Retropupillary Iris-fixated versus Sutured Scleral-fixated Intraocular Lenses.

Aim: To compare the anatomical and functional results and patient satisfaction following retropupillary implantation of Artisan Aphakia iris-fixated intraocular lens (rAAIF) and sutured scleral fixated intraocular lens (SFIOL). Subjects and methods: We presented a prospective double-arm non-blinded study. Forty-one eyes with acquired aphakia, no age-related macular degeneration, no previous keratoplasty, no combined procedures, no AC reaction (cells, fibrin), normal intraocular pressure, no history of endothelial corneal dystrophy in relatives or fellow eye were included. Indications, complications, corrected distance visual acuity (CDVA), endothelial cell density (ECD), and patient satisfaction score were assessed. Results: Retropupillary AAIF was implanted in 21 (51.22%) eyes and SFIOL in 20 (48.78%) eyes. The most common indication was complicated cataract surgery in 18 cases (43.90%), followed by trauma in 16 (39.02%), and spontaneous dislocation in 7 (17.07%). No difference between rAAIF and SFIOL in terms of sex, laterality (χ=0.13, p=0.72), indications (χ=0.78, p=0.68), previous ocular history, and comorbidities was observed. The complications and the visual outcomes at 6 months postoperatively were similar between the two groups (p=0.95 and p=0.321, respectively). The ECD loss in the two groups was also similar (p=0.89). The patient satisfaction score was 58.67±8.80 in the rAAIF and 56.69±11.50 in the SFIOL group, which was statistically similar (p=0.764). Conclusion: Retropupillary AAIF and SFIOL showed similar results concerning visual acuity, endothelial cell loss, and patient satisfaction. Careful preoperative individual assessment is required to have optimal results with either technique. Abbreviations: AAIF = Artisan Aphakia iris-fixated intraocular lens, rAAIF = retropupillary Artisan Aphakia iris-fixated intraocular lens, CDVA = corrected distance visual acuity, ECD = endothelial cell density, IOL = intraocular lens, SD = standard deviation, SFIOL = scleral fixated intraocular lens.

An Analysis of the Progression of Conjunctivalisation after Transplantation of Cultivated Corneal Epithelium.

PURPOSE: To analyse the recurrence of superficial neovascularisation after previous corneal surface reconstruction with cultivated corneal epithelial cells. MATERIALS AND METHODS: Forty-eight eyes underwent autologous transplantation of cultivated corneal epithelium to treat partial or total limbal stem cell deficiency caused by chemical or thermal injury. The carrier for the epithelial sheets was a denuded amniotic membrane. Follow-up was conducted for up to 120 months. Recurrent revascularisation (measured in terms of clock hours affected) was evaluated with slit-lamp examination and the support of confocal microscopy. RESULTS: During the long-term observation, only 7 eyes had stable epithelia with no neovascularisation from the conjunctiva. Nineteen eyes developed pathologic vessels in 1 quadrant, with additional 4 eyes developing them in 2 quadrants. Twelve patients developed subtotal or total conjunctivalisation of the corneal surface. They were referred for second cultivated epithelium transplantation (3 patients), allogenic keratolimbal transplantation (7 patients), or keratoprosthesis (2 patients). Six patients withdrew consent. The use of confocal scans of up to 100 µm in resolution enabled the detection of pathologic microvasculature originating from the conjunctiva and the exclusion of stromal vascular ingrowth. CONCLUSIONS: Local ingrowth of the conjunctiva is a common complication after the transplantation of cultivated epithelial cells. Severe and progressive vascularisation inevitably leads to graft failure. However, if local ingrowth stops before reaching the central cornea, the treatment even with this complication can be considered a success.

Double vision in Parkinson's Disease: a systematic review.

INTRODUCTION: The prevalence of diplopia in Parkinson's disease (PD) ranges from 10% to 30%. Diplopia is usually limited to specific situations such as reading and looking around, however, it can also be constant. The aim of this review, supplemented by two case studies, was to summarise current knowledge on the frequency, possible causes, differential diagnosis, pathophysiology and treatment approaches to double vision in PD patients. METHODOLOGY: An electronic search (PubMed, Scopus, Embase and Web of Science) to identify studies regarding diplopia in PD patients was performed in May 2020. The following search terms were used: Parkinson's Disease and diplopia. RESULTS: Five articles are included in this literature review. In the literature, the number of included patients with PD who presented with symptoms of diplopia varied from a single case report to 88 patients. Diplopia was usually intermittent and binocular. The most commonly reported type of diplopia was single object diplopia, and the second most common was complete diplopia. Risk factors contributing to developing diplopia were: older age, disease duration, disease severity, cognitive decline, presence of visual hallucinations, and higher levodopa equivalent dose. Results also showed that diplopia had a significant impact on quality of life. Possible comorbidities of diplopia include myasthenia gravis and vascular disease. CONCLUSION: Diplopia is relatively common in PD, but still understudied. The research shows that it has a clear impact on health-related quality of life and patient safety. The acute onset of diplopia should always result in tests to exclude other diseases. Tailored interventions should be developed, leading to improved patient safety, quality of life, and quality of care.

Simple limbal epithelial transplantation: a review on current approach and future directions.

Simple limbal epithelial transplantation is a recently developed technique for treating limbal stem cell deficiency caused by ocular burns. A small limbal biopsy from the donor eye, usually from the patient's healthy eye, is excised and dissected into multiple pieces. An amniotic membrane is atttached using fibrin glue on the diseased eye after removing the conjunctivalized pannus from the corneal surface. The limbal biopsy pieces are placed onto the amniotic membrane, fixed with fibrin glue, followed by bandaging of the ocular surface with a contact lens. This technique (auto simple limbal epithelial transplantation) offers easier surgical manipulations and economic advantages over other techniques for the treatment of limbal stem cell deficiency. We therefore review simple limbal epithelial transplantation along with recent modifications in the technique and case studies, including challenges and failures.

Stage-related central corneal epithelial transformation in congenital aniridia-associated keratopathy.

PURPOSE: To relate central corneal epithelial phenotype to degree of keratopathy in a limbal stem cell deficient population. METHODS: 37 patients (67 eyes) with aniridia-associated keratopathy (AAK) underwent corneal examination including slit lamp biomicroscopy to determine the Grade of AAK, Cochet-Bonnet esthesiometry, and in vivo confocal microscopy (IVCM) to assess morphology of the central corneal epithelium and subepithelial region. RESULTS: AAK Grade ranged from 1 (limbal involvement only) to 4 (total conjunctivalization), with progression from Grade 1 occurring after the age of 20. 30% of subjects had an asymmetric Grade between eyes. In early-stage AAK (Grades 1-2), central epithelial cells had mixed corneal-conjunctival phenotype, touch sensitivity and subbasal nerves diminished, and mature dendritic cells, inflammatory leukocytes, and blood vessels were present despite central transparency in the slit lamp. In later stages (Grades 3-4) of the LSCD, neural deficit and nerve function worsened, immune cell invasion increased, and lymphatic vessels were detected in several cases. Goblet cells and epithelial cysts were observed to varying degrees in all stages, but without clear association to AAK severity. The clinical grade and progression of AAK was strongly associated with the central corneal epithelial phenotype. CONCLUSIONS: AAK is associated with degradation of epithelial phenotype, a neural deficit, and immune compromised status even in the clear central cornea in the earliest stages. IVCM can aid in assessing whether the conditions for limbal stem cell maintenance are likely to exist, based on morphology of the central epithelial microenvironment.

Cultivated Oral Mucosa Epithelium in Ocular Surface Reconstruction in Aniridia Patients.

PURPOSE: Efficacy of cultivated oral mucosa epithelial transplantation (COMET) procedure in corneal epithelium restoration of aniridia patients. METHODS: Study subjects were aniridia patients (13 patients; 17 eyes) with irregular, vascular conjunctival pannus involving visual axis who underwent autologous transplantation of cultivated epithelium. For the procedure oral mucosa epithelial cells were obtained from buccal mucosa with further enzymatic treatment. Suspension of single cells was seeded on previously prepared denuded amniotic membrane. Cultures were carried on culture dishes inserts in the presence of the inactivated with Mitomycin C monolayer of 3T3 fibroblasts. Cultures were carried for seven days. Stratified oral mucosa epithelium with its amniotic membrane carrier was transplanted on the surgically denuded corneal surface of aniridia patients with total or subtotal limbal stem cell deficiency. Outcome Measures. Corneal surface, epithelial regularity, and visual acuity improvement were evaluated. RESULTS: At the end of the observation period, 76.4% of the eyes had regular transparent epithelium and 23.5% had developed epithelial defects or central corneal haze; in 88.2% of cases visual acuity had increased. VA range was from HM 0.05 before the surgery to HM up to 0.1 after surgery. CONCLUSION: Application of cultivated oral mucosa epithelium restores regular epithelium on the corneal surface with moderate improvement in quality of vision.

A novel proteotoxic stress associated mechanism for macular corneal dystrophy.

Macular corneal dystrophy is a rare autosomal recessive eye disease affecting primarily the corneal stroma. Abnormal accumulation of proteoglycan aggregates has been observed intra- and extracellularly in the stromal layer. In addition to the stromal keratocytes and corneal lamellae, deposits are also present in the basal epithelial cells, endothelial cells and Descemet's membrane. Misfolding of proteins has a tendency to gather into aggregating deposits. We studied interaction of molecular chaperones and proteasomal clearance in macular dystrophy human samples and in human corneal HCE-2 epithelial cells. Seven cases of macular corneal dystrophy and four normal corneal buttons collected during corneal transplantation were examined for their expression patterns of heat shock protein 70, ubiquitin protein conjugates and SQSTM1/p62. In response to proteasome inhibition the same proteins were analyzed by western blotting. Slit-lamp examination, in vivo confocal cornea microscopy and transmission electron microscopy were used for morphological analyses. Heat shock protein 70, ubiquitin protein conjugates and SQSTM1/p62 were upregulated in both the basal corneal epithelial cells and the stromal keratocytes in macular corneal dystrophy samples that coincided with an increased expression of the same molecules under proteasome inhibition in the HCE-2 cells in vitro. We propose a novel regulatory mechanism that connects the molecular chaperone and proteasomal clearance system in the pathogenesis of macular corneal dystrophy.

[Regeneration of corneal epithelium using keratin modified chitosan membranes]. / Regeneracja nablonka rogówki przy zastosowaniu membran chitozanowych modyfikowanych keratyna.

The cornea is a transparent front layer of the eye. It functions like a window that controls and focuses the light entering into the eye. The cornea contributes to 65-75% of the eye's total focusing power and it acts as a physical barrier against pathogenic microorganisms, dirt and other noxious physical factors. The corneal tissue is arranged in five basic layers. The outermost layer (epithelium) is made up of highly regenerative cells that allow for quick healing of superficial injuries. Eye infections, diseases, or mechanical injury can harm corneal epithelium and cause blindness. Under certain circumstances, to prevent that, it is recommended to perform complete corneal transplantation. However, due to lack of sufficient number of donors, researchers are searching for alternative solutions.. Regeneration of epidermal tissue can restore and ensure normal functioning of cornea. For that purpose proper grafts are needed. The goal of current research was to develop the material for scaffold preparation providing optimal conditions for the epithelium cornea cell culturing and to determine its chemical, physical, and biological properties. The scaffolds, which could be applied in ophthalmology should fulfill a lot of requirements, among them such as biocompatibility, biodegradability, restorability, non-toxicity. They should also have adequate mechanical strength, flexibility and porosity. The aim of this work was to synthesize and to determine the properties of polymeric material for ophthalmic surgery applications. A hydrogel scaffold in the form of membrane was obtained from chitosan - natural, biocompatible, biologically inert, stable in the natural environmental and antibacterial polysaccharide derived from chitin. Biodegradable chitosan films containing keratin were crosslinked with genipin - a naturally occurring and nontoxic agent. In this study we present physicochemical characterization of the scaffolds. Porosity, contact angle and swelling ratio (at different pH) were determined. The optical microscope technique was used to visualize the microstructure of the scaffolds. Atomic force microscopy (AFM) measurements revealed the topography of the surfaces of membranes. The biological tests have shown that epithelial cells seeded on the membranes proliferated efficiently.

Application of autologous cultivated corneal epithelium for corneal limbal stem cell insufficiency--short-term results.

PURPOSE: To present results of ocular surface reconstruction with application of cultured corneal epithelium in limbal stem cell insufficiency. MATERIAL AND METHODS: 25 patients suffered from limbal insufficiency in one eye after a chemical or thermal burn. Their healthy eyes were the source of limbal epithelium for corneal epithelial culture. Limbal cells from a 2 mm2 biopsy were seeded on amniotic membrane. Cultures were carried out in standard conditions in supplemented DMEM in presence of 3T3 fibroblasts. After superficial keratectomy the amniotic carriers with epithelial cells were transplanted on denuded corneas. The presence of corneal vascularization, epithelial regularity and visual acuity were evaluated. RESULTS: Postoperative follow-up ranged from 3 up to 9 months, average 4.9 +/- 1.1 months. 3 months after the surgery 72.0% of the eyes showed stable epithelium with slight corneal haze caused by the amnion. In 60.0% of the eyes there was no recurrent conjunctival neovascularization. 28.0% of the eyes remained cloudy due to stromal revascularization. In 2 eyes total conjunctival pannus developed again. Visual acuity ranged from counting fingers to 0.6. CONCLUSION: Transplantation of cultured epithelium is a promising method in treatment of limbal stem cell insufficiency giving satisfactory restoration of corneal epithelium.

Culture morphology of the autologous cultivated corneal epithelium.

PURPOSE: Ocular surgery based on cultivated corneal epithelium has become a very promising procedure eligible to restore the ocular surface. Analysis of morphologic features and the phenotype of cultivated epithelial cells determines their quality and eligibility of transplantation. MATERIAL AND METHODS: Corneal epithelial cultures were carried out in 25 patients suffering from limbal deficiency after chemical or thermal burns. Fellow healthy eyes were the source of limbal epithelium for the culture. Limbal cells from a 2 mm2 biopsy were seeded on an amniotic membrane after enzymatic pretreatment. Cultures were carried in standard conditions in a supplemented DMEM HAM/F12 medium in the presence of 3T3 fibroblasts. Light microscopy was used to analyze the regularity of the cultivated epithelial layer, histologic examination was used to establish number of epithelial layers, and immunohistochemistry for epithelial and proliferation markers was applied to confirm cell origin and proliferative potential. Staining for cytokeratin 3, 12, 19, connexin 43, and protein p63 was performed. RESULTS: In 25 donors, 27 cultures of the epithelium were performed. In 2 cases, plates were contaminated. Both cultures were repeated. In 84% of the cultures, regular stratified growth of the epithelium with complete covering of amniotic membrane was observed. In 16% of cultures, growth was not regular, showing differences in the number of cell layers. Staining for cytokeratin 3/12 confirmed the corneal origin of cultivated epithelia. The number of epithelial layers ranged from 3 to 9; the average was 5.3 +/- 1.9 layers. CONCLUSION: Cultures of limbal epithelial cells are a valuable source of tissue for restoration of the corneal epithelium.