A Tenon's capsule/bulbar conjunctiva interface biomimetic to model fibrosis and local drug delivery.

Glaucoma filtration surgery is one of the most effective methods for lowering intraocular pressure in glaucoma. The surgery efficiently reduces intra-ocular pressure but the most common cause of failure is scarring at the incision site. This occurs in the conjunctiva/Tenon's capsule layer overlying the scleral coat of the eye. Currently used antimetabolite treatments to prevent post-surgical scarring are non-selective and are associated with potentially blinding side effects. Developing new treatments to target scarring requires both a better understanding of wound healing and scarring in the conjunctiva, and new means of delivering anti-scarring drugs locally and sustainably. By combining plastic compression of collagen gels with a soft collagen-based layer, we have developed a physiologically relevant model of the sub-epithelial bulbar conjunctiva/Tenon's capsule interface, which allows a more holistic approach to the understanding of subconjunctival tissue behaviour and local drug delivery. The biomimetic tissue hosts both primary human conjunctival fibroblasts and an immune component in the form of macrophages, morphologically and structurally mimicking the mechanical proprieties and contraction kinetics of ex vivo porcine conjunctiva. We show that our model is suitable for the screening of drugs targeting scarring and/or inflammation, and amenable to the study of local drug delivery devices that can be inserted in between the two layers of the biomimetic. We propose that this multicellular-bilayer engineered tissue will be useful to study complex biological aspects of scarring and fibrosis, including the role of inflammation, with potentially significant implications for the management of scarring following glaucoma filtration surgery and other anterior ocular segment scarring conditions. Crucially, it uniquely allows the evaluation of new means of local drug delivery within a physiologically relevant tissue mimetic, mimicking intraoperative drug delivery in vivo.

Evaluation of the Northern Ireland National Artificial Eye Service: A Regional Audit of Patient and Prosthetic Characteristics.

PURPOSE: The purpose of this study is to establish an up-to-date baseline of the profile of patients using the National Artificial Eye Service in Northern Ireland and to understand key areas of service provision, to contribute to patient and health-care provider education, and thus to improve patient outcomes for future researchers. METHODS: A prospective audit of artificial eye wearers attending the Northern Ireland National Artificial Eye Service between May 18, 2015 and June 26, 2015 was conducted. RESULTS: A total of 131 patients, who attended consecutively for appointments over the 6-week period, were included: males 68%; females 32%. The majority of eyes were lost secondary to trauma (54%). In recent decades, medical causes have now taken over as the primary referral cause for prosthetic eyes. Approximately, one-third of patients attending the service required further education on how to maintain the hygiene of their ocular prosthesis. CONCLUSION: Patients attending artificial eye services should be further educated about using lubricants to maintain the hygiene of their prosthesis. Primary care health professionals (General Medical Practitioners and Primary Care Optometrists) should be informed about artificial eye services and of how to contact the service for advice if required. Trauma remains the most common cause for referral; however, in recent decades more patients are attending secondary to a medical cause of eye loss. Health service providers should be aware of the changing profile of patients attending artificial eye services and of the medical and traumatic causes of eye loss.