Charles Costa de Farias

Transplantation of Conjunctival Epithelial Cells Cultivated Ex Vivo in Patients With Total Limbal Stem Cell Deficiency

Purpose: To report the outcomes of transplantation of autologous conjunctival epithelial cells cultivated ex vivo (EVCAU) in patients with total limbal stem cell deficiency (LSCD). Methods: EVCAU were cultivated on denuded human amniotic membrane and transplanted in 12 eyes of 10 patients with total LSCD. We evaluated the improvement in the defined clinical parameters of LSCD (loss of corneal epithelial transparency, superficial corneal neovascularization and epithelial irregularity/recurrent epithelial breakdown), vision acuity, impression cytology, immunocytochemical analysis (CK3/CK19), and the appearance of a regular hexagonal basal layer of cells on corneal confocal microscopy. Histologic and immunohistochemical features were studied in 3 corneal buttons of patients submitted to penetrating keratoplasty after EVCAU. Results: Cultivated conjunctival epithelium formed 4 to 5 layers with the formation of basement membrane–like structures. Immunocytochemical analysis showed positivity for CK3, CK19, MUC5AC, Ki-67, P63, and ABCG2. The improvement of the clinical parameters for this treatment in our cohort was 10 of 12 (83.3%) in a mean follow-up time of 18.5 months (range, 15–26 months), and these eyes showed an improvement in impression cytology, immunocytochemistry, and in vivo confocal analysis. Corneal buttons showed a well-formed epithelium with 5 to 6 layers, with rare cells periodic acid–Schiff+, and positivity for CK3, CK19, P63, connexin 43, and MUC5AC. Conclusion: We demonstrated the preliminary results of transplantation of EVCAU for corneal surface reconstruction in cases with total LSCD. Future studies are needed to further assess the long-term efficacy of this procedure.

Lente de contato escleral na reabilitação ocular de pacientes com síndrome de Stevens-Johnson

PURPOSE To evaluate the efficacy of scleral contact lenses use on the management of ocular sequelae from Stevens-Johnson syndrome patients. METHODS In a retrospective study, patients who suffered sequelae of Stevens-Johnson syndrome and started the use of scleral contact lenses were followed. Patients were submitted to an evaluation of symptoms through a questionnaire; ophthalmologic exam (visual acuity measurement, biomicroscopy, ocular surface staining with fluorescein drops, Schirmer test). RESULTS Ten eyes of seven patients were analyzed. Visual acuity varied from hand movements to 20/25. All patients presented some degree of corneal opacity and slight symblepharon. In patients whose adaptation to scleral contact lenses was successful (90%), they all refered improvement of symptoms and sight. As for the biomicroscopic findings it was observed an improvement of conjunctival hyperemia and keratitis and a reduction of the mucous secretion in 90% the cases. CONCLUSIONS A successful adaptation to scleral contact lenses was feasible on most patients, with relief of symptoms and better visual acuity, probably due to regularization of the surface. Scleral contact lenses represent an important and accessible alternative to reduce the limitations inferred by the damages from Stevens-Johnson syndrome.

Ceratopatia bolhosa: etiopatogênese e tratamento

A ceratopatia bolhosa caracteriza-se pelo edema corneano estromal acompanhado de bolhas epiteliais e subepiteliais devido a perda de celulas e/ou alteracoes da juncao endotelial. Nos casos mais avancados, ocorre espessamento do estroma e presenca de fibrose subepitelial e vascularizacao corneana. Apresenta baixa de acuidade visual devido a diminuicao da transparencia da cornea e pode estar acompanhada de sensacao de corpo estranho, lacrimejamento e dor devido as alteracoes epiteliais como a presenca de bolhas integras ou rotas. Ceratite bolhosa e uma das principais causas de transplante de cornea em diferentes regioes e paises. A principal etiologia e a perda de celulas endoteliais, principalmente apos cirurgia de catarata e na distrofia endotelial de Fuchs. Sabe-se que atualmente ha cerca de 20 milhoes de pessoas com catarata no mundo, e esta complicacao pode afetar 1 a 2% das cirurgias de catarata. Este texto faz uma revisao sobre a etiopatogenese da ceratopatia bolhosa e sobre os tratamentos clinicos e cirurgicos disponiveis para a doenca.Bullous keratopathy is characterized by corneal stromal edema with epithelial or subepithelial bullae due to cell loss and endothelial decompensation. In more advanced cases, subepithelial fibrosis, formation of a posterior collagenous layer or retrocorneal fibrous membrane, and corneal vascularization can occur. Decreased vision is present because the loss of corneal transparency with symptoms like tearing and pain caused by epithelial bullae that can rupture. Currently, bullous keratopathy is the most common indication for penetrating keratoplasty and regraft. The main etiology is the endothelial cell loss after ophthalmic surgeries as cataract surgery. Cataract affects approximately 20 million people worldwide, and this complication can occur in 1 to 2% of cataract surgeries. This study revised bullous keratopathy etiopathogenesis, clinical and surgical treatment available for this corneal disease.

Amniotic membrane transplantation with narrow-strip conjunctival autograft vs conjunctival autograft for recurrent pterygia.

Purpose To compare amniotic membrane transplantation (AMT) associated with narrow-strip conjunctival autograft vs conjunctival autograft alone for the treatment of recurrent pterygium. Methods In this prospective consecutive interventional study, patients with recurrent pterygium were randomly divided into one of 2 groups; group 1: patients undergoing AMT associated with autologous conjunctival graft; and group 2: patients undergoing conjunctival autograft alone. Results Of the 80 operated eyes included in this study, 39 (group 1, mean patient age 52.1 ± 11.7 SD years) underwent AMT associated with narrow-strip conjunctival autograft and 41 (group 2, mean patient age 45.8 ± 12.9 SD years) underwent conjunctival autograft alone. In group 1, 6 eyes (15.4%) had grade 1 pterygium, 19 eyes (48.7%) had grade 2 pterygium, and 14 eyes (35.9%) had grade 3 pterygium. In the second group, 5 eyes (12.2%) had grade 1 pterygium, 18 eyes (43.9%) had grade 2 pterygium, and 14 eyes (35.9%) had grade 3 pterygium. No statistically significant difference was found between the 2 groups (p = 0.752). Of the 39 eyes in group 1, recurrent pterygium was observed in 7 cases (17.9%). However, of the 41 eyes in group 2, recurrent pterygium was observed in only 4 cases (9.75%). No statistically significant difference was found between the 2 groups (p = 0.2684). Conclusions The results of this study indicate that conjunctival autograft alone might be a better surgical choice for the treatment of recurrent pterygia than combining it with AMT; however, this second option provides a good surgical alternative in cases where little conjunctival donor tissue is available.

Síndrome mascarada como primeira manifestação de adenocarcinoma pulmonar: relato de caso e revisão de literatura

PURPOSE: To describe a case of masquerade syndrome as the first manifestation of lung adenocarcinoma. METHODS: A 57- year-old female was referred with a 6-month history of blurred vision in her right eye. She was treated for relapsing uveitis but signs and symptons remained despite treatment with topical steroids. On physical examination she had conjuctival hyperemia, moderate cilliary injection and choroidal peripapillary lesion. Ancillary examinations were requested. RESULTS: A lung adenocacirnoma was diagnosed as the primary lesion. The choroidal peripapillary lesion in her right eye was consistent with the appearance of a choroidal metastatic lesion. CONCLUSIONS: The incidence of uveal metastasis ranges from 0.7 to 12% in patients with pulmonary tumors. Treatment depends on characteristics such as size of the lesion, number of metastases, visual acuity, bilaterality and the patient´s general health. As confirmed by this case, ocular involvement may be the first clinical manifestation of lung adenocarcinoma.

Rothmund-Thomson syndrome and ocular surface findings: case reports and review of the literature

Rothmund-Thomson syndrome (RTS) is a rare dermatosis with about 300 cases reported to date. The authors describe two siblings with RTS and inflammatory conjunctival disease featuring fornix shortening and symblepharon as well as palpebral disease with sparse eyelashes. These cases demonstrate RTS ocular surface findings different to those usually described.