To provide an overview of conjunctival-limbal autografting (CLAU) for ocular surface rehabilitati... more To provide an overview of conjunctival-limbal autografting (CLAU) for ocular surface rehabilitation with emphasis on more recent literature detailing outcomes of the procedure over the last 2 decades as well as technique variations and adjuvant techniques. Limbal autografting initially described in 1964 by Barraquer and Strampelli and later popularized by Kenyon and Tseng is considered the best option for restoration of corneal phenotype in unilateral limbal stem-cell deficiency. Although there have been developments in alternative limbal epithelial stem-cell techniques including ex-vivo tissue engineering methods, because of the benefit of immunohistocompatability, this procedure still provides better long-term outcomes. As autograft donor tissue is valuable, optimization of the recipient eye preoperatively with good lid closure and reduction of inflammation is vital for success as is close postoperative follow-up. Variations in the technique described have included the modified Cincinnati technique combining CLAU with cadaveric keratolimbal allograft to avoid conjunctivalization. In addition, simple limbal epithelial autograft transplantation, a less-invasive technique combined with amniotic membrane transplantation, has shown promise. In spite of the development of new epithelial transplant techniques, in unilateral limbal stem-cell deficiency, CLAU from a healthy unaffected fellow eye remains the best option available for restoration of corneal phenotype.
Purpose: To investigate the clinical features of orbital and ocular adnexal malignant lymphoma an... more Purpose: To investigate the clinical features of orbital and ocular adnexal malignant lymphoma and the effectiveness of radiotherapy for its treatment. Methods: We retrospectively reviewed the medical records of 54 eyes in 44 patients who were diagnosed with orbital and ocular adnexal malignant lymphoma and who underwent radiotherapy. Results: The main symptoms of malignant lymphoma patients were conjunctival mass, lid mass, lid swelling, and exophthalmos. Histopathologically, MALT-lymphoma was the most common in 39 patients (88.6%). In all 54 eyes of the 44 patients, the mass either decreased or disappeared completely after radiotherapy. The mean follow-up period was 31 months, ranging from 4 to 68 months. There was no recurrence of malignant lymphoma in the orbit or ocular adnexa during this period. However, there were three cases where the tumor recurred in other systemic organs. Complications of radiotherapy included mild punctate epithelial erosion, xerophthalmia, cataract, and retinopathy. Conclusions: Localized radiotherapy is an effective and safe way to treat malignant lymphoma of the orbit and the ocular adnexa. In order to decrease complications, the use of lens shielding and optimized radiation amount should be considered.
Greetings to the readership, and welcome to another issue of CRST Europe. We start a new decade o... more Greetings to the readership, and welcome to another issue of CRST Europe. We start a new decade of this millennium amidst a number concerns, including a recession and downturn in elective activity; a period of consolidation for both the profession and the industry; and increased scrutiny over relationships between doctors/health care professionals (HCPs) and the industry. This issue touches on all of the above topics. PHAKIC IOL S Adding new tools and technologies to our
PurposeTo evaluate the outcomes of living related conjunctival limbal allograft transplantation f... more PurposeTo evaluate the outcomes of living related conjunctival limbal allograft transplantation for the treatment of stem cell deficiency.
To evaluate the outcome of using upper eyelid gold weight implantation for patients with non-para... more To evaluate the outcome of using upper eyelid gold weight implantation for patients with non-paralytic lagophthalmos on blink (LOB) only. We highlight the features of incomplete blink and reduced blink rate in patients with non-facial palsy as an exacerbating factor in dry eye keratopathy. Retrospective, noncomparative case series. Twelve patients (21 procedures) who underwent upper eyelid gold weight implantation for non-paralytic LOB only. Retrospective case note review of patients who underwent upper eyelid loading for non-paralytic LOB only over a 5-year period at a single institution. Improvement in LOB, gentle and forced closure, increased frequency of blinking (FOB), degree of corneal staining, incidence of epithelial defects or corneal ulcer, improvement in vision, and subjective improvement in ocular discomfort. Twenty-one procedures in 12 patients. Nine patients underwent bilateral surgery. Mean age was 56 (range, 8-80) years. Median postoperative follow-up was 15 months, and mean follow-up was 20.38 ± 16.61 (6-58) months. Eleven of 12 patients had an improvement in LOB and increased FOB, resulting in improvement of keratopathy and reduced ocular discomfort. One patient developed superior corneal thinning and descemetocele, requiring removal of the gold weight; 1 patient required ptosis surgery; and 1 patient developed a gold allergy and underwent platinum chain exchange. We highlight the need to consider incomplete blink and reduced FOB as exacerbating factors for corneal-related disorders, including dry eye. Upper eyelid loading with gold weight implantation is a useful and predictive method of improving exposure-related keratopathy due to LOB in the absence of facial palsy.
PURPOSE The pathologic features of a variant of granular corneal dystrophy has been described in ... more PURPOSE The pathologic features of a variant of granular corneal dystrophy has been described in which the presence of lattice changes in addition to characteristic granular lesions has been documented. The authors investigated the mode of inheritance, natural history, and clinical manifestations of this dystrophy. METHODS A family with this condition was investigated, and a pedigree was established. Family members underwent ophthalmic examination, and ophthalmic history was obtained. In addition, pathologic examination of corneal tissue from affected patients was performed. RESULTS Similar to the four previously described cases, this family also traced its origins to Avellino, Italy. This autosomal dominant condition affected 27 of 92 family members, ranging in age from 5 to 77 years. Granular deposits were the earliest and most common manifestations. Lattice lesions were present in some patients with granular lesions. Older patients had anterior stromal haze between deposits, which impaired visual acuity. Recurrent granular deposits were noted in donor corneal tissue after penetrating keratoplasty for this condition. Pathologic examination of corneal tissue from affected patients confirmed the presence of hyaline material seen in granular dystrophy as well as fusiform deposits of amyloid, similar to those seen in lattice dystrophy type I. CONCLUSION This study establishes the natural history and clinical manifestations of this condition.
To provide an overview of conjunctival-limbal autografting (CLAU) for ocular surface rehabilitati... more To provide an overview of conjunctival-limbal autografting (CLAU) for ocular surface rehabilitation with emphasis on more recent literature detailing outcomes of the procedure over the last 2 decades as well as technique variations and adjuvant techniques. Limbal autografting initially described in 1964 by Barraquer and Strampelli and later popularized by Kenyon and Tseng is considered the best option for restoration of corneal phenotype in unilateral limbal stem-cell deficiency. Although there have been developments in alternative limbal epithelial stem-cell techniques including ex-vivo tissue engineering methods, because of the benefit of immunohistocompatability, this procedure still provides better long-term outcomes. As autograft donor tissue is valuable, optimization of the recipient eye preoperatively with good lid closure and reduction of inflammation is vital for success as is close postoperative follow-up. Variations in the technique described have included the modified Cincinnati technique combining CLAU with cadaveric keratolimbal allograft to avoid conjunctivalization. In addition, simple limbal epithelial autograft transplantation, a less-invasive technique combined with amniotic membrane transplantation, has shown promise. In spite of the development of new epithelial transplant techniques, in unilateral limbal stem-cell deficiency, CLAU from a healthy unaffected fellow eye remains the best option available for restoration of corneal phenotype.
Purpose: To investigate the clinical features of orbital and ocular adnexal malignant lymphoma an... more Purpose: To investigate the clinical features of orbital and ocular adnexal malignant lymphoma and the effectiveness of radiotherapy for its treatment. Methods: We retrospectively reviewed the medical records of 54 eyes in 44 patients who were diagnosed with orbital and ocular adnexal malignant lymphoma and who underwent radiotherapy. Results: The main symptoms of malignant lymphoma patients were conjunctival mass, lid mass, lid swelling, and exophthalmos. Histopathologically, MALT-lymphoma was the most common in 39 patients (88.6%). In all 54 eyes of the 44 patients, the mass either decreased or disappeared completely after radiotherapy. The mean follow-up period was 31 months, ranging from 4 to 68 months. There was no recurrence of malignant lymphoma in the orbit or ocular adnexa during this period. However, there were three cases where the tumor recurred in other systemic organs. Complications of radiotherapy included mild punctate epithelial erosion, xerophthalmia, cataract, and retinopathy. Conclusions: Localized radiotherapy is an effective and safe way to treat malignant lymphoma of the orbit and the ocular adnexa. In order to decrease complications, the use of lens shielding and optimized radiation amount should be considered.
Greetings to the readership, and welcome to another issue of CRST Europe. We start a new decade o... more Greetings to the readership, and welcome to another issue of CRST Europe. We start a new decade of this millennium amidst a number concerns, including a recession and downturn in elective activity; a period of consolidation for both the profession and the industry; and increased scrutiny over relationships between doctors/health care professionals (HCPs) and the industry. This issue touches on all of the above topics. PHAKIC IOL S Adding new tools and technologies to our
PurposeTo evaluate the outcomes of living related conjunctival limbal allograft transplantation f... more PurposeTo evaluate the outcomes of living related conjunctival limbal allograft transplantation for the treatment of stem cell deficiency.
To evaluate the outcome of using upper eyelid gold weight implantation for patients with non-para... more To evaluate the outcome of using upper eyelid gold weight implantation for patients with non-paralytic lagophthalmos on blink (LOB) only. We highlight the features of incomplete blink and reduced blink rate in patients with non-facial palsy as an exacerbating factor in dry eye keratopathy. Retrospective, noncomparative case series. Twelve patients (21 procedures) who underwent upper eyelid gold weight implantation for non-paralytic LOB only. Retrospective case note review of patients who underwent upper eyelid loading for non-paralytic LOB only over a 5-year period at a single institution. Improvement in LOB, gentle and forced closure, increased frequency of blinking (FOB), degree of corneal staining, incidence of epithelial defects or corneal ulcer, improvement in vision, and subjective improvement in ocular discomfort. Twenty-one procedures in 12 patients. Nine patients underwent bilateral surgery. Mean age was 56 (range, 8-80) years. Median postoperative follow-up was 15 months, and mean follow-up was 20.38 ± 16.61 (6-58) months. Eleven of 12 patients had an improvement in LOB and increased FOB, resulting in improvement of keratopathy and reduced ocular discomfort. One patient developed superior corneal thinning and descemetocele, requiring removal of the gold weight; 1 patient required ptosis surgery; and 1 patient developed a gold allergy and underwent platinum chain exchange. We highlight the need to consider incomplete blink and reduced FOB as exacerbating factors for corneal-related disorders, including dry eye. Upper eyelid loading with gold weight implantation is a useful and predictive method of improving exposure-related keratopathy due to LOB in the absence of facial palsy.
PURPOSE The pathologic features of a variant of granular corneal dystrophy has been described in ... more PURPOSE The pathologic features of a variant of granular corneal dystrophy has been described in which the presence of lattice changes in addition to characteristic granular lesions has been documented. The authors investigated the mode of inheritance, natural history, and clinical manifestations of this dystrophy. METHODS A family with this condition was investigated, and a pedigree was established. Family members underwent ophthalmic examination, and ophthalmic history was obtained. In addition, pathologic examination of corneal tissue from affected patients was performed. RESULTS Similar to the four previously described cases, this family also traced its origins to Avellino, Italy. This autosomal dominant condition affected 27 of 92 family members, ranging in age from 5 to 77 years. Granular deposits were the earliest and most common manifestations. Lattice lesions were present in some patients with granular lesions. Older patients had anterior stromal haze between deposits, which impaired visual acuity. Recurrent granular deposits were noted in donor corneal tissue after penetrating keratoplasty for this condition. Pathologic examination of corneal tissue from affected patients confirmed the presence of hyaline material seen in granular dystrophy as well as fusiform deposits of amyloid, similar to those seen in lattice dystrophy type I. CONCLUSION This study establishes the natural history and clinical manifestations of this condition.
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