Clinical outcomes of traumatic globe rupture in corneal graft patients.

PURPOSE: This study reports the mechanisms, complications and graft survival following sight-threatening traumatic globe rupture in patients having previously undergone corneal transplantation in the same eye. METHODS: A retrospective, observational, single-center consecutive cohort study at the Royal Victoria Infirmary, Newcastle upon Tyne, UK over a 20-year period. Medical records and Newcastle Corneal Transplantation Service electronic database (eNCTS) review was undertaken of all consecutive patients who underwent corneal transplantation with a history of traumatic globe rupture. Main outcome measures include mechanism of injury, final best-corrected distance visual acuity (BCDVA), graft survival and complications. RESULTS: A total of 921 keratoplasties were undertaken between 1997 and 2017 with 24 (3.0%) patients identified with a history of traumatic globe rupture. A bimodal relationship of age and mechanism of trauma was observed. The mean age (SD) of individuals reporting cause as a fall was 71.5 (14.8) years, and 45.3 (20.8) years (P < 0.05) amongst individuals reporting accidental trauma or assault. The pre- and post-trauma mean (SD) LogMAR BCDVA was 0.6 (0.9) and 1.7 (1.0), respectively (P = 0.001). The overall graft-failure rate was 60.9% (11 grafts) during a mean (SD) follow-up period of 3.5 (4.1) years. Globe rupture with lens damage was associated with poorer final BCDVA (P < 0.05). CONCLUSIONS: This study represents the first published series from England for this type of patient cohort. Overall visual outcomes were poor with a bimodal relationship of age and mechanism of trauma. Worse prognostic factors included lens and posterior segment complications. Re-grafting in these select group of patients may prove valuable.

Effect of radiation and cell implantation on wound healing in a rat model.

BACKGROUND AND OBJECTIVES: Having shown that intra-dermal injection of fibroblasts decreases the effect of radiation on healing of superficial wounds, we now test the effect of fibroblasts and syngeneic marrow stromal cells on irradiated deep and superficial wounds. METHODS: Wistar rats received bilateral buttock irradiation followed by partial excision of the gluteus muscle bilaterally. In Protocol 1, one irradiated wound was treated with 1.2 x 10(7) autologous cells injected intra-dermally. In Protocol 2, the experimental side was treated with a fibrin and autologous cell implant (1.2 x 10(7) cells). Twenty-one days later, wound mechanical characteristics were tested. In Protocol 3, the effect of pooled marrow stromal cells on healing of superficial irradiated wounds in Lewis rats was similarly tested. RESULTS: The fibrin-fibroblast implant (Protocol 2) had no effect on wound mechanics. Superficial injection of fibroblasts (Protocol 1) significantly improved wound breaking strength when compared to the control group (mean +/- SEM, breaking strength: treated 504.6 +/- 37.0 g vs. control 353.4 +/- 35.2 g, P = 0.005). The dermal injection of marrow stromal cells also resulted in marked increases in breaking strength (mean +/- SEM, breaking strength: treated 338.5 +/- 39.9 g vs. control 187.1 +/- 12.0 g, P < 0.01). In both Protocols 1 and 3, ultimate tensile strength and toughness were increased in the side receiving cell transplantation. CONCLUSIONS: Cell implantation holds promise for decreasing the effect of radiation on healing of irradiated wounds.