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Jo KS, Kim KY, Lee YW, Han SB, Choi CY. Clinical Outcomes and Indications of In-Office Sutureless Dried Gamma Ray-Sterilized Human Amniotic Membrane Transplantation With Bandage Contact Lenses in Various Ocular Surface Disorders. Cornea 2024:00003226-990000000-00503. [PMID: 38421931 DOI: 10.1097/ico.0000000000003491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/27/2023] [Indexed: 03/02/2024]
Abstract
PURPOSE The purpose of this study was to investigate the efficacy and indications of using dried gamma ray-sterilized amniotic membrane (AM) transplantation with bandage contact lenses for the in-office sutureless treatment of various ocular surface diseases. METHODS This study retrospectively included 56 eyes of 52 patients with various ocular surface diseases treated with sutureless dehydrated AM-assisted therapeutic contact lenses. The patients were followed up and assessed 1, 2, and 4 weeks after the treatment, and the therapeutic contact lenses were removed after 1 or 2 weeks. The size of the corneal lesion and the degree of pain experienced by each patient before and after the procedure were measured. Corneal re-epithelization rate and clinical aspects related to re-epithelialization were evaluated. RESULTS Complete corneal re-epithelialization of the epithelial defect was observed in 40 eyes. The complete re-epithelialization rates of persistent epithelial defect caused by infectious ulcers, neurotrophic ulcers, ulcers due to burn, toxic keratopathy, previous penetrating keratoplasty or other corneal surgeries, and severe dry eye disease were 69.2%, 80.0%, 77.8%, 100%, 75.0%, and 100%, respectively. Five patients with uncontrolled infectious ulcers, neurotrophic ulcer, bullous keratopathy, and ulcers associated with rheumatic disease did not show significant improvement. Patient pain scores significantly decreased after the procedure. CONCLUSIONS Dehydrated AM transplantation with a bandage contact lens is minimally invasive and easily applicable through in-office procedures. This approach is expected to be more actively applied in various ocular surface disorders, not only in severe corneal diseases but also in relatively mild corneal surface diseases.
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Affiliation(s)
- Kyu Seong Jo
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, South Korea
| | | | - Yong Woo Lee
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, South Korea
| | - Sang Beom Han
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, South Korea
| | - Chul Young Choi
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, South Korea
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Yoon S, Na M, Eom Y, Kim HM, Song JS. Morphometric Measurement of Pterygium with Anterior Segment Optical Coherence Tomography and Relationship with Astigmatism. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2022. [DOI: 10.3341/jkos.2022.63.8.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: We used anterior segment optical coherence tomography (AS-OCT) to measure the pterygial subepithelial invasion length and thickness before and after surgery, and to evaluate the corneal epithelium and the extent of astigmatism.Methods: This was a retrospective study. Ten eyes that underwent pterygial excision surgery were analyzed. We used corneal topographic data to assess astigmatism before surgery and employed AS-OCT to measure corneal epithelial thickness and the length of subepithelial invasion. We measured the relative pterygial length, width, and area on anterior segment photographs. Corneal topographic assessment and AS-OCT were repeated 1 month after surgery. Multiple regression and Pearson correlation analyses were used to analyze the relationships between normalization of astigmatism and the size and thickness of the excised pterygium.Results: The mean With-the-Rule proportion of preoperative astigmatism was 2.9 ± 2.3 D and the mean corneal epithelial thickness 269.60 ± 84.17 µm. The mean thickness of the excised pterygia was 210.73 ± 80.36 µm. Pterygial thickness was significantly associated with the extent of preoperative With-the-Rule astigmatism and the normalized With-the-Rule astigmatism after pterygial excision. These correlations were stronger than those of the relative pterygial length, width, and area. The mean subepithelial invasion length was 595.00 ± 310.32 µm.Conclusions: An increase in pterygial epithelial thickness influenced the extent of With-the-Rule astigmatism to a much greater extent than did the relative pterygial length, width, and area. AS-OCT measurement of the subepithelial invasion length identifies the required excisional area prior to surgery.
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Pedrotti E, Bertolin M, Fasolo A, Bonacci E, Bosello F, Ponzin D, Marchini G. Autologous simple conjunctival epithelial transplantation for primary pterygium. Int Ophthalmol 2022; 42:3673-3680. [PMID: 35612687 DOI: 10.1007/s10792-022-02364-9] [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: 07/14/2021] [Accepted: 04/28/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the feasibility of a new method of conjunctival transplantation to achieve recovery of the normal conjunctival epithelium over the bare sclera after pterygium excision and prevent its recurrence. METHODS After excision of the primary pterygium, we performed simple conjunctival epithelial transplantation (SCET) in which we glued an amniotic membrane patch pre-loaded with tiny autologous conjunctival tissue fragments over the scleral defect. Slit-lamp evaluation was performed at 2 and 7-10 days, and then at 1, 3, 6, and 12 months after surgery, together with confocal microscopy at 3, 6, and 12 months. RESULTS Surgical excision and SCET for nasal primary pterygium were performed in 6 eyes (6 patients). No graft detachment occurred. An inflammatory granuloma was excised without sequelae in one patient 2 months after surgery. No signs of recurrence or sight-threatening complications were recorded at 12 months, and in vivo confocal microscopy showed progressive expansion of the conjunctival cell population and formation of a clear corneal-conjunctival transition. CONCLUSIONS SCET takes advantage of the ability of the amniotic membrane and conjunctival cells to renew. Outcomes after SCET are comparable to conventional conjunctival flap surgery and can be achieved in less surgical time and with less donor tissue to be removed.
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Affiliation(s)
- Emilio Pedrotti
- Ophthalmology Clinic, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le L.A. Scuro 1, 37134, Verona, Verona, Italy
| | - Marina Bertolin
- Research Unit, The Veneto Eye Bank Foundation (Fondazione Banca degli Occhi del Veneto), Pad. G. Rama, Via Paccagnella 11, 30174, Venezia, Italy
| | - Adriano Fasolo
- Ophthalmology Clinic, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le L.A. Scuro 1, 37134, Verona, Verona, Italy. .,Research Unit, The Veneto Eye Bank Foundation (Fondazione Banca degli Occhi del Veneto), Pad. G. Rama, Via Paccagnella 11, 30174, Venezia, Italy.
| | - Erika Bonacci
- Ophthalmology Clinic, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le L.A. Scuro 1, 37134, Verona, Verona, Italy
| | - Francesca Bosello
- Ophthalmology Clinic, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le L.A. Scuro 1, 37134, Verona, Verona, Italy
| | - Diego Ponzin
- Research Unit, The Veneto Eye Bank Foundation (Fondazione Banca degli Occhi del Veneto), Pad. G. Rama, Via Paccagnella 11, 30174, Venezia, Italy
| | - Giorgio Marchini
- Ophthalmology Clinic, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le L.A. Scuro 1, 37134, Verona, Verona, Italy
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Xanthopoulou PT, Elanwar M, Alzyadi M, Lavaris A, Kopsacheilis N. Α Novel Sutureless Pterygium Excision Surgery Using Human-Derived Dehydrated Amniotic Membrane. Cureus 2022; 14:e23839. [PMID: 35530838 PMCID: PMC9072255 DOI: 10.7759/cureus.23839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 12/05/2022] Open
Abstract
There are many surgical techniques available for the management of pterygium. Excision with limbal conjunctival autograft is currently the most popular surgical procedure and has been shown to have low recurrence rate and fewer complications. The fixation of limbal conjunctival autograft is performed with either sutures or fibrin glue. The use of sutures results in longer operating time and intense postoperative irritation and epiphora. We describe a new technique for pterygium excision using a human amniotic membrane-derived dry matrix (Omnigen®; Nottingham, UK: Nu-Vision Biotherapies). The use of Omnigen instead of conjunctival autograft in pterygium surgery is a new promising technique and results in shorter operation time, easier graft fixation, reduction in complications, and less postoperative discomfort. This is a simple technique for pterygium surgery with dry amniotic membrane matrix and without the need for anchoring limbal sutures or an assistant holding the graft whilst it is glued in place.
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Pilot study of a glue-less, suture-less amniotic membrane for pterygium excision. Int Ophthalmol 2022; 42:2933-2938. [PMID: 35364745 DOI: 10.1007/s10792-022-02281-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] [Received: 08/29/2021] [Accepted: 03/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Pterygium is a non-cancerous, fibrovascular growth of the bulbar conjunctiva that can cause visual disturbance, ocular pain, and cosmetic concerns. Surgical management is required in certain cases, which consists of excising the pterygium and associated Tenon's, then overlaying the bare sclera with an autograft or amniotic membrane using glue or sutures. The purpose of this study is to assess outcomes of pterygium repair using a newly developed self-adhesive amniotic membrane that does not require glue or sutures for fixation. METHODS Chart review of pterygium excision using a new self-adhesive amniotic membrane from a single surgical practice from 2012-2018. Descriptive statistics from 51 primary cases of pterygium excision were included. RESULTS Pterygium recurrence occurred in 3 of the 51 self-adhesive amniotic membrane cases studied, resulting in a recurrence rate of 5.9%. Pterygium excision with the self-adhesive amniotic membrane had high rate of pyogenic granuloma formation of 27%. Self-adhesive amniotic membranes were found to perform comparably to more widely used techniques for pterygium excision, namely amniotic membranes and conjunctival autographs with glue or sutures. However, the self-adhesive grafts are associated with substantially more pyogenic granuloma formation. CONCLUSION Self-adhesive amniotic membranes offer comparable efficacy for preventing pterygium recurrence in comparison to other amniotic membranes and the conjunctival autograft. The incidence of pyogenic granuloma formation is higher in self-adhesive grafts compared to other widely used options.
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Maeng S, Park TY, Min JS, Jin L, Joo KI, Park WC, Cha HJ. Sutureless Transplantation of Amniotic Membrane Using a Visible Light-Curable Protein Bioadhesive for Ocular Surface Reconstruction. Adv Healthc Mater 2021; 10:e2100100. [PMID: 34050621 DOI: 10.1002/adhm.202100100] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/16/2021] [Indexed: 02/06/2023]
Abstract
The conjunctiva is a thin mucous membrane of the eye. Pterygium, a commonly appearing disease on the ocular surface, requires surgery to excise the conjunctiva to prevent visual deterioration. Recently, transplantation of the amniotic membrane (AM), which is the innermost membrane of the placenta, has been highlighted as an efficient method to cure conjunctiva defects because of its advantages of no side effects compared to mitomycin C treatment and not leaving additional scars on donor site compared to conjunctival autografting. However, to minimize additional damage to the ocular surface by suturing, AM transplantation (AMT) needs to be simplified by using a less invasive, time-saving method. In this work, a visible light-curable protein bioadhesive (named FixLight) for efficient sutureless AMT is applied. FixLight, which is based on bioengineered mussel adhesive protein (MAP), is easily applied between damaged ocular surfaces and transplanted AM, and rapidly cured by harmless blue light activation. Through in vivo evaluation using a rabbit model, the authors demonstrated that FixLight enabled facile, fast, and strong attachment of AM on sclera and promoted ocular surface reconstruction with good biocompatibility. Thus, FixLight can be successfully used as a promising clinical bioadhesive in opthalmological surgeries that require sutureless and rapid operation.
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Affiliation(s)
- Seong‐Woo Maeng
- Department of Chemical Engineering Pohang University of Science and Technology Pohang 37673 Republic of Korea
| | - Tae Yoon Park
- Department of Chemical Engineering Pohang University of Science and Technology Pohang 37673 Republic of Korea
| | - Ji Sang Min
- Department of Ophthalmology Dong‐A University College of Medicine Busan 49201 Republic of Korea
- Institute of Vision Research Department of Ophthalmology Yonsei University College of Medicine Seoul 03722 Republic of Korea
| | - Longyu Jin
- Department of Ophthalmology Dong‐A University College of Medicine Busan 49201 Republic of Korea
- Department of Ophthalmology Shenzen People's Hospital Shenzen 1017 China
| | - Kye Il Joo
- Department of Chemical Engineering Pohang University of Science and Technology Pohang 37673 Republic of Korea
- Division of Chemical Engineering and Materials Science Ewha Womans University Seoul 03760 Republic of Korea
| | - Woo Chan Park
- Department of Ophthalmology Dong‐A University College of Medicine Busan 49201 Republic of Korea
| | - Hyung Joon Cha
- Department of Chemical Engineering Pohang University of Science and Technology Pohang 37673 Republic of Korea
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Lacorzana J. Amniotic membrane, clinical applications and tissue engineering. Review of its ophthalmic use. ACTA ACUST UNITED AC 2019; 95:15-23. [PMID: 31784120 DOI: 10.1016/j.oftal.2019.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/06/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
The use of amniotic membrane in ophthalmology has been increasing in recent years due to its multiple biological and tectonic properties, improvement in the process of obtaining, ease of use, and advancement in tissue engineering. The amniotic membrane has become one of the main adjuvant treatments, in ophthalmic surgery as well as in other medical-surgical specialties. The development of tissue engineering has allowed it to be used, not only in its classic form, but also by the use of drops and other presentations. The different steps prior to its use (preparation and conservation), the different surgical techniques, and their main clinical applications are described throughout the article.
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Affiliation(s)
- J Lacorzana
- Departamento de Oftalmología, Hospital Universitario Virgen de las Nieves, Granada, España; Escuela de Doctorado y Posgrado, Universidad de Granada, Granada, España; Master en Ingeniería Tisular, Universidad de Granada. Granada, España.
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Feng QY, Hu ZX, Song XL, Pan HW. Aberrant expression of genes and proteins in pterygium and their implications in the pathogenesis. Int J Ophthalmol 2017; 10:973-981. [PMID: 28730091 DOI: 10.18240/ijo.2017.06.22] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/11/2017] [Indexed: 12/29/2022] Open
Abstract
Pterygium is a common ocular surface disease induced by a variety of factors. The exact pathogenesis of pterygium remains unclear. Numbers of genes and proteins are discovered in pterygium and they function differently in the occurrence and development of this disease. We searched the Web of Science and PubMed throughout history for literatures about the subject. The keywords we used contain pterygium, gene, protein, angiogenesis, fibrosis, proliferation, inflammation, pathogenesis and therapy. In this review, we summarize the aberrant expression of a range of genes and proteins in pterygium compared with normal conjunctiva or cornea, including growth factors, matrix metalloproteinases and tissue inhibitors of metalloproteinases, interleukins, tumor suppressor genes, proliferation related proteins, apoptosis related proteins, cell adhesion molecules, extracellular matrix proteins, heat shock proteins and tight junction proteins. We illustrate their possible mechanisms in the pathogenesis of pterygium as well as the related intervention based on them for pterygium therapy.
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Affiliation(s)
- Qing-Yang Feng
- Department of Ophthalmology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, Guangdong Province, China
| | - Zi-Xuan Hu
- Department of Public Health and Preventive Medicine, Jinan University, Guangzhou 510632, Guangdong Province, China
| | - Xi-Ling Song
- Department of Public Health and Preventive Medicine, Jinan University, Guangzhou 510632, Guangdong Province, China
| | - Hong-Wei Pan
- Department of Ophthalmology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, Guangdong Province, China.,Department of Public Health and Preventive Medicine, Jinan University, Guangzhou 510632, Guangdong Province, China.,Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou 510632, Guangdong Province, China
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