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Korbmacher JP, Borrelli M, Geerling G. Use of Endoscopy in Keratoprostheses with Biological Haptics. Klin Monbl Augenheilkd 2023; 240:1004-1009. [PMID: 35322872 DOI: 10.1055/a-1807-2197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In severe ocular surface disease where penetrating keratoplasty cannot be successfully performed, implantation of a keratoprosthesis can achieve visual rehabilitation. Osteo-odonto-keratoprosthesis offers good tissue integration due to its biological haptics, resulting in a better survival rate and lower extrusion rate. Due to corneal opacity, which is often complete, assessing the potential visual acuity is challenging. Also, during implantation of a keratoprosthesis or during later intraocular revision surgery, there is a limited field of view of the peripheral retina or ciliary body region. This is due to the small size and central location of the prosthesis optics and the geometric conditions of the prosthetic haptics. These factors can complicate surgery. METHODS Endoscopic video assistance was used in 7 eyes of 6 different patients (6 male, 2 female, mean age 66 ± 9 years). In 3 eyes the indication was for preoperative estimation of potential visual acuity during a 23 G vitrectomy. In 2 eyes it was used during implantation surgery itself, and in 2 eyes it was used during revision surgery and vitrectomy. An endoscope with semirigid optics and an image guidance system with 3,000 pixels and 70°field of view from PolyDiagnost was used, with a 23 G trocar system. RESULTS Endoscopy was successfully applied in all eyes examined. In 1 of 3 eyes where endoscopy was performed to estimate the visual acuity potential, a keratoprosthesis was subsequently planned. In the other two eyes, the visual acuity potential was rated insufficient for future keratoprosthesis surgery. Detailed assessment of the retina and optic disc was limited to gross pathologies because of low image resolution. During implantation, it was possible to visualize correct positioning of the posterior haptic behind the host cornea. Retroprosthetic membranes could successfully be removed by endoscopy-assisted vitrectomy. CONCLUSION Endoscopy assistance offers advantages in visualization both for determining the indication for KPro surgery, during implantation, and in the management of complications after implantation of a keratoprosthesis. Low resolution of the imaging system places limits on assessment capabilities. Although technical improvements and miniaturization may enhance its future capabilities, endoscopy in its current form is already a valuable addition in the context of keratoprosthesis surgery.
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Affiliation(s)
| | - Maria Borrelli
- Augenklinik, Universitätsklinikum Düsseldorf, Deutschland
| | - Gerd Geerling
- Augenklinik, Universitätsklinikum Düsseldorf, Deutschland
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Singh S, Basu S, Geerling G. Salivary gland transplantation for dry eye disease: Indications, techniques, and outcomes. Ocul Surf 2022; 26:53-62. [DOI: 10.1016/j.jtos.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/29/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022]
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Metcalfe D, Iqbal O, Chodosh J, Bouchard CS, Saeed HN. Acute and Chronic Management of Ocular Disease in Stevens Johnson Syndrome/Toxic Epidermal Necrolysis in the USA. Front Med (Lausanne) 2021; 8:662897. [PMID: 34322500 PMCID: PMC8311126 DOI: 10.3389/fmed.2021.662897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022] Open
Abstract
Stevens Johnson syndrome and toxic epidermal necrolysis are on a spectrum of a severe, immune-mediated, mucocutaneous disease. Ocular involvement occurs in the vast majority of cases and severe involvement can lead to corneal blindness. Treatment in the acute phase is imperative in mitigating the severity of chronic disease. Advances in acute treatment such as amniotic membrane transplantation have shown to significantly reduce the severity of chronic disease. However, AMT is not a panacea and severe chronic ocular disease can and does still occur even with aggressive acute treatment. Management of chronic disease is equally critical as timely intervention can prevent worsening of disease and preserve vision. This mini-review describes the acute and chronic findings in SJS/TEN and discusses medical and surgical management strategies.
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Affiliation(s)
- Derek Metcalfe
- Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, United States
| | - Omer Iqbal
- Loyola University Medical Center, Maywood, IL, United States
| | - James Chodosh
- Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, United States
| | | | - Hajirah N Saeed
- Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, United States
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[Health-related quality of life after implantation of a keratoprosthesis with biological haptic]. Ophthalmologe 2017; 115:34-39. [PMID: 28986623 DOI: 10.1007/s00347-017-0576-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Many studies report comparatively good long-term results among patients with keratoprostheses with biological haptic. However, overall costs are correspondingly high. A clear cost-benefit relationship is therefore desirable. OBJECTIVE This study investigates health-related quality of life after implantation of a keratoprosthesis with biological haptic. MATERIALS AND METHODS We present a retrospective analysis of medical data of 25 patients treated between 1996 and 2006 at the Department of Ophthalmology, University Hospital Homburg/Saar and the Klinikum Offenburg. Health-related quality of life was assessed by means of a questionnaire based on validated instruments, with particular emphasis on physical symptoms, mental health, functional limitations, and social interactions. RESULTS At a patient age of 49.8 ± 15.7 years (minimum-maximum: 19-78 years; 6 female, 19 male), the mean duration of corneal blindness was 13.8 ± 13.1 years (minimum-maximum: 1-47 years). Changes in visual acuity and subjective satisfaction were statistically significant (p <0.001). Quality of life (on a scale of 1 to 6: median 2) at the time "before the onset of eye disease" and ≥15 months after surgery were identical. Patients with a postoperative visual acuity ≤0.1 (n =11) also showed a statistically significant (p =0.016) benefit in this context. CONCLUSION The expenditures and costs of keratoprosthetics can be justified by an improvement in the health-related quality of life of the persons concerned. Even a postoperative visual acuity of ≤0.1 correlates with a statistically significant improvement in the subjective quality of life of these patients.
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Kohanim S, Palioura S, Saeed HN, Akpek EK, Amescua G, Basu S, Blomquist PH, Bouchard CS, Dart JK, Gai X, Gomes JAP, Gregory DG, Iyer G, Jacobs DS, Johnson AJ, Kinoshita S, Mantagos IS, Mehta JS, Perez VL, Pflugfelder SC, Sangwan VS, Sippel KC, Sotozono C, Srinivasan B, Tan DTH, Tandon R, Tseng SCG, Ueta M, Chodosh J. Acute and Chronic Ophthalmic Involvement in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis - A Comprehensive Review and Guide to Therapy. II. Ophthalmic Disease. Ocul Surf 2016; 14:168-88. [PMID: 26882981 DOI: 10.1016/j.jtos.2016.02.001] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 02/03/2016] [Accepted: 02/03/2016] [Indexed: 02/07/2023]
Abstract
Our purpose is to comprehensively review the state of the art with regard to Stevens- Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), with particular attention to improving the management of associated ocular surface complications. SJS and TEN are two ends of a spectrum of immune-mediated disease, characterized in the acute phase by a febrile illness followed by skin and mucous membrane necrosis and detachment. Part I of this review focused on the systemic aspects of SJS/TEN and was published in the January 2016 issue of this journal. The purpose of Part II is to summarize the ocular manifestations and their management through all phases of SJS/TEN, from acute to chronic. We hope this effort will assist ophthalmologists in their management of SJS/TEN, so that patients with this complex and debilitating disease receive the best possible care and experience the most optimal outcomes in their vision and quality of life.
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Affiliation(s)
- Sahar Kohanim
- Vanderbilt Eye Institute, Vanderbilt University School of Medicine, USA
| | - Sotiria Palioura
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, USA
| | - Hajirah N Saeed
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, USA
| | - Esen K Akpek
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, USA
| | - Guillermo Amescua
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, USA
| | | | | | | | - John K Dart
- Moorfields Eye Hospital, NHS Foundation Trust, UK
| | - Xiaowu Gai
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, USA
| | | | - Darren G Gregory
- Rocky Mountain Lions Eye Institute, University of Colorado School of Medicine, USA
| | - Geetha Iyer
- Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Sankara Nethralaya, India
| | - Deborah S Jacobs
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, USA; Boston Foundation for Sight, USA
| | | | | | | | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Victor L Perez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, USA
| | | | | | | | | | - Bhaskar Srinivasan
- Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Sankara Nethralaya, India
| | - Donald T H Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Radhika Tandon
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, India
| | - Scheffer C G Tseng
- Ocular Surface Center, Ocular Surface Research & Education Foundation, USA
| | - Mayumi Ueta
- Kyoto Prefectural University of Medicine, Japan
| | - James Chodosh
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, USA.
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Spaniol K, Metzger M, Roth M, Greve B, Mertsch S, Geerling G, Schrader S. Engineering of a Secretory Active Three-Dimensional Lacrimal Gland Construct on the Basis of Decellularized Lacrimal Gland Tissue. Tissue Eng Part A 2015. [PMID: 26222647 DOI: 10.1089/ten.tea.2014.0694] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Lacrimal gland (LG) insufficiency is a main cause for severe dry eye leading to pain, visual impairment, and eventually loss of sight. Engineering of transplantable LG tissue with secretory capacity is a desirable goal. In this study, a three-dimensional decellularized LG (DC-LG) scaffold with preserved LG morphology was generated by treatment with 1% sodium deoxycholate and DNase solution using porcine LG tissue. To address clinical applicability, the primary in vitro culture of secretory active LG cells from a small tissue biopsy of 1.5 mm diameter was introduced and compared with an established isolation method by enzymatic digestion. Cells from both isolation methods depicted an epithelial phenotype, maintained their secretory capacity for up to 30 days, and exhibited progenitor cell capacity as measured by aldehyde dehydrogenase-1 activity, side population assay, and colony-forming units. Cells from passage 0 were reseeded into the DC-LG and secretory active cells migrated into the tissue. The cells resembled an LG-like morphology and the constructs showed secretory activity. These results demonstrate the possibility of engineering a secretory competent, three-dimensional LG construct using LG cells expanded from a small tissue biopsy and DC-LG as a matrix that provides the native structure and physiological niche for these cells.
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Affiliation(s)
- Kristina Spaniol
- 1 Department of Ophthalmology, University of Düsseldorf , Düsseldorf, Germany
| | - Marco Metzger
- 2 Department of Tissue Engineering and Regenerative Medicine (TERM), University Hospital Würzburg and Translational Center Würzburg "Regenerative Therapies for Oncology and Musculoscelettal Diseases ," Würzburg, Germany
| | - Mathias Roth
- 1 Department of Ophthalmology, University of Düsseldorf , Düsseldorf, Germany
| | - Burkhard Greve
- 3 Department of Radiotherapy, University of Münster , Münster, Germany
| | - Sonja Mertsch
- 4 Institute for Experimental Ophthalmology, University of Münster , Münster, Germany
| | - Gerd Geerling
- 1 Department of Ophthalmology, University of Düsseldorf , Düsseldorf, Germany
| | - Stefan Schrader
- 1 Department of Ophthalmology, University of Düsseldorf , Düsseldorf, Germany
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Wilson-Miller R, Stanley H. The psychosocial needs of patients undergoing ocular-odonto-kerato-prosthesis (OOKP) surgery: a nurse perspective. ACTA ACUST UNITED AC 2013. [DOI: 10.12968/ijop.2013.4.4.163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Helen Stanley
- Head of the Centre for Academic and Practice Development and Director of the Graduate Programme in Health and Social Sciences. School of Nursing and Midwifery, University of Brighton, UK
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Osteo-odonto-keratoprosthesis - a maxillofacial perspective. J Craniomaxillofac Surg 2012; 40:e426-31. [PMID: 22425501 DOI: 10.1016/j.jcms.2012.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 02/16/2012] [Accepted: 02/16/2012] [Indexed: 11/23/2022] Open
Abstract
The OOKP (osteo-odonto-keratoprosthesis) is the treatment of choice for conditions like Stevens-Johnson syndrome, ocular cicatricial pemphigoid, trachoma, multiple failed grafts and chemical burns which are not amenable to penetrating keratoplasty. The OOKP is an autograft which replaces the cornea with a polymethacrylate cylinder mounted on a tooth-bone complex. The aim of this paper was to retrospectively analyze the records in 26 patients undergoing OOKP surgery between 2007 and 2011. The paper describes our experience with the procedure, with emphasis on its oral and maxillofacial aspects and management of associated complications. The aetiology of blindness in 23 patients was Stevens-Johnson's syndrome and chemical burns in three. Twenty-two patients had their maxillary canines, two had mandibular canines and two had maxillary first premolars as the choice of donor tooth. An oroantral fistula developed in four patients. One patient needed to undergo a surgical procedure for closure of the same. Roots of adjacent teeth were exposed in 12 patients. Twenty-four patients underwent both stages of the procedure with 19 being visually rehabilitated successfully. There was no improvement in the vision of four patients. One patient was lost to follow-up. Two patients have yet to undergo Stage 2.
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Borrelli M, Schröder C, Dart JK, Collin JRO, Sieg P, Cree IA, Matheson MA, Tiffany JM, Proctor G, van Best J, Hyde N, Geerling G. Long-term follow-up after submandibular gland transplantation in severe dry eyes secondary to cicatrizing conjunctivitis. Am J Ophthalmol 2010; 150:894-904. [PMID: 20920813 DOI: 10.1016/j.ajo.2010.05.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 05/12/2010] [Accepted: 05/12/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the long-term results of autologous submandibular gland transplantation in eyes with cicatrizing conjunctivitis and to determine biomechanical and biochemical features of the resulting salivary tear film. DESIGN Prospective, observational case series. METHODS Fifteen eyes with cicatrizing conjunctivitis with a viable autologous submandibular gland transplantation were compared with 10 eyes with cicatrizing conjunctivitis and a failed submandibular gland transplantation or no submandibular gland transplantation. Best-corrected visual acuity, frequency of tear substitute instillation, severity of dry eye discomfort, lid margin erythema, conjunctival hyperemia, corneal epithelial edema, tear film break-up time, Schirmer test results, and corneal fluorescein and conjunctival Rose Bengal staining were evaluated. In a subgroup central corneal thickness and sensitivity, corneal epithelial barrier function, conjunctival and lid margin flora, and conjunctival impression cytologic analysis results were evaluated. In 3 patients, preoperative and postoperative tear samples were analyzed for viscosity, surface tension, and presence of mucins. RESULTS Submandibular gland autotransplantation resulted in long-term improvement of subjective, objective, and some ocular surface parameters. Salivary mucins were detectable in salivary tears after submandibular gland transplantation. The viscosity of salivary tears was more similar to normal saliva and the surface tension was intermediate between the 2 original secretions. CONCLUSIONS Submandibular gland autotransplantation provides long-term relief from pain and reduces the need for frequent installation of lubricants.
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De Rojas MV, Dart JKG, Saw VPJ. The natural history of Stevens Johnson syndrome: patterns of chronic ocular disease and the role of systemic immunosuppressive therapy. Br J Ophthalmol 2007; 91:1048-53. [PMID: 17314145 PMCID: PMC1954786 DOI: 10.1136/bjo.2006.109124] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To characterize patterns of chronic ocular disease in patients with Stevens-Johnson syndrome (SJS) and its variant toxic epidermal necrolysis (TEN), and to describe their response to treatment. METHODS Retrospective case series. A review of hospital records of 30 patients (60 eyes) with ocular manifestations of SJS or TEN was carried out. The principal outcome measure was to identify and classify the patterns of chronic ocular disease in SJS and TEN. The secondary outcome measure was the response to treatment. RESULTS Patterns of chronic ocular disease observed after the acute episode included: mild/moderate SJS, severe SJS, ocular surface failure (SJS-OSF), recurrent episodic inflammation (SJS-RI), scleritis (SJS-S) and progressive conjunctival cicatrisation resembling mucous membrane pemphigoid (SJS-MMP). The median follow-up was 5 years (range 0-29). 19 patients (29 eyes (48%)) developed SJS-OSF, SJS-RI, SJS-S or SJS-MMP during follow-up. SJS-OSF was present in 12 patients (18 eyes (30%)). In 5 patients (eight eyes) this developed 1 year after the acute illness, without any further inflammatory episodes; it was associated with SJS-RI in 1 patient (2 eyes), with SJS-RI and SJS-S in 1 patient (1 eye), with SJS-S in 1 patient (1 eye) and with SJS-MMP in 4 patients (6 eyes). Episodes of SJS-RI occurred in 4 patients (7 eyes (12%)). The median time from acute disease to the first episode of SJS-RI was 8.5 years (range 5-63). SJS-S developed in 2 patients (4 eyes (7%)), of which 2 eyes subsequently developed SJS-OSF. SJS-MMP developed in 5 patients (10 eyes (16.6%)). The median duration from the acute stage to the diagnosis of SJS-MMP was 2 years (range 1-14). Immunosuppressive therapy successfully controlled inflammation in 10/10 patients with SJS-MMP, SJS-RI or SJS-S. CONCLUSION Ocular disease in SJS/TEN is not limited solely to the sequelae of the acute phase illness. Patients and physicians need to know that ocular disease progression, due to surface failure and/or acute inflammatory conditions, may occur at variable periods following the acute disease episode. Recognition of this, and prompt access to specialist services, may optimise management of these uncommon patterns of disease in SJS.
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Hille K, Grabner G, Liu C, Colliardo P, Falcinelli G, Taloni M, Falcinelli G. Standards for Modified Osteoodontokeratoprosthesis (OOKP) Surgery According to Strampelli and Falcinelli. Cornea 2005; 24:895-908. [PMID: 16227830 DOI: 10.1097/01.ico.0000157401.81408.62] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To establish a time-proven "gold standard" in modified osteoodontokeratoprosthesis (OOKP) surgery. METHODS The OOKP is the procedure of choice for restoring sight in patients with corneal blindness caused by end-stage ocular surface disease not amenable to penetrating keratoplasty. Members of the OOKP Study Group met in Rome, Italy in 2001 and Vienna, Austria in 2002 to discuss indications and contraindications, patient selection, surgical technique, postoperative care, and recognition and management of complications of OOKP surgery according to Strampelli and modified by Falcinelli. RESULTS Falcinelli's modification of Strampelli's technique of OOKP surgery remains the gold standard as far as visual and keratoprosthesis-retention results are concerned. The agreement on indications and contraindications, patient selection, surgical technique, postoperative care, and recognition and management of complications of this technique of OOKP surgery is summarized in the text of this manuscript. CONCLUSION This standard technique of modified OOKP surgery, where adequately performed, is capable of providing excellent anatomic and functional results even in the long term. In patients with corneal blindness untreatable by other approaches, we strongly recommend this technique for visual rehabilitation. Students of OOKP surgery should become familiar with the protocol described in this paper before subjecting the technique to further modifications.
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Affiliation(s)
- Konrad Hille
- Eye Department and Hospital, University of Saarland, Homburg (Saar), Germany.
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