myopic refractive error compared to those with same size or oversized grafts.ConclusionVCL measurement is more accurate than AL measurement in deciding upon graft-host size disparity for corneal graft in patients with keratoconus. In patients with increased VCL, undersizing the donor button helps in reducing postoperative myopia. We recommend VCL measurement as part of the routine workup in all keratoconus patients undergoing corneal transplants.

Choroidal detachment in perforated corneal ulcers: frequency and management.

AIMS: To determine the frequency of choroidal detachment (CD) in eyes with non-traumatic corneal ulcer perforation and, also, to assess the efficacy and safety of cyanoacrylate glue in sealing corneal perforations. METHODS: 18 eyes of 17 patients were studied. Inclusion criterion was any patient with a non-traumatic perforated corneal ulcer. All patients had a thorough history taken and complete ophthalmic examination including B-scan ultrasonography. Patient demographics, presence of CD, and efficacy of corneal gluing were assessed. RESULTS: Eight of the 18 eyes (44%) were documented to have a CD. Among perforations of >2 mm2, six eyes (75%) were documented to have CD compared with two eyes (20%) with perforations of

Impression cytology of the ocular surface.

Impression cytology refers to the application of a cellulose acetate filter to the ocular surface to remove the superficial layers of the ocular surface epithelium. These cells can then be subjected to histological, immunohistological, or molecular analysis. Proper technique is essential as the number of cells sampled can vary considerably. Generally two to three layers of cells are removed in one application but deeper cells can be accessed by repeat application over the same site. Applications for impression cytology include diagnosing a wide range of ocular surface disorders, documenting sequential changes in the conjunctival and corneal surface over time, staging conjunctival squamous metaplasia, and monitoring effects of treatment. It is also a useful investigational tool for analysing ocular surface disease with immunostaining and DNA analysis. It is non-invasive, relatively easy to perform, and yields reliable information about the area sampled with minimal discomfort to the patient. Major ophthalmic centres should develop and introduce this technique into routine clinical practice. This is best achieved with a team approach including the ophthalmologist, pathologist, microbiologist, and the immunologist.