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Bulloch G, Seth I, Sukumar S, Chen Y, Zhu Z. Scleral thinning causes, diagnosis, and management: A narrative review. Cont Lens Anterior Eye 2023; 46:101825. [PMID: 36894372 DOI: 10.1016/j.clae.2023.101825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 02/23/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Sclera forms the outer fibrous coat of the eye and provides structural integrity for the housing of intraocular contents. Scleral thinning is a serious progressive condition which can lead to perforation and worsening visual functioning. This review aims to summarize the anatomical consideration and causes of scleral thinning, diagnosis, and the various surgical approaches available to treat scleral thinning. MATERIALS AND METHODS The narrative literature review was conducted by senior Ophthalmologists and researchers. PubMed, EMBASE, Web of Science, Scopus, and Google Scholar databases were searched for relevant literature from infinity till March 2022. Terms of the search referred to 'sclera' or 'scleral thinning' or 'scleral melting', and were combined with 'treatment', or 'management' or 'causes'. Publications were included in this manuscript if they offered information about the nature of these topics. Reference lists of relevant literature was searched. There were no limits on type of article to be included for this review. RESULTS Scleral thinning arises from diverse congenital, degenerative, immunological, infectious, post-surgical, and traumatic etiologies. It is diagnosed upon slit-lamp examination, indirect ophthalmoscopy, and optical coherence tomography. Conservative pharmacological treatment of scleral thinning may include anti-inflammatory drugs, steroid drops, immunosuppressors, monoclonal antibodies, and surgical treatments including tarsorrhaphy, scleral transplantation, amniotic membrane transplantation, donor corneal graft, conjunctival flaps, tenon's membrane flap, pericardial graft, dermis graft, cadaveric dura mater graft, and other autologous and biological grafts. CONCLUSION Scleral thinning treatments have developed dramatically in recent decades and the rise of alternative grafts for scleral transplantation procedures or use of conjunctival flaps have taken center stage in surgical management. This review adds a comprehensive summary of the scleral thinning with attention to the positive and negative features of new treatments alongside previous mainstay management strategies.
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Affiliation(s)
- Gabriella Bulloch
- Department of Ophthalmology, Royal Victorian Ear and Eye Hospital, Centre for Eye Research Australia, Melbourne, Australia; Faculty of Science, Medicine, and Health, The University of Melbourne, Australia
| | - Ishith Seth
- Department of Ophthalmology, Royal Victorian Ear and Eye Hospital, Centre for Eye Research Australia, Melbourne, Australia; Faculty of Science, Medicine, and Health, The University of Melbourne, Australia; Faculty of Medicine, Central Clinical School, Monash University, Australia.
| | - Sharanya Sukumar
- Department of Ophthalmology, Royal Victorian Ear and Eye Hospital, Centre for Eye Research Australia, Melbourne, Australia
| | - Yanping Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Province Key Laboratory of Ophthalmology and Vision Science, Guangzhou, China
| | - Zhuoting Zhu
- Department of Ophthalmology, Royal Victorian Ear and Eye Hospital, Centre for Eye Research Australia, Melbourne, Australia; Faculty of Science, Medicine, and Health, The University of Melbourne, Australia
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Sun X, Qiao Y, Zhao L, Shi Z, Zhang X, Cao R, Zhou Q, Shi W. Application of Decellularized Porcine Sclera in Repairing Corneal Perforations and Lamellar Injuries. ACS Biomater Sci Eng 2022; 8:5295-5306. [PMID: 36454184 DOI: 10.1021/acsbiomaterials.2c00972] [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: 12/02/2022]
Abstract
Scleras are mainly used for the treatment of glaucoma, eyelid damage, and scleral ulcers. Given that the sclera and cornea collectively constitute the complete external structure of the eyeball and both have the same tissue and cell origin, we attempted to identify scleral materials to treat lamellar and penetrating corneal injuries. Based on research in our center, antigenic components in decellularized porcine sclera (DPS) were removed using a simplified decellularization method, leaving the collagen structure and active components undamaged. DPS preserved the mechanical properties and did not significantly inhibit the proliferation and replication of human corneal epithelial cells. In vivo, the graft epithelium healed well after lamellar and penetrating scleral grafting, and the graft thickness did not change evidently. DPS can resist suture traction during scleral transplantation and maintain anterior chamber stability until day 28 post-operatively, especially in penetrating repairs. No obvious immune rejection of lamellar or penetrating scleral grafts was found 28 days after DPS transplantation. This study shows that DPS could be used as an alternative material for the emergency repair of corneal perforations and lamellar injuries, representing another application of sclera.
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Affiliation(s)
- Xiuli Sun
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Jingsi Road, Jinan 271000, China
| | - Yujie Qiao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Jingsi Road, Jinan 271000, China
| | - Long Zhao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Jingsi Road, Jinan 271000, China
| | - Zhen Shi
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Jingsi Road, Jinan 271000, China
| | - Xiaoyu Zhang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Jingsi Road, Jinan 271000, China
| | - Rui Cao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Jingsi Road, Jinan 271000, China
| | - Qingjun Zhou
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Shandong First Medical University, 5 Yan'erdao Road, Qingdao 266071, China
| | - Weiyun Shi
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Jingsi Road, Jinan 271000, China
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Latrach R, Ben Chehida N, Allous A, Redid H, Rejeb A, Abdelmelek H. Effects of sub-acute co-exposure to WIFI (2.45 GHz) and Pistacia lentiscus oil treatment on wound healing by primary intention in male rabbits. Vet Med Sci 2022; 8:1085-1095. [PMID: 35120283 PMCID: PMC9122460 DOI: 10.1002/vms3.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background The bioeffects of WIFI on cutaneous wound healing remains unexplored. In addition, several medicinal plant products including lentisk oil have been shown to interfere with wound healing process. Since the use of this oil is increasing, the co‐exposure (WIFI‐Lentisk oil) assessment is of paramount importance. Objectives We aimed in the present study to investigate the effects of WIFI exposure as well as the application of Pistacia lentiscus oil on sutured wounds (SW). Methods New Zealand male rabbits (n = 24) were used and randomly divided into four groups of six animals each: a control group (SW) and three experimental groups (i) a first group exposed to WIFI (2.45 GHz, 6 h/day) during 16 days (SWW); (ii) a second group exposed to WIFI (2.45 GHz, 6 h/day) during 16 days and treated with lentisk oil (SWWL) and (iii) a third group not exposed to WIFI but treated with lentisk oil (SWL). The wound healing was evaluated by monitoring clinical parameters (temperature, food intake, relative weight variation, and macroscopic aspect) and histology. Results The mean food intake was higher in the SWWL group compared to the three other groups (p < 0.001) and higher in the SWL group compared to the SW group (p = 0.014). The exposition to WIFI (SWW group) or lentisk oil application (SWL group) can promote the collagen deposition and ameliorate the general aspect of wounds. By contrast, the co‐exposure to WIFI and lentisk oil (SWWL) results in antagonist effects and extends the inflammatory phase of wound healing. Conclusions Wounds treated topically with Pistacia lentiscus oil should not be exposed to WIFI.
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Affiliation(s)
- R Latrach
- Surgery Service, Clinical Department, National School of Veterinary Medicine of Sidi Thabet, Sidi Thabet, Tunisia
| | - N Ben Chehida
- Surgery Service, Clinical Department, National School of Veterinary Medicine of Sidi Thabet, Sidi Thabet, Tunisia
| | - A Allous
- Surgery Service, Clinical Department, National School of Veterinary Medicine of Sidi Thabet, Sidi Thabet, Tunisia
| | - H Redid
- Surgery Service, Clinical Department, National School of Veterinary Medicine of Sidi Thabet, Sidi Thabet, Tunisia
| | - A Rejeb
- Pathological Anatomy Service, Clinical Department, National School of Veterinary Medicine of Sidi Thabet, Sidi Thabet, Tunisia
| | - H Abdelmelek
- Laboratory of Integrated Physiology, Faculty of Sciences of Bizerte, University of Carthage, Tunis, Tunisia
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Jung YH, Yoon CH, Kim MK. Preserved corneal lamellar transplantation for infectious and noninfectious scleral defects: Three case reports and literature review. Medicine (Baltimore) 2021; 100:e26607. [PMID: 34398015 PMCID: PMC8294895 DOI: 10.1097/md.0000000000026607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/22/2021] [Indexed: 11/26/2022] Open
Abstract
RATIONALE : Reinforcement of thinned or necrotizing sclera has been conducted using various materials, including allogeneic sclera, allogenic cornea, amniotic membrane, fascia lata, pericardium, periosteum, and perichondrium. Among them, good outcomes have traditionally been obtained using preserved scleral grafts. However, scleral patch grafts have complications such as graft retraction, thinning, dehiscence, and necrosis. Furthermore, to promote epithelial healing, scleral patch grafting must be accompanied by procedures such as amniotic membrane transplantation (AMT) or grafting using conjunctival flaps or autografts. Recently, acellular preserved human corneas have been used in various ophthalmic surgeries, with emerging evidence supporting its use for treating scleral defects as an option that does not require AMT or conjunctival autografting. We investigated whether corneal patch grafting would show wound healing and tectonic success rate outcomes comparable to those of existing techniques. PATIENT PRESENTATION : Three patients presented with intractable ocular pain. Slit-lamp examination showed marked scleral thinning at the nasal side. DIAGNOSIS : Scleral thinning progressed with conservative treatment; microbial staining and culturing were performed. Infectious or non-infectious scleritis was diagnosed according to slit-lamp examination and microbial culture results. INTERVENTIONS : A preserved corneal lamellar patch was grafted at the scleral thinning area. OUTCOMES All patients achieved tectonic success with reduction of inflammation following corneal patch grafting. Two patients achieved complete re-epithelialization within 7 days, while 25 days were required for the third patient. No patients experienced graft thinning, rejection, or infection. LESSONS : Our report suggests the feasibility of using acellular preserved human cornea patch grafts to reinforce inflammatory scleral defects and obtain successful outcomes in terms of wound healing. This technique shows a comparable tectonic success rate and superior effect on scleral defect healing without the need for adjunctive AMT or conjunctival autografting.
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Affiliation(s)
- Young-ho Jung
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Chang Ho Yoon
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
- Transplantation Research Institute, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, Korea
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Chen Y, Zhang X, Liu Z, Yang J, Chen C, Wang J, Yang Z, He L, Xu P, Hu X, Luo G, He W. Obstruction of the formation of granulation tissue leads to delayed wound healing after scald burn injury in mice. BURNS & TRAUMA 2021; 9:tkab004. [PMID: 34212057 PMCID: PMC8240558 DOI: 10.1093/burnst/tkab004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/01/2020] [Indexed: 05/11/2023]
Abstract
BACKGROUND Delayed wound healing remains a common but challenging problem in patients with acute or chronic wound following accidental scald burn injury. However, the systematic and detailed evaluation of the scald burn injury, including second-degree deep scald (SDDS) and third-degree scald (TDS), is still unclear. The present study aims to analyze the wound-healing speed, the formation of granulation tissue, and the healing quality after cutaneous damage. METHODS In order to assess SDDS and TDS, the models of SDDS and TDS were established using a scald instrument in C57BL/6 mice. Furthermore, an excisional wound was administered on the dorsal surface in mice (Cut group). The wound-healing rate was first analyzed at days 0, 3, 5, 7, 15 and 27, with the Cut group as a control. Then, on the full-thickness wounds, hematoxylin and eosin (H&E) staining, Masson staining, Sirius red staining, Victoria blue staining and immunohistochemistry were performed to examine re-epithelialization, the formation of granulation tissue, vascularization, inflammatory infiltration and the healing quality at different time points in the Cut, SDDS and TDS groups. RESULTS The presented data revealed that the wound-healing rate was higher in the Cut group, when compared with the SDDS and TDS groups. H&E staining showed that re-epithelialization, formation of granulation tissue and inflammatory infiltration were greater in the Cut group, when compared with the SDDS and TDS groups. Immunohistochemistry revealed that the number of CD31, vascular endothelial growth factor A, transforming growth factor-β and α-smooth muscle actin reached preferential peak in the Cut group, when compared with other groups. In addition, Masson staining, Sirius red staining, Victoria blue staining, Gordon-Sweets staining and stress analysis indicated that the ratio of collagen I to III, reticular fibers, failure stress, Young's modulus and failure length in the SDDS group were similar to those in the normal group, suggesting that healing quality was better in the SDDS group, when compared with the Cut and TDS groups. CONCLUSION Overall, the investigators first administered a comprehensive analysis in the Cut, SDDS and TDS groups through in vivo experiments, which further proved that the obstacle of the formation of granulation tissue leads to delayed wound healing after scald burn injury in mice.
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Affiliation(s)
- Yunxia Chen
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
- Chongqing Key Laboratory for Disease Proteomics, Chongqing 400038, China
| | - Xiaorong Zhang
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
- Chongqing Key Laboratory for Disease Proteomics, Chongqing 400038, China
| | - Zhihui Liu
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
- Chongqing Key Laboratory for Disease Proteomics, Chongqing 400038, China
| | - Jiacai Yang
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
- Chongqing Key Laboratory for Disease Proteomics, Chongqing 400038, China
| | - Cheng Chen
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Jue Wang
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Zengjun Yang
- Department of Dermatology, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Lei He
- Department of Osteopathic Medicine, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Pengcheng Xu
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Xiaohong Hu
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
- Chongqing Key Laboratory for Disease Proteomics, Chongqing 400038, China
| | - Gaoxing Luo
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
- Chongqing Key Laboratory for Disease Proteomics, Chongqing 400038, China
| | - Weifeng He
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
- Chongqing Key Laboratory for Disease Proteomics, Chongqing 400038, China
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