Generation and characterization of Aldh3-Cre transgenic mice as a tool for conditional gene deletion in postnatal cornea.

Conditional gene targeting in mice by means of Cre-loxP strategy represents a powerful approach to study mammalian gene function. This approach is however dependent on the availability of suitable strains of mice with a tissue or time restricted activity of the Cre recombinase. Here we describe Aldh3-Cre transgenic mice as a useful tool to conditionally delete genes in cornea, a specialized transparent tissue found on the anterior-most part of the eye, which acts as a protective barrier and contributes to the refractive power. Using a set of floxed alleles we demonstrate high Aldh3-Cre activity in corneal epithelial cells, corneal stroma and conjunctival epithelial cells at postnatal stages. Aldh3-Cre will thus be particularly beneficial for functional analysis of genes which are vital for postnatal development of cornea and conjunctiva.

Use of trypan blue to assess lymphatic function following trabeculectomy.

IMPORTANCE: To illustrate the importance of lymphatic drainage in assessing trabeculectomy bleb function using intracameral trypan blue. BACKGROUND: To study the lymphatic drainage of trabeculectomy blebs using trypan blue, correlate with bleb function and classify them accordingly. DESIGN: Prospective cross-sectional study in a tertiary care centre. PARTICIPANTS: Thirteen glaucoma patients post-trabeculectomy were studied. METHODS: Trypan blue was injected into the anterior chamber. MAIN OUTCOME MEASURES: The duration taken for dye to stain a drainage bleb or lymphatics is recorded. The extent of the lymphatic structures were measured in clock hours. Intraocular pressure (IOP) prior to surgery was recorded. RESULTS: Eight post-trabeculectomy subjects with dye stained lymphatic vessels had lower IOP (12.6 mmHg, P = .013) compared to the five with no lymphatic vessel staining (mean IOP 23.6 mmHg). Lymphatic extent was inversely related to IOP (P = .021). CONCLUSIONS AND RELEVANCE: Eyes with lymphatic connections to drainage blebs had lower IOP and reduced requirement for topical medications. The extent of lymphatic connection to drainage blebs is related to lower IOP.

Development and Long-Term Evaluation of Ocular Surface Conditions Using Ovariectomized Cynomolgus Monkey.

OBJECTIVES: We aim to use the ovariectomized cynomolgus monkey to observe the effect of long-term changes of sex hormone levels on ocular surface. METHODS: Six healthy adolescent cynomolgus monkeys were randomly assigned to control and experimental groups (n=3/group). Bilateral ovariectomy was performed in experimental group, and sham operation was performed on control animals with their ovaries reserved. The concentrations of serum estradiol and testosterone in cynomolgus monkeys' lower-limb venous were detected by radioimmunoassay before surgery, and at 6, 12, 18, and 24 months after the surgery. Phenol red cotton thread test, tear osmolarity, corneal fluorescein staining, and conjunctival impression cytology were performed to evaluate the ocular surface conditions before surgery, and at 6, 12, 18, and 24 months after the surgery. The histological examinations of the bulbar conjunctiva and labial glands tissues were performed at 12 and 24 months after the surgery. RESULTS: There were no significant differences in the serum level of estradiol and testosterone between the experimental and control groups before surgery, at 6, and 12 months after surgery (P>0.05). Serum level of estradiol and testosterone were significantly less in experimental versus control group at 18 and 24 months after surgery (P<0.05). There was no significant differences in phenol red cotton between the experimental and control groups before surgery, at 6, 12, 18, and 24 months after surgery (P>0.05). Tear osmolarity had no significant differences between experimental and control group before surgery (P>0.05), and it was significantly higher in experimental versus control group at all four time-points after surgery (P<0.05). The number of conjunctival goblet cells had no significant differences between experimental and control group before surgery, at 6 months after surgery (P>0.05), and it was significantly lower in experimental versus control group at 12, 18, and 24 months after surgery (P<0.05). There were no significant differences in the corneal fluorescein staining score between the experimental and control groups before surgery, at 6, 12, and 18 months after surgery (P>0.05), and it was higher in experimental than control group at 24 months after surgery (P<0.05). In addition, inflammatory cell infiltration in bulbar conjunctiva and labial glands tissues was observed in experimental group and was unobserved in control group at 24 months after surgery. CONCLUSIONS: Ovariectomy led to decreased sex hormone levels in cynomolgus monkey. In turn, tear osmolarity was increased, the number of conjunctival goblet cells were decreased, the corneal fluorescence staining was increased, and the pathological examination of the bulbar conjunctiva and labial glands tissues were abnormal, phenol red cotton thread test did not change significantly.

Conjunctival Tear Layer Temperature, Evaporation, Hyperosmolarity, Inflammation, Hyperemia, Tissue Damage, and Symptoms: A Review of an Amplifying Cascade.

PURPOSE: This review examines the evidence for and significance of pre-conjunctival tear temperature being higher than central pre-corneal temperature with associated more rapid evaporation of warmer pre-conjunctival tears in normal eyes but especially in hyperemic dry eye disease. METHODS: PubMed searches using the terms "evaporative dry eye," "conjunctival tear evaporation," "tear evaporation," and "dry eye conjunctival hyperemia" indicated 157, 49, 309, and 96 potentially relevant papers, respectively. Selections from these lists were the basis for examining the significance of the evidence relevant to pre-conjunctival tear layer temperature and evaporation. RESULTS: There is evidence supporting an amplifying inflammatory and para-inflammatory hyperemia dry eye cascade, which increases pre-conjunctival tear temperature and the risk of accelerated pre-conjunctival tear evaporation with exacerbated osmolarity elevation and inflammation. Dry eye cascade amplification is consistent with increases in symptoms and inflammatory as well as para-inflammatory hyperemia toward the end of the waking day. Apart from age-related conjunctivochalasis, dry eye-related conjunctival epithelial cell pathology including reduced goblet cell numbers and associated mucin deficiency, squamous metaplasia, and increased separation of cell layers could help to destabilize tears and facilitate evaporation as part of an amplifying cascade. CONCLUSIONS: Greater difficulty in assessing conjunctival tear break up may contribute to an underestimation of a role for faster evaporation of pre-conjunctival tears in dry eye disease and help explain any non-correspondence between symptoms and corneal signs of dry eye disease. Success with anti-inflammatory therapies for dry eye disease may be at least partly due to reductions in conjunctival hyperemia and deamplification of evaporative cascades. Conjunctival inflammatory hyperemia in other diseases may contribute to accelerated pre-conjunctival tear evaporation and the risk of tear-deficiency- associated exacerbation of those diseases including impaired responses to therapeutic approaches to them. Similarly, postsurgical conjunctival inflammation and associated acceleration of tear evaporation could contribute to delayed wound healing.

Safety of Using Matrix Metalloproteinase Inhibitor in Experimental Glaucoma Filtration Surgery.

We evaluated the safety of matrix metalloproteinase (MMP) inhibitor in experimental glaucoma filtration surgery in an animal model. Fifteen New Zealand white rabbits underwent an experimental trabeculectomy and were randomly allocated into 3 groups according to the adjuvant agent: no treatment group (n = 5), 0.02% mitomycin C (MMC) soaking group (n = 5), and MMP inhibitor (ilomastat) subconjunctival injection group (n = 5). Slit lamp examination with Seidel testing, pachymetry, and specular microscopy was performed preoperatively and postoperatively. The conjunctiva and ciliary body toxicity were evaluated with scores according to the pathologic grading systems. Electron microscopy was used to examine the structural changes in cornea, conjunctiva, and ciliary body. In the ilomastat-treated group, there was no statistically significant change in central corneal thickness preoperatively and at 28 days postoperatively (P = 0.655). There were also no significant changes in specular microscopy findings over the duration of the study in the ilomastat-treated group. The conjunctival toxicity score was 1 in the control group, 1.5 in the ilomastat-treated group, and 2 in the MMC-treated group. When assessing ciliary body toxicity scores, the ilomastat-treated group score was 0.5 and the MMC-treated group score was 1.5. Transmission electron microscopy did not show structural changes in the cornea and ciliary body whereas the structural changes were noticed in MMC group. A single subconjunctival injection of MMP inhibitor during the experimental trabeculectomy showed a less toxic affect in the rabbit cornea, conjunctiva, and ciliary body compared to MMC.

Development of a conjunctival tissue substitute on the basis of plastic compressed collagen.

Ocular surface disorders, such as pterygium, cicatricial pemphigoid and external disruptions, can cause severe inflammation, scarring, fornix shortening as well as ankyloblepharon. Current treatments do not resolve these conditions sufficiently. The aim of this study was to evaluate clinical applicability and suitability of plastic compressed collagen to serve as a substrate for the expansion of human conjunctival epithelial cells in order to develop an epithelialized conjunctival substitute for fornix reconstruction. Human conjunctival epithelial cells were expanded on plastic compressed collagen gels. Epithelial cell characteristics were evaluated by haematoxylin and eosin staining, electron microscopy and cytokeratin expression. The expression of putative epithelial progenitor cell markers p63α, ABCG2 and CK15 was assessed by immunostaining. The proliferative capacity and clonal growth of the cells was evaluated before (P0) and after expansion (P1) on the plastic compressed collagen gels by colony forming efficiency assay. The potential clinical applicability of this gel substitutes was evaluated by assessment of their biomechanical properties as well as their surgical handling. Human conjunctival epithelial cells cultured on plastic and plastic compressed collagen gels formed a confluent cell layer and expressed CK19. The cells showed expression of the putative epithelial progenitor cell markers p63α, ABCG2 and CK15 and sustained colony forming ability. The compressed collagen gels showed a high ultimate tensile strength and elasticity and the surgical handling of gels was comparable to amniotic membrane. An epithelialized conjunctival tissue construct on the basis of compressed collagen might therefore be a promising alternative bioartificial tissue substitute for conjunctival reconstruction. Copyright © 2015 John Wiley & Sons, Ltd.

Prosthetic Replacement of the Ocular Surface Ecosystem Scleral Lens Therapy for Exposure Keratopathy.

OBJECTIVES: To investigate the utility of Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) scleral lenses in patients with exposure keratopathy, with outcomes based on changes in visual acuity, visual function, and corneal staining. METHODS: A retrospective interventional case series of patients evaluated and treated from September 2009 through June 2014 at a single multi-specialty institutional practice. Eighteen of 29 patients with exposure keratoconjunctivitis, lagophthalmos, ectropion, or lid retraction, referred to USC Eye Institute after failing conventional therapies completed PROSE scleral lens fitting and were included in the study. Visual function was assessed before and after PROSE fitting with the Ocular Surface Disease Index (OSDI) survey. Visual acuity (VA) and corneal staining changes were also evaluated before and after treatment. RESULTS: Visual acuity improved from 0.60±0.68 logMAR pre-PROSE to 0.25±0.34 logMAR (Z=-3.81, P=0.00014) post-PROSE, which corresponds to an improvement of about 20/80 to 20/35 on Snellen VA. Ocular Surface Disease Index scores improved from 56.54±29.75 pre-PROSE to 24.98±21.23 post-PROSE (Z=-2.98, P=0.0029), and corneal staining values decreased from 2.17±0.84 pre-PROSE to 0.64±0.70 post-PROSE (Z=-3.27, P=0.011). CONCLUSIONS: The results suggest that PROSE scleral lens therapy is effective in patients with exposure keratopathy who had failed conventional therapies and can serve as an alternative to lid surgery.

Apoptosis of conjunctival epithelial cells before and after the application of autologous serum eye drops in severe dry eye disease.

AIMS: To assess the impact of autologous serum eye drops on the level of ocular surface apoptosis in patients with bilateral severe dry eye disease. METHODS: This prospective study was conducted on 10 patients with severe dry eye due to graft versus host disease (group 1) and 6 patients with severe dry eye due to primary Sjögren's syndrome (group 2). Impression cytology specimens from the bulbar conjunctiva were obtained before and after a three-month treatment with 20% autologous serum eye drops applied a maximum of 12 times a day together with regular therapy with artificial tears. The percentage of apoptotic epithelial cells was evaluated immunochemically using anti-active caspase 3 antibody. RESULTS: In group 1, the mean percentage of apoptotic cells was 3.6% before the treatment. The three-month treatment led to a significant decrease to a mean percentage of 1.8% (P = 0.028). The mean percentage of apoptotic conjunctival cells decreased from 5.4% before the treatment to 3.8% in group 2; however, these results did not reach the level of significance. CONCLUSION: Three-month autologous serum treatment led to the improvement of ocular surface apoptosis, especially in the group of patients with severe dry eye due to graft versus host disease. This result supports the very positive effect of autologous serum on the ocular surface in patients suffering from severe dry eye.

Involvement of Eyelid Pressure in Lid-Wiper Epitheliopathy.

OBJECTIVES: To determine whether eyelid pressure is involved in the development of lid-wiper epitheliopathy (LWE). METHODS: Study 1: The eyelid pressure was measured with a blepharo-tensiometer, and the degree of LWE was assessed in 79 eyes of 43 non-contact lens (CL) wearers. Study 2: The movements of the eyelids and displacement of the eyes during spontaneous blinking were photographed with a high-speed camera. The eyelid pressure was also measured in 34 normal eyes of 19 non-CL wearers who were not part of Study 1. RESULTS: Study 1: Upper-LWE was detected in 24 of 79 eyes (30.4%), and no significant difference was detected in the eyelid pressure between any grade of upper-LWE. Lower-LWE was detected in 41 of 79 eyes (51.9%), and the eyelid pressure (27.9 ± 2.8 mmHg) in eyes with grade 3 LWE was significantly higher than that with grade 0 LWE (19.7 ± 1.3 mmHg; p < 0.05). Study 2: The lower eyelid pressure was significantly correlated with the length of the horizontal movement of the lower eyelids (p < 0.05) and also with the degree of posterior movement of the eye globe (p < 0.05). CONCLUSIONS: The higher pressure from the eyelid may be one of the causes for the development of lower-LWE.

Healing indicators after pterygium excision by optical coherence tomography.

PURPOSE: To establish the sequence of tomographic changes in the tissue recovery process after pterygium excision and to propose healing indicators. METHODS: Optical coherence tomography (OCT) images were taken at 1 week, 1, 3 and 6 months after lesion excision in 73 eyes of 73 patients (33 male, 40 female; mean age 50, S.D. 5.0, range 40-70 years) with primary nasal pterygium. Biomicroscopy was performed at each visit and at 12 months, to diagnose clinical healing or lesion recurrence. The presence of well demarcated corneal epithelium, conjunctival epithelium, limbal demarcation area, and graft thickening were analysed. Comparisons between tomographic data of both clinical situations were made at each time point using contingency tables. RESULTS: Eleven eyes displayed lesion recurrence (R group) and 62 eyes showed no recurrence (NR group). Normal anatomical structures, corneal and conjunctival epithelium and limbal demarcation area, were identified by OCT images in a higher percentage of NR cases over time, compared to the R group where most of the cases presented without these markers of tissue recovery. In contrast, the variable graft thickening, which analysed a pathological event, revealed similar results in both groups (p > 0.05; Fisher's exact statistic), with a clear decrease of cases which showed graft thickening over time. Differences between groups started at 1 month, when no eye had yet presented clinical recurrence, with greater identification of corneal epithelium in the NR group (p = 0.04; Fisher's exact statistic). At 3 months, corneal and conjunctival epithelium identification tended to be more frequent in the NR than in the R group (in both cases, p = 0.0001; Fisher's exact statistic). Finally, at 6 months these different patterns consolidated, with a significantly higher number of limbal demarcation areas being identified in the NR group (p = 0.001; Fisher's exact statistic). In fact, this landmark of a normally structured limbus was never found in the R group. CONCLUSIONS: The sequence of tissue restoration, according to OCT images, seems to start in the cornea and end in the limbal area, similar to the process of pterygium injury in reverse. Although the visualisation of corneal epithelium could be an early indicator of successful surgery, identification of the limbal demarcation area, as a normal limbal pattern in OCT images, seems to be a better positive predictive value in diagnosing healing.

Transplantation of PEDF-transfected pigment epithelial cells inhibits corneal neovascularization in a rabbit model.

BACKGROUND: The purpose of this study was to investigate the effect of recombinant pigment epithelium-derived factor (rPEDF), secreted by ARPE-19 cells transfected with the human PEDF gene and transplanted subconjunctivally in normal and in rabbits in which corneal neovascularization was elicited by a chemical burn. METHODS: Twenty grey Chinchilla Bastard rabbits were randomly assigned to four groups; neovascularization was induced in groups A, B, and C by alkali cauterization. Seven days later, group A received no cell implantation, non-transfected ARPE-19 cells were implanted subconjunctivally in group B, and PEDF-transfected ARPE-19 cells were implanted subconjunctivally in groups C and D (non-cauterized). In-vivo rPEDF secretion was analyzed by immunoblotting, and ELISA of extracts of conjunctival tissue samples taken at different time points. Digital photographs acquired on days 7, 14, and 21 after cauterization were evaluated for lead vessel length, vascular invasion area, and overall neovascularization rate. RESULTS: At days 14 and 21 after cauterization, significant differences were observed between groups A, B, and C in lead vessel length (day 21: 5.91 ± 0.45, 5.11 ± 1.22, 3.79 ± 0.59 mm, repectively), vascular invasion area (day 21: 35.5 ± 8.65, 34.86 ± 4.92, 19.2 ± 5.03 mm(2) respectively), and rate of corneal neovascularization. Compared to controls, neovascularization was reduced by 37.5 % on day 14 and 47 % on day 21. Analysis of conjunctival tissue extracts showed that rPEDF was secreted by the transplanted PEDF-transfected cells. CONCLUSION: Subconjunctivally transplanted, PEDF-transfected ARPE-19 cells secrete rPEDF, which inhibits the corneal neovascularization elicited by alkali cauterization.

Thyronamine induces TRPM8 channel activation in human conjunctival epithelial cells.

3-Iodothyronamine (T1AM), an endogenous thyroid hormone (TH) metabolite, induces numerous responses including a spontaneously reversible body temperature decline. As such an effect is associated in the eye with increases in basal tear flow and thermosensitive transient receptor potential melastatin 8 (TRPM8) channel activation, we determined in human conjunctival epithelial cells (IOBA-NHC) if T1AM also acts as a cooling agent to directly affect TRPM8 activation at a constant temperature. RT-PCR and quantitative real-time PCR (qPCR) along with immunocytochemistry probed for TRPM8 gene and protein expression whereas functional activity was evaluated by comparing the effects of T1AM with those of TRPM8 mediators on intracellular Ca(2+) ([Ca(2+)]i) and whole-cell currents. TRPM8 gene and protein expression was evident and icilin (20µM), a TRPM8 agonist, increased Ca(2+) influx as well as whole-cell currents whereas BCTC (10µM), a TRPM8 antagonist, suppressed these effects. Similarly, either temperature lowering below 23°C or T1AM (1µM) induced Ca(2+) transients that were blocked by this antagonist. TRPM8 activation by both 1µM T1AM and 20µM icilin prevented capsaicin (CAP) (20µM) from inducing increases in Ca(2+) influx through TRP vanilloid 1 (TRPV1) activation, whereas BCTC did not block this response. CAP (20µM) induced a 2.5-fold increase in IL-6 release whereas during exposure to 20µM capsazepine this rise was completely blocked. Similarly, T1AM (1µM) prevented this response. Taken together, T1AM like icilin is a cooling agent since they both directly elicit TRPM8 activation at a constant temperature. Moreover, there is an inverse association between changes in TRPM8 and TRPV1 activity since these cooling agents blocked both CAP-induced TRPV1 activation and downstream rises in IL-6 release.

Vitrified collagen-based conjunctival equivalent for ocular surface reconstruction.

The main functions of the conjunctiva, an essential part of the ocular surface, are to maintain the equilibrium of the tear film and to protect the eye. Upon injuries, the prerequisite to successful ocular surface repair is conjunctival reconstruction. Tissue engineering techniques, including transplantation of autografts, amniotic membranes and numerous synthetic/natural materials, have been developed. However, none of these strategies is completely satisfactory due to lack of goblet cell repopulation, poor mechanical properties or non-standardized preparation procedure. Here, we cultured conjunctival epithelial cells on vitrified collagen membranes and developed a tissue equivalent for repairing damaged conjunctiva. Optimized vitrified collagen has superior mechanical and optical properties to previous biomaterials for ocular surface application, and its unique fibrillar structure significantly benefited conjunctival epithelial cell growth and the phenotypic development in vitro. In a rabbit model, vitrified collagen greatly promoted conjunctival regeneration with rapid re-epithelization, sufficient repopulation of goblet cells and minimized fibrosis and wound contracture, proved by gene expression analyses and histological staining. In conclusion, we have demonstrated the potential suitability of utilizing vitrified collagen-based tissue equivalent in ocular surface reconstruction.

Endophthalmitis and severe blebitis following trabeculectomy. Epidemiology and risk factors; a single-centre retrospective study.

PURPOSE: To study the epidemiology and risk factors of early- and late-onset postoperative endophthalmitis (PE) and severe blebitis following trabeculectomy. METHODS: Retrospective, single-centre, observational study with a case-control design in part. Patients sustaining PE and severe blebitis following trabeculectomy or a combined trabeculectomy with a cataract extraction procedure performed from 1990 through 2008 and diagnosed from 1990 through 2012 were recorded at St Erik Eye Hospital. Incidence data were calculated with help from the hospital records. Notes data of cases and of six randomly selected but procedure matched control patients for each case were compared. RESULTS: The joint rate of infection was 0.46% or 34 incidents in 7402 procedures. The frequency of early (occurring <6 weeks after surgery) onset PE was 0.19%, late PE was 0.19% and severe blebitis was 0.08%. Dominating aetiologies were staphylococci and streptococci. Overall, the infection severely impaired the visual function. Combined cataract and fistulating operations were less prone to develop late infections, p = 0.04, but no other decisive factors were identified in the case-control study. Data collection for all trabeculectomy surgeries from 1998 and onward identified an increased rate for late infection with the use of mitomycin C (MMC), 8 in 1171 surgeries or 0.7%, versus no such use, 0 case of late PE in 2136 surgeries, p < 0.001. CONCLUSIONS: Postoperative endophthalmitis is a devastating complication after trabeculectomy. The use of MMC increases the risk for delayed infection. Early PE after trabeculectomy is clearly more common than PE after cataract surgery. Developing efficacious prophylactic antibiotic regimens to reduce early PE after penetrating filtering procedures should be a major priority in ophthalmic surgery.

Adaptation of impression cytology to enable conjunctival surface cell transcriptome analysis.

PURPOSE: This study investigates the extent of the human transcriptome that can be quantified from conjunctival impression cytology extracts. The aim is to determine if sufficient RNA can be isolated from a patient's conjunctival surface to identify differences in gene expression between dry eye and normal patients of (a) an array of 96 inflammatory biomarkers and associated receptors, and (b) if this comparison can be expanded to the entire transcriptome. MATERIALS AND METHODS: CIC was used to collect conjunctival surface cells from 53 qualifying normal and dry eye patients. Based on prior optimization of all assay steps, RNA was isolated from the samples using a Qiagen RNeasy Plus Mini Kit and qRT-PCR was used to determine gene expression of 96 genes using TaqMan Low Density Array cards. Samples from six normal and six dry eye patients were then assayed on an Illumina Human HT-12 BeadChip. RESULTS: Optimization steps yielded an RNA processing procedure that improved yield from an initial 12 genes through 96, then to the entire human transcriptome. For the HT-12 BeadChip, more than 30 genes differed by a factor of >1.5 between the dry eye and normal groups and seven genes were down-regulated by a factor of >2.0 in the dry eye group: HLA-DRB5, PSCA, FOS, lysozyme, TSC22D1, CAPN13 and CXCL6. CONCLUSIONS: Conjunctival impression cytology can be used to collect sufficient RNA from conjunctival surface cells that, when processed optimally, allows successful transcriptome-wide expression analysis. While the current transcriptome analysis used a limited patient group, larger studies of patients with various types and severities of dry eye should reveal significant gene expression trends that can then be targeted to improve dry eye treatment options.

Dermis-fat grafts and enucleation in Ghanaian children: 5 years' experience.

BACKGROUND: Enucleation in young children often results in retarded orbital growth ipsilaterally. The need for an implant that will naturally grow with the child, like Dermis-fat Graft (DFG), for managing the anophthalmia has been of interest over the years. OBJECTIVE: To evaluate the use of DFG as an implant for volume replacement post-enucleation. STUDY DESIGN: A prospective non-comparative case series involving 18 consecutive children who had DFG either primarily or secondarily in conjunction with enucleation for intraocular pathologies, from December 2007 to September 2012, at the ophthalmology unit, Korle-Bu. Data from patients who had a minimum of three months follow up(FUP) were analysed. OUTCOME MEASURES: Complete covering of DFG with healthy conjunctiva, increase in volume of DFG, and presence or absence of complications. RESULTS: Fifteen patients were analysed, aged nine months to ten years (mean (SD), 3.7±2.7years). Eight (53.3%) were females. Thirteen (86.7%) DFGs were secondary and 2(13.3%) primary. Indications for enucleation were intraocular retinoblastoma (n=10, 66.7%), unexplained retinal detachment mimicking retinoblastoma (n=3,20.0%), anterior staphyloma (n=1,6.7%) and medulloepithelioma (n=1,6.7%). Fourteen (93.3%) patients showed increase in volume of DFG. Time for Conjunctival reepithelialisation of the dermal surface was four to fourteen weeks (mean/median=5.5/4.0). Complications encountered were infection (n=1,6.7%), infection with necrosis (n=1,6.7%), melanosis /keratinization (n=2, 13.3%) and cysts(n=2,13.3%). The patients were followed up for 3 to 54 months (mean/median 20.13 /16.00). CONCLUSION: DFG for management of post-enucleation anophthalmia in Ghanaian children showed 93.3% success.

[Darwin or Lamarck? Understanding the ocular surface and its normal or abnormal differentiation in order to cure ocular surface destruction with corneal opacification]. / Rôle des cellules souches épithéliales de la cornée et de leur micro-environnement dans le traitement des destructions de la surface oculaire.

According to the World Health Organization, 5.1% of blindnesses or visual impairments are related to corneal opacification. Cornea is a transparent tissue placed in front of the color of the eye. Its transparency is mandatory for vision. The ocular surface is a functional unit including the cornea and all the elements involved in maintaining its transparency i.e., the eyelids, the conjunctiva, the lymphoid tissue of the conjunctiva, the limbus, the lacrymal glands and the tear film. The destruction of the ocular surface is a disease caused by : traumatisms, infections, chronic inflammations, cancers, toxics, unknown causes or congenital abnormalities. The treatment of the ocular surface destruction requires a global strategy including all the elements that are involved in its physiology. The microenvironnement of the ocular surface must first be restored, i.e., the lids, the conjunctiva, the limbus and the structures that secrete the different layers of the tear film. In a second step, the transparency of the cornea can be reconstructed. A corneal graft performed in a healthy ocular surface microenvironnement will have a better survival rate. To achieve these goals, a thorough understanding of the renewal of the epitheliums and the role of the epithelial stem cells are mandatory.

Scleral fixation underneath an intact conjunctiva.

PURPOSE: To describe a technique for the fixation of intraocular lenses or capsular tension rings through the ciliary sulcus or pars plana. METHODS: This alternative technique allows burial of the knot and the free suture ends within the sclera, without using a scleral flap or pocket or even a conjunctival opening. RESULTS: No suture exposure has occurred with the use of the suture burial technique in approximately 25 eyes in 4 years. Additional benefits include less patient discomfort and an improved anatomic and cosmetic outcome starting from the first postoperative day. CONCLUSIONS: This technique causes minimal tissue damage and scarring with almost no postoperative discomfort.