PURPOSE: To report a case of ocular surface squamous cell carcinoma with intraorbital extension in a patient with renal transplantation and long-term immunosuppressive therapy. CASE SUMMARY: A 59-year-old Korean male presented with a whitish mass in the medial limbus and conjunctiva of the right eye. The patient had undergone renal transplantation 17 years prior due to lupus nephritis and was on systemic immunosuppression with daily prednisolone (10 mg), tacrolimus (5 mg), and mycophenolate sodium (720 mg). The complete excision of the mass was performed and mitomycin C application and amniotic membrane transplantation on the excised area were combined. Histopathological examination revealed the mass was squamous cell carcinoma. There were no abnormal findings on the orbit computed tomography (CT). The patient was additionally treated with topical interferon alpha 2b 6 months postoperatively. One year later, a mass recurred at the same site in the right eye. The complete excision of the mass, mitomycin C application, cryotherapy, and amniotic membrane transplantation were performed. Orbit CT showed a 1.9 cm-sized intraorbital mass involving the medial rectus of the right eye. The orbital exenteration was performed and the intraorbital mass was histologically proven to be squamous cell carcinoma. CONCLUSIONS: Ocular surface squamous neoplasia in patients with renal transplantation and long-term immunosuppressive therapy should be monitored closely for the possibility of orbital invasion.
Amnion ; Carcinoma, Squamous Cell* ; Conjunctiva ; Cryotherapy ; Humans ; Immunosuppression* ; Interferon-alpha ; Kidney Transplantation ; Lupus Nephritis ; Male ; Middle Aged ; Mitomycin ; Orbit ; Prednisolone ; Sodium ; Tacrolimus

No abstract available.
Aged ; Amnion/*transplantation ; Conjunctiva/*surgery ; Female ; Glaucoma/surgery ; Humans ; Intraoperative Complications/*surgery ; Trabeculectomy/*adverse effects

PURPOSE: To report the clinical outcomes of deep anterior lamellar keratoplasty (DALK) when sterile gamma-irradiated acellular corneal tissues (VisionGraft) are used in combination with amniotic membrane transplantation (AMT) for intractable ocular surface diseases. METHODS: The medical records of fifteen patients who had DALK with AMT were retrospectively reviewed. Indications for surgery included ocular burn, bacterial keratitis, herpes simplex virus keratitis, corneal opacity with Stevens-Johnson syndrome, Mooren's ulcer, idiopathic myxoid degeneration of corneal stroma, and recurrent band keratopathy. DALK was performed using partial-thickness acellular corneal tissue and a temporary amniotic membrane patch was added at the end of the operation. RESULTS: All cases that underwent DALK with AMT became epithelialized within 2 postoperative weeks. Twelve patients showed favorable outcomes without graft rejection, corneal opacification, or neovascularization. The other three grafts developed corneal opacification and neovascularization, and required additional penetrating keratoplasty (PK). Unlike the results of previous PKs, there were no graft rejections and the graft clarity was well-maintained in these three cases for at least 8 months after PK. CONCLUSIONS: DALK using sterile acellular corneal tissues in combination with AMT may be a good therapeutic strategy for treating intractable ocular surface diseases because of lowered immune rejection, fibroblast activation, and facilitation of epithelialization. Furthermore, DALK can help stabilize the ocular surface, prolong graft survival, and may allow better outcomes when combined with subsequent PK.
Adult ; Aged ; Amnion/*transplantation ; Corneal Diseases/pathology/*surgery ; Corneal Stroma/radiation effects/*transplantation ; Female ; Graft Survival ; Humans ; Keratoplasty, Penetrating/*methods ; Male ; Middle Aged ; Retrospective Studies ; Visual Acuity ; Young Adult

PURPOSE: To introduce autologous tragal perichondrium transplantation as a novel surgical modality for the management of intractable symptomatic bullous keratopathy. METHODS: In three eyes of three patients with painful bullous keratopathy, autologous tragal perichondria were transplanted on the corneal surface with the human amniotic membrane transplanted above. We included an additional three eyes of three patients with painful bullous keratopathy who received amniotic membrane transplantation only to serve as controls. Clinical symptom outcomes were assessed using a visual analogue scale at postsurgical months 1, 3, 5, 7, and 9. In addition, transplanted tragal perichondrium and amniotic membrane complex tissue button obtained from one patient who underwent penetrating keratoplasty was evaluated by immunohistochemical analysis of CD34, vimentin, and alcian blue staining. RESULTS: All three patients who underwent autologous tragal perichondrium and human amniotic membrane co-transplantation showed improvements in pain and tearing. However, all three patients in the control group experienced aggravation of tearing and no further improvement of pain 3 months after surgery. In addition, one patient in the control group developed premature degradation of the amniotic membrane. Histopathologic and immunohistochemical analysis showed intact surface epithelization and positive CD34, vimentin and alcian blue staining of transplanted tragal perichondria. CONCLUSIONS: The tragal perichondrium has a high mechanical structural force and high potency due to well-organized epithelization and the presence of mesenchymal stem cells. Autologous tragal perichondrium transplantation may be an effective modality for the management of painful bullous keratopathy.
Adult ; Aged ; Amnion/*transplantation ; Corneal Diseases/*pathology/*surgery ; Ear Cartilage/*transplantation ; Female ; Humans ; Keratoplasty, Penetrating/*methods ; Male ; Middle Aged ; Transplantation, Autologous ; Treatment Outcome

PURPOSE: This retrospective observational case series of fifty-one consecutive patients referred to the eye clinic with acute-stage Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) from 1995 to 2011 examines the effect of early treatment with a systemic corticosteroid or intravenous immunoglobulin (IVIG) on the ocular outcomes in patients with SJS or TEN. METHODS: All patients were classified by age (< or =18 years vs. >18 years) and analyzed by treatment modality and early intervention with systemic corticosteroids (< or =5 days), IVIG (< or =6 days), or amniotic membrane graft transplantation (AMT) (< or =15 days). The main outcomes were best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR) and ocular involvement scores (OIS, 0-12), which were calculated based on the presence of superficial punctate keratitis, epithelial defect, conjunctivalization, neovascularization, corneal opacity, keratinization, hyperemia, symblepharon, trichiasis, mucocutaneous junction involvement, meibomian gland involvement, and punctal damage. RESULTS: The mean logMAR and OIS scores at the initial visit were not significantly different in the pediatric group (logMAR = 0.44, OIS = 2.76, n = 17) or the adult group (logMAR = 0.60, OIS = 2.21, n = 34). At the final follow-up, the logMAR and OIS had improved significantly in the adult group (p = 0.0002, p = 0.023, respectively), but not in the pediatric group. Early intervention with IVIG or corticosteroids significantly improved the mean BCVA and OIS in the adult group (p = 0.043 and p = 0.024, respectively for IVIG; p = 0.002 and p = 0.034, respectively for corticosteroid). AMT was found to be associated with a significantly improved BCVA or OIS in the late treatment group or the group with a better initial OIS (p = 0.043 and p = 0.043, respectively for BCVA; p = 0.042 and p = 0.041, respectively for OIS). CONCLUSIONS: Our findings suggest that patients with SJS or TEN who are aged 18 years or less have poorer ocular outcomes than older patients and that early treatment with steroid or immunoglobulin therapy improves ocular outcomes.
Acute Disease ; Adolescent ; Age Factors ; Amnion/*transplantation ; Biopsy ; Child ; Child, Preschool ; Corneal Diseases/etiology/pathology/*therapy ; Female ; Follow-Up Studies ; Glucocorticoids/*administration & dosage ; Humans ; Immunoglobulins, Intravenous/*administration & dosage ; Infant ; Male ; Retrospective Studies ; Stevens-Johnson Syndrome/complications/pathology/*therapy ; Time Factors ; Treatment Outcome ; *Visual Acuity

This paper conducted research on biomechanical characteristics and biological activity of concavity-convex amniotic membrane (CCAM) and discussed its superiority as ocular surface repair material. Folding and compression with vacuum of fresh amniotic membrane were used to prepare CCAM. After cutting the striga of CCAM, sixteen CCAM tissue section were chosen at random to test their tensile strength using electronic universal testing machine. The bilayer amniotic membrane (BAM), the double-deck amniotic membrane (DAM) and the monolayer amniotic membrane (MAM) were as controls. The test parameters included yield strength, tensile strength, elongation at break, elastic modulus and so on. The cytokines of fresh amniotic membrane (FAM), MAM and CCAM were analyzed by radioimmunoassay method. The CCAM was obviously thicker than MAM and DAM. After 15 min in PBS, the CCAM tissue can recover the normal shape. The tensile strength and the elongation at break of CCAM were higher than those of the MAM and the DAM (P < 0.05). The elastic modulus of the CCAM was smaller than that of the MAM and the DAM (P < 0.05). The content of 10 cytokines [epidermal growth factor (EGF), fibroblast growth factor (FGF), b-fibroblast growth factor b-FGF, hepatocyte growth factor (HGF), transforming growth factor-beta (TGF-beta), insulin-like growth factor (IGF), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), nerve growth factor (NGF), brain-derived nellrotrophic factor (BDNF), ciliary neurotrophic factor (CNTF)] of CCAM decreased significantly compared with the FAM and increased significantly compared with MAM and DAM in 6 cytokines (EGF, FGF, HGF, TGF-betap, PDGF, NGF; P < 0.05). The CCAM composites is thinner and has higher cytokine content than MAM, and better biomechanical properties than the MAM and the DAM, showing the superiority as ocular surface repair material.
Amnion ; chemistry ; physiology ; transplantation ; Biomechanical Phenomena ; Cytokines ; analysis ; Epidermal Growth Factor ; analysis ; Fibroblast Growth Factors ; analysis ; Hepatocyte Growth Factor ; analysis ; Humans ; Tissue Engineering ; methods ; Tissue Scaffolds

An 81-year-old woman with a raised pigmented nodule over her left cornea for 7 months duration was examined. Dark conjunctival pigmentation was observed in the upper bulbar fornix conjunctiva. She had previously undergone primary surgical excision of a malignant conjunctival melanoma four years earlier. The tumor separated easily from the corneal surface, but remained slightly attached to the corneoscleral surface. A corneoscleral lamellar dissection of 3 mm in width and 2 mm in depth as well as a corneoscleral lamellar keratoplasty for the reconstruction of the corneoscleral defect were performed. The wide upper bulbar and fornix conjunctiva were excised, and an amniotic membrane transplantation was performed. Biopsy revealed an invasive melanoma with a depth of 1 mm. Left, right, and inferior tumor margins of the corneoscleral lesion and the pigmentary lesion in the conjunctiva were free of the tumor. After surgery, 0.04% mitomycin was administered topically 4 times daily for 4 weeks. There was no recurrence 2 years after surgery, and systemic evaluation revealed no metastasis.
Aged, 80 and over ; Amnion/*transplantation ; Conjunctival Neoplasms/*surgery ; *Corneal Transplantation ; Female ; Humans ; Melanoma/*surgery ; Neoplasm Recurrence, Local ; Recurrence

Adolescent ; Adult ; Amnion ; transplantation ; Blood Transfusion, Autologous ; Eye Burns ; therapy ; Humans ; Male ; Middle Aged ; Occupational Injuries ; therapy ; Young Adult

PURPOSE: To report a case of herpes simplex keratitis after descemet stripping automated endothelial keratoplasty (DSAEK). CASE SUMMARY: A 66-year-old male underwent DSAEK in his right eye due to bullous keratopathy after cataract surgery. The corneal epithelium which was removed during surgery was healed, but the patient was experiencing pain and decreased visual acuity in his right eye 1 month after surgery. Increasing corneal epithelial defects and corneal edema were observed on slit-lamp examination. Therapeutic soft contact lenses and artificial tears were used for treatment but were not effective, thus amniotic membrane transplantation was performed. Three months after transplantation, the epithelial defect appeared as a geographic ulcer suspecting to be herpes simplex keratitis; therefore, ganciclovir ophthalmic ointment and oral acyclovir were administered. Six months after antiviral therapy, the epithelial lesion of herpes simplex keratitis completely disappeared, leaving only mild corneal opacity. CONCLUSIONS: If corneal epithelial defects are persistent after DSAEK in patients even with no past history of herpes simplex keratitis, herpes simplex keratitis should be considered in the differential diagnosis.
Acyclovir ; Aged ; Amnion ; Cataract ; Contact Lenses, Hydrophilic ; Corneal Edema ; Corneal Transplantation ; Diagnosis, Differential ; Epithelium, Corneal ; Eye ; Ganciclovir ; Herpes Simplex ; Humans ; Keratitis, Herpetic ; Male ; Methylmethacrylates ; Ophthalmic Solutions ; Polystyrenes ; Transplants ; Ulcer ; Visual Acuity

OBJECTIVE: To explore the clinical effectiveness of endoscopic myringoplasty with homoplastic amniotic membrane. METHOD: A retrospective study in 43 patients underwent endoscopic myringoplasty with homoplastic amniotic membrane was observed at the wound healing of tympanic membrane perforation and the hearing improve-threshold audiometry in 43 patients after surgery. RESULT: The tympanic membrane's perforation healing rate was 95.3% (41/43), and air conduction threshold audiometry in language frequency improved average 10 dB. The follow up was 1--4 years, and no recurrence or complications had occurred. CONCLUSION The endoscopic myringoplasty could be able to simple myringoplasty whose air conduction threshold audiometry in language frequency was less than 40 dB. It could be used to repair not only the central perforation in tympanic membrane, but also the marginal perforation which has residual tympanic membrane in most of the regional. Human amniotic membrane is an ideal materials for repair of tympanic membrane.
Adolescent ; Adult ; Amnion ; transplantation ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Myringoplasty ; methods ; Otitis Media, Suppurative ; surgery ; Retrospective Studies ; Transplantation, Homologous ; Treatment Outcome ; Tympanic Membrane Perforation ; surgery ; Young Adult