Potential candidate cells for constructing tissue-engineered lacrimal duct epithelium: a histological and cytological study in rabbits.

OBJECTIVE: Injury and deficiency of the lacrimal duct epithelium (LDE) can lead to a variety of lacrimal diseases. The purpose of this study was to characterize potential candidate cells for constructing a tissue-engineered LDE. METHODS: Different areas of the conjunctiva and lacrimal duct tissue were removed from male adult New Zealand white rabbits for histological evaluation. Hematoxylin and eosin staining and immunohistochemical staining of cytokeratin AE1+AE3, cytokeratin 4, Ki-67, and MUC5AC were observed by light microscopy. The surface morphologies of different epithelial tissues and cellular structures were examined using field-emission scanning electron microscopy and transmission electron microscopy. Epithelial cells were isolated from tissues and identified by specific markers. In vitro, proliferative ability and Western blot analyses of the proliferating cell nuclear antigen (PCNA) of different epithelial cells cultured in identical environments were investigated and compared. RESULTS: Histologically, the epithelial specific markers, cytokeratin AE1+AE3 and cytokeratin 4, were expressed in the conjunctiva epithelium and the LDE. Notably, highly proliferative cells stained with Ki-67 were concentrated under the epithelium in a dome structure of the posterior palpebral conjunctiva. Differentiated goblet cells were also found to a lesser extent in this region. Primary palpebral and fornical conjunctival epithelial cells (PFCECs), bulbar conjunctival epithelial cells (BCECs), and lacrimal duct epithelial cells (LDECs) were successfully separated from tissues. In vitro, rabbit PFCECs and LDECs grew faster and expressed more PCNA than BCECs. CONCLUSIONS: PFCECs are anatomically similar to LDECs. They also have similar morphological characteristics, immune phenotypes, and proliferation features. PFCECs are therefore potential candidate cells to replace LDECs in tissue engineering to treat lacrimal duct diseases.

GCDFP-15, AR, and Her-2 as biomarkers for primary ductal adenocarcinoma of the lacrimal gland: a Chinese case and literature review.

PURPOSE: Primary ductal adenocarcinoma (PDA) of the lacrimal gland is a rare malignant epithelial tumor, and its clinicopathological characteristics are still unclear. This study aimed to report a novel case of PDA of the lacrimal gland in the People's Republic of China, as well as to determine its histopathological and immunohistochemical characteristics to support early diagnosis and direct further therapy. PATIENT AND METHODS: Clinical data (including ocular examination, computed tomography, magnetic resonance imaging, positron emission tomography, mammography, and serum tumor marker examination) and treatment of a 49-year-old woman with a left lacrimal gland mass, which was diagnosed as PDA of the lacrimal gland, were reported. Histopathological and immunohistochemical studies were performed. Eleven papers regarding this uncommon neoplasm were reviewed. RESULTS: Histopathologically, most of the tumor cells featured abundant granular eosinophilic cytoplasm, while few of them had a frothy appearance. The mass showed breast ductal carcinoma-like structural features, which most commonly demonstrated central necrosis, while less of these features showed cord-like infiltration. Immunohistochemically, the tumor cells were positive for GCDFP-15, CK 18 (++), AR (90%), Her-2 (+++), P53 (100%), and Ki-67 (with a proliferation index approximately 60%), while they were negative for ER, PR, P63, calponin, and CD 117. CONCLUSION: This was the first Chinese case of PDA of the lacrimal gland that had been reported. We suggested that GCDFP-15, AR, and Her-2 should be tested as biomarkers for ductal adenocarcinoma of lacrimal gland to confirm diagnosis, guide therapy, and further predict prognosis.

Value of (18)F-FDG-PET/CT in ocular sebaceous adenocarcinoma: a case report and literature review.

Ocular sebaceous adenocarcinoma is a rare malignant tumor. We report an unusual case of orbital sebaceous adenocarcinoma in a 48-year-old woman. The patient underwent F-18 2-fluoro-2-deoxy-glucose positron emission tomography/computed tomography ((18)F-FDG-PET/CT) to determine the initial clinical stage. (18)F-FDG-PET/CT showed strong uptake in the orbital lesion, but neither regional lymphatic nor distant metastases were seen. (18)F-FDG-PET/CT plays a role in the diagnosis, staging, restaging, and follow-up of ocular sebaceous carcinoma, although its application has some limitations in other primary and ocular malignancies due to the rarity of ocular sebaceous carcinoma.

Orbital Rosai-Dorfman Disease in a fifty-eight years old woman.

Rosai-Dorfman disease (RDD) is rare and characterized by histiocytic proliferation and massive cervical lymphadenopathy. About 40% of patients have extra-nodal involvement. Opthalmic involvement is seen in 10% of cases. A case of orbital Rosai Dorfman disease in a 58 years old woman is presented here, who was misdiagnosed as orbital inflammatory disease initially. The patient did not respond to a course of oral prednisolone. Then complete surgical excision of the mass was performed and the histopathological examination was consistent with a diagnosis of RDD.

Effects and complications of placement of motility coupling post in porous polyethylene orbital implants.

OBJECTIVE: To investigate the effects and complications of primary and secondary placements of motility coupling post (MCP) in the unwrapped porous polyethylene orbital implant (PPOI) following enucleation. METHODS: We investigated 198 patients who received PPOI implantation following the standard enucleation procedure in the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China, from 2002 to 2004. These patients were subgrouped into PPOI-only patients (112 cases, received PPOI following enucleation), primary MCP patients (46 cases, received primary placement of MCP during PPOI operation), and secondary MCP patients (40 cases, received secondary placement of MCP 6 months after the initial surgery). Effects and complications among these three groups were compared. RESULTS: The PPOI-only patients took shorter treatment course when compared with other two MCP groups (P<0.001), without significant difference noted between the two MCP groups. However, the two MCP groups had better prosthetic motility than PPOI-only group (P<0.001), without significant difference between the two MCP groups. In the early stage, 2 eyes in the PPOI-only group and 1 eye in the primary MCP group had PPOI infection. In PPOI-only group, 3 (2.68%) eyes had PPOI exposure, which occurred after fitting the prostheses; 4 eyes (8.70%) in primary MCP group and 1 eye (2.50%) in secondary MCP had PPOI exposure, which occurred before fitting the prostheses. After prosthesis was fit successfully, the excessive discharge and granuloma were 33.9% and 1.79% in PPOI group-only, 53.3% and 8.9% in primary MCP group, and 52.5% and 7.5% in secondary MCP group, respectively. CONCLUSION: Both primary and secondary placements of MCP into the PPOI following enucleation can help patients to obtain desirable prosthetic motility, but may be associated with more complications. The primary placement of MCP with skilled operation in selected patients is more recommendable than secondary placement.

Amniotic membrane transplantation for porous sphere orbital implant exposure.

OBJECTIVE: This study is aimed at describing the clinical outcome of amniotic membrane transplantation for exposure of porous sphere implants. METHODS: A retrospective review of consecutive cases of porous sphere orbital implant exposure was carried out. Eight cases were presented between May 2004 and Oct. 2006 (5 males, 3 females; mean age 44.5 years). Six had enucleation and two had evisceration. Exposure occurred in two primary and six secondary. Orbital implant diameter was 22 mm in seven cases and 20 mm in one case. Six patients are with hydroxyapatite and two with high-density porous polyethylene (Medpor) orbital implants. The mean time from implantation to exposure was 1.1 months (range 0.8-2 months). All patients required surgical intervention. RESULTS: The time of follow-up ranged from 3.0 to 28.0 months (mean 16.5 months). Amniotic membrane grafting successfully closed the defect without re-exposure in all of these patients. The grafts were left bare with a mean time to conjunctiva of about 1 month (range 0.8-1.5 months). CONCLUSION: Exposed porous sphere implants were treated successfully with amniotic membrane graft in all of patients. The graft is easy to harvest. This technique is useful, dose not lead to prolonged socket inflammation and infection, and it is valuable application extensively.

Effect of basic fibroblast growth factor (bFGF) on the treatment of exposure of the orbital implants.

OBJECTIVE: To evaluate the efficacy and the indication of basic fibroblast growth factor (bFGF) in the treatment of exposure of orbital implants. DESIGN: Retrospective and observational case series. METHODS: We reviewed 41 patients (41 eyes) suffering exposure of orbital implants from Jan. 2000 to June 2006. The study group patients with mild exposure received combined treatment with bFGF and antibiotic drops, and while the control group patients with mild exposure were treated with antibiotic drops only. The study group patients with moderate and severe exposure received combined treatment with bFGF and antibiotic drops, and after 2 months they were subjected to amniotic membrane transplantation, while the control group patients with moderate and severe exposure underwent amniotic membrane transplantation after using antibiotic drops. Observation of the growth of conjunctival epithelium and comparison of the healing rate of the two groups. RESULTS: The healing rates of the mild, moderate and severe exposure study group were 100% and 92.3%. The healing rates of the mild, moderate and severe exposure control group were 55.6% and 66.7% respectively. The difference of the healing rates of the mild exposure study group and the control group was significant (P=0.033). And the difference of the healing rates of the moderate and severe exposure study group and the control group was not significant (P=0.167). CONCLUSION: bFGF may promote obviously the healing of orbital implant exposure, particularly it can be the first choice for the treatment of mild degree exposure. For the moderate and severe cases, it can be administered before surgical repair to enhance neovascularization and will tend to increase the success rate of surgical repair.

High density porous polyethylene material (Medpor) as an unwrapped orbital implant.

OBJECTIVE: To introduce the clinical effect among patients who received an unwrapped orbital implant with high density porous polyethylene material (Medpor) after enucleation or evisceration. METHODS: Retrospective analysis of a series of 302 patients with anophthalmia who underwent placement of an unwrapped high density porous polyethylene orbital implant. We compared the patients (n=180) who accepted primary implant placement with those (n=122) who accepted secondary implant placement. Parameters evaluated included: age at time of surgery, date of surgery, sex, implant type and size, surgery type, the surgical procedure and technique performed, and complications. RESULTS: The time of follow-up ranged from 2.0 to 58.0 months (mean 32.5 months). A total of 5 of 302 (1.66%) cases had documented postoperative complications. The following problems were noted after surgery: implant exposure, 3 patients (0.99%); implant removed due to orbital infection, 1 patient (0.34%); ptosis, 1 patient (0.34%). There were no significant complications observed in other 297 cases and all implants showed good orbital motility. The clinical effect of primary implant placement is better than that of secondary placement. CONCLUSION: High density porous polyethylene material can be used successfully as an unwrapped orbital implant in anopthalmic socket surgery with minimal complications. The material is well tolerated, nonantigenic and has low rate of infection and migration.

[Analysis of high density porous polyethylene (Medpor) orbital implant in 266 cases].

OBJECTIVE: To evaluate the postoperative complications, the appearance and motility in patients who underwent placement of Medpor orbital implant after enucleation, or secondary implantion. METHODS: A retrospective study was carried out on the 266 cases in whom a Medpor orbital implant was implanted from 2001 to 2004. RESULTS: All the cases were followed up from 3 to 26 months. A total of 23 in 266 (8.6%) cases had documented postoperative complications: inflammatory granuloma in 2 cases (0.8%), and moderate or severe ptosis in 4 cases (1.5%), and remained upper eyelid notch with mild ptosis in 8 cases (3.0%), and lower eyelid laxity in 2 cases (0.8%). In 5 cases (1.9%), implant exposure developed: 3 cases were resolved with conservative therapy, and 2 cases with surgical revision of the socket. 2 cases experienced persistent pyogenic discharge in conjunctival sac, and the implant was took out because the discharge couldn't control with local and systemic antibiotic therapy. The motility is excellent in 148 cases and good in 11 cases after the primary obital implant, and excellent in 36 cases and good in 68 cases and bad in 3 case after the secondary implant. The difference between the primary and the secondary obital implant is obvious. CONCLUSIONS: It is considered that Medpor orbital implant is a good method of ocular plasty. Although there are some mild postoperative complications, but those can be resolved with conservative therapy or surgical revision. Medpor orbital implant has good histocompatibility, and the operative processes are convenient. Patients are satisfied with appearance and motility. So the Medpor orbital implant is one of the best selection in ocular socket plasty.

[Clinical effect of amniotic membrane transplantation for reconstruction of conjunctival sac combined with orbital implantation].

OBJECTIVE: To observe the clinical effect of amniotic membrane transplantation for reconstruction of conjunctival sac combined with orbital implantation. METHODS: Twenty three cases suffered of conjunctival constriction were treated with amniotic membrane transplantation for reconstruction of conjunctival sac and combined with orbital implantation simultaneously. Buried suture of inferior conjunctival fornix via skin next to the inferior orbital margin was performed. The preserved amniotic membrane was flattened onto the conjunctival defect area and the superior and lower eyelid were closed with mattress suture. The eyelids were opened and stained with fluorescein test paper every week in order to observe the growth of conjunctival epithelium. Stitches were removed two months after surgery and the suitable prosthesis was made. RESULTS: Conjunctival epithelium migrated to the surface of the amniotic membrane and covered it completely in 20 cases four weeks after surgery. Amniotic membrane was dissolved and conjunctival epithelium could not cover the defect areas in the rest 3 cases. Two months after surgery, 4 eyes of degree I conjunctival sac constriction were all cured. In degree II conjunctival sac constriction, 8 eyes were cured and 2 eyes were improved. In degree III conjunctival sac constriction, 3 eyes were cured, 3 eyes improved, and 3 eyes failed. Among the failed eyes, one eye was underwent reconstruction of conjunctival sac again in six months. No exposure, secondary infection or symblepharon were occurred in 21 eyes with completed treatment, and these patients were satisfied with the good motility and the cosmetic results. CONCLUSION: Preserved amniotic membrane transplantation for reconstruction of conjunctival sac combined with orbital implantation is safe and effective in degree I and degree II conjunctival sac constriction, but less than perfect in degree III conjunctival sac constriction.