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Murashima ADAB, Sant’Ana AMS, Faustino-Barros JF, Machado Filho EB, da Silva LCM, Fantucci MZ, Módulo CM, Chahud F, Garcia DM, Rocha EM. Exorbital Lacrimal Gland Ablation and Regrafting Induce Inflammation but Not Regeneration or Dry Eye. Int J Mol Sci 2024; 25:8318. [PMID: 39125889 PMCID: PMC11312169 DOI: 10.3390/ijms25158318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
The study evaluated the regenerative responses of the lacrimal functional unit (LFU) after lacrimal gland (LG) ablation. The LG of Wistar rats was submitted to G1) partial LG ablation, G2) partial ablation and transplantation of an allogeneic LG, or G3) total LG ablation, (n = 7-10/group). The eye wipe test, slit lamp image, tear flow, and histology were evaluated. RT-PCR analyzed inflammatory and proliferation mediators. The findings were compared to naïve controls after 1 and 2 months (M1 and M2). G3 presented increased corneal sensitivity, and the 3 groups showed corneal neovascularization. Histology revealed changes in the LG and corneal inflammation. In the LG, there was an increase in MMP-9 mRNA of G1 and G2 at M1 and M2, in RUNX-1 at M1 and M2 in G1, in RUNX-3 mRNA at M1 in G1, and at M2 in G2. TNF-α mRNA rose in the corneas of G1 and G2 at M2. There was an increase in the IL-1β mRNA in the trigeminal ganglion of G1 at M1. Without changes in tear flow or evidence of LG regeneration, LG ablation and grafting are unreliable models for dry eye or LG repair in rats. The surgical manipulation extended inflammation to the LFU.
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Affiliation(s)
- Adriana de Andrade Batista Murashima
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil
| | - Ariane M. S. Sant’Ana
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil
| | - Jacqueline Ferreira Faustino-Barros
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil
| | - Elísio B. Machado Filho
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil
| | - Lilian Costa Mendes da Silva
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil
| | - Marina Zilio Fantucci
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil
| | - Carolina Maria Módulo
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil
| | - Fernando Chahud
- Department of Pathology and Legal Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil
| | - Denny Marcos Garcia
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil
| | - Eduardo M. Rocha
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto 14049-900, SP, Brazil
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[Beyond esthetics-Regenerative medicine for severe diseases of the adnexa oculi]. DIE OPHTHALMOLOGIE 2022; 119:878-890. [PMID: 35925347 DOI: 10.1007/s00347-022-01643-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Restoration of eyelid and lacrimal functions are important steps on the way to an intact ocular surface. Clinically available substitute tissues or therapeutic options for eyelid reconstruction and lacrimal gland regeneration often reach their limits in patients with severe diseases of the adnexa oculi. Several approaches in regenerative medicine have been intensively researched and clinically tested in recent years. These range from reconstructive approaches with novel tissue matrices in the field of eyelid surgery to stem cell therapies to regenerate lacrimal gland function. MATERIAL AND METHODS The state of the art in the current literature is presented and an overview of clinically applied or currently researched tissues for eyelid reconstruction is given. Furthermore, approaches in stem cell therapy of the lacrimal gland as well as own results are presented. RESULTS Acellular dermis has been successfully used for eyelid reconstruction and represents a viable option in cases of limited availability of autologous tissue. In vitro grown cellular constructs or tissues with genetically modified cells have already been successfully applied in dermatology for the treatment of burns or severe genodermatoses. First studies on stem cell therapy for severe dry eye in Sjögren syndrome showed a safe and effective application of mesenchymal stem cells by injection into the lacrimal gland. CONCLUSION Due to the limitations of currently available replacement tissues, there is a clinical need for the development of new materials for adnexa oculi reconstruction. Constructs grown in vitro with allogeneic and/or genetically engineered cells are slowly making their way into clinical practice. The efficacy and mode of action of stem cells in severe dry eye are subject matters of current clinical trials.
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Avisar I, Nahum Y, Mimouni M, Kremer I, Malhotra R. Oculoplastic aspects of ocular surface disease and their management. Surv Ophthalmol 2019; 65:312-322. [PMID: 31837384 DOI: 10.1016/j.survophthal.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 11/13/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
The normal structure and function of the eyelids, eyelashes, conjunctival fornices, and lacrimal system are essential for the health of the ocular surface, and abnormalities of these structures accompany many cases of ocular surface disease. We describe the role of oculoplastic intervention in the context of ocular surface disease, focusing on blink disorders, lagophthalmos, entropion, lid scarring and keratinization, trichiasis, and punctal and lacrimal sac disease.
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Affiliation(s)
- Inbal Avisar
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yoav Nahum
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel; Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Israel Kremer
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raman Malhotra
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
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Jones L, Downie LE, Korb D, Benitez-del-Castillo JM, Dana R, Deng SX, Dong PN, Geerling G, Hida RY, Liu Y, Seo KY, Tauber J, Wakamatsu TH, Xu J, Wolffsohn JS, Craig JP. TFOS DEWS II Management and Therapy Report. Ocul Surf 2017; 15:575-628. [DOI: 10.1016/j.jtos.2017.05.006] [Citation(s) in RCA: 578] [Impact Index Per Article: 82.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 02/06/2023]
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Vazirani J, Sangwan VS. Surgical Management of SJS Sequelae: Outcomes and Alternatives. CURRENT OPHTHALMOLOGY REPORTS 2016. [DOI: 10.1007/s40135-016-0109-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Vazirani J, Mariappan I, Ramamurthy S, Fatima S, Basu S, Sangwan VS. Surgical Management of Bilateral Limbal Stem Cell Deficiency. Ocul Surf 2016; 14:350-64. [DOI: 10.1016/j.jtos.2016.02.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 01/10/2016] [Accepted: 02/01/2016] [Indexed: 01/01/2023]
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Stewart WC, Stewart JA, Nelson LA. Ocular surface disease in patients with ocular hypertension and glaucoma. Curr Eye Res 2011; 36:391-8. [PMID: 21501071 DOI: 10.3109/02713683.2011.562340] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To review the prevalence, diagnosis, causes, and treatment of ocular surface disease (OSD) in patients with ocular hypertension or primary open-angle glaucoma. METHODS A review of the literature pertaining to OSD and glaucoma. RESULTS Recent studies indicate that OSD demonstrates an overall prevalence in glaucoma of 42% (range 20-59%) and is severe in 36% (range 14-66%). Further, the prevalence appears to increase with the greater the number of glaucoma drugs prescribed. Symptoms and signs are non-specific to the anterior surface of the eye and are thought to result from allergic, toxic, or pro-inflammatory conditions. However, the specific causes remain incompletely described, but may result from the benzalkonium chloride (BAK) preservative or occasionally the ocular hypotensive active molecule itself. Additionally, anterior segment ocular diseases might be causative, such as allergy, blepharitis, dry eye, and eyelid anatomical abnormalities. Treatment may consist of using preservative-free or non-BAK preserved glaucoma medications. Also, although unproven specifically in glaucoma patients, treatment of associated diseases of the anterior surface might reduce signs and symptoms. CONCLUSIONS OSD is common in treated glaucoma patients causing symptoms and signs that may impact on a patient's quality of life. Treatment is directed towards any underlying disease process and the use of preservative-free or non-BAK-preserved glaucoma preparations.
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Affiliation(s)
- William C Stewart
- PRN Pharmaceutical Research Network, LLC, Charleston, South Carolina, USA.
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Abstract
Dry eye (DED) is a multifactorial disease that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface, accompanied by increased osmolarity of the tear film and inflammation. DED is a common clinical problem and is among the most frequent diagnoses in ophthalmology. It substantially affects quality of life because of the constant ocular discomfort and decrease in visual function. This review discusses the etiology, classification, diagnosis procedures, clinical, and surgical treatments of dry eye.
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Meyer-ter-Vehn T, Schmidt E, Zillikens D, Geerling G. [Mucous membrane pemphigoid with ocular involvement. Part II: therapy]. Ophthalmologe 2008; 105:405-19. [PMID: 18392628 DOI: 10.1007/s00347-008-1700-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Treatment of mucous membrane pemphigoid (MMP) aims at reduction of conjunctival inflammation by means of systemic immunosuppression. In addition, cicatricial progression and management of the resulting ocular surface disease requires topical conservative or surgical measures. The former includes systemic immunosuppression with steroids and other immunosuppressive agents: dapsone in mild to moderate disease and cyclophosphamide in severe cases have been established in two randomized trials. Other agents such as methotrexate, azathioprine, mycophenolate mofetil or monoclonal antibodies including daclizumab or rituximab were found to be effective in uncontrolled small studies. Surgery is primarily focused on eyelid problems such as entropium and trichiasis. Ocular surface disease and secondary complications, e.g. cataract formation and glaucoma, may need surgical treatment. Any surgery is associated with the risk of a relapse of inflammation and should be postponed until inflammation is controlled by systemic therapy. Management of MMP patients requires close collaboration of a specialized ophthalmologist with specialists from dermatology and internal medicine.
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Affiliation(s)
- T Meyer-ter-Vehn
- Klinik für Augenheilkunde, Julius-Maximilians-Universität Würzburg, Josef-Schneider-Strasse 11, 97080 Würzburg, Deutschland
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Abstract
The conceptual advantage of phototherapeutic keratectomy (PTK) include the option to remove diseased tissue on a micrometer scale. Although less invasive than other forms of corneal surgery, it remains a surgical procedure which carries inherent risks. In phototherapeutic indications this risk is higher than in otherwise healthy eyes undergoing photorefractive surgery. Potential general complications include wound-healing problems, infection, inflammation, or a recurrence of the underlying disease. More specifically, PTK is associated with unwanted refractive changes, such as a hyperopic shift or an irregular astigmatism. In this review, we discuss these problems along with prevention and treatment strategies in detail.
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Affiliation(s)
- G Geerling
- Klinik für Augenheilkunde, Bayerische Julius-Maximilian-Universität, Josef-Schneider-Strasse 11, 97080 Würzburg.
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