Rosario Touriño

Multilayer amniotic membrane transplantation in the treatment of corneal perforations.

Purpose: To determine if multilayer amniotic membrane transplantation (AMT) is useful in the treatment of corneal perforations, and in particular to assess to what extent efficacy is affected by perforation size. Methods: Fifteen patients (15 eyes) with corneal perforations of different sizes were divided into 3 groups: group A (microperforation, 6 eyes), group B (0.5–1.5 mm, 4 eyes), and group C (>1.5 mm, 5 eyes). The corneal perforation was caused by autoimmunity-related ulcer (3 eyes), neurotrophic ulcer (9 eyes), infectious keratitis (1 eye), or postkeratoplasty ulcer (2 eyes). Two layers of AM (for microperforations) or 3–4 layers (for the other groups) were trimmed to the size of the ulcer and sutured in place with interrupted 10-0 nylon sutures. In all cases, a bandage contact lens was then applied. Results: Mean epithelialization time was 3.7 weeks (range 2–6). Mean time to recovery of corneal stroma thickness was 10.1 weeks (range 7–15). In all cases, ocular inflammation subsided within 2–5 weeks. The treatment was judged successful in 73% (11/15) of eyes. Three of the 4 unsuccessful treatments were of perforations 3 mm or more in diameter; of the 5 eyes with perforations of more than 1.5 mm in diameter, only 2 were treated successfully. Conclusions: These results suggest that multilayer AMT is effective for treating corneal perforations with diameter less than 1.5 mm. The technique may be a good alternative to penetrating keratoplasty, especially in acute cases in which graft rejection risk is high.

Pterygium surgery: conjunctival autograft using a fibrin adhesive.

Purpose: To evaluate the efficiency and safety of using a fibrin adhesive (Tissucol Duo®, Baxter AG, Vienna, Austria) to avoid the need for sutures during conjunctival autograft surgery for primary pterygium. Methods: Twenty patients (20 eyes) with primary nasal pterygium were subjected to conjunctival autograft surgery. The free conjunctival graft placed over the bare sclera was fixed to the surrounding conjunctiva and cornea using the fibrin glue. An occlusive patch was applied. The outcome of surgery and any possible complications were periodically assessed. Results: Mean patient age was 54.9 years (28-75 years). The mean follow-up time was 26.05 ± 3.15 (SD) weeks. The time of surgery was 15 to 20 minutes. During the postoperative course, none of the patients felt pain, and only 5/20 (25%) had the mild sensation of the presence of a foreign body. In 18/20 (90%) patients, the conjunctival autograft was observed to be correctly positioned and fixed in all the follow-up exams. No sutures were used during or after surgery. There were no cases of regrowth of the pterygium. Conclusion: Our findings demonstrate the safety and efficiency of Tissucol Duo® as a conjunctival adhesive for pterygium autograft surgery as treatment of primary pterygium. Because of its fast and easy application, this product considerably reduces the time of surgery. Its use also avoids complications derived from sutures and diminishes the sensation of a foreign body in the eye following surgery.

Effects of lyophilization on human amniotic membrane

Purpose:  This study aimed to evaluate the effects of lyophilization and cryopreservation on human amniotic membrane (HAM) in terms of histological characteristics and growth factor levels.

Donor age and gestational age influence on growth factor levels in human amniotic membrane.

Acta Ophthalmol. 2010: 88: e211–e216

Value of the congenital hypertrophy of the retinal pigment epithelium in the diagnosis of familial adenomatous polyposis.

Background: Several kinds of congenital hypertrophy of the retinal pigment epithelium (CHRPE) have been described in patients with familial adenomatous polyposis (FAP). This study aims to assess which properties of CHRPE better predict FAP and investigate whether a relationship exists between specific CHRPE characteristics and FAP variants. Methods: We examined 286 subjects, Group I — patients with FAP plus individuals “at risk”; n = 173; Group II — controls n = 113. Retinal lesions were classified in five types (A–E) and different characteristics (distribution, number, shape, size, pigmentation and site) were evaluated. Results: The most common lesions in affected subjects were types A–D (83.4%) whilst in the “at risk” and control groups were type E. Greater numbers of lesions and bilateral distribution occurred more frequently among affected subjects than in other participants (p < 0.001). Large lesions with mixed pigmentation were associated with polyposis (p > 0.5). Controls had solitary CHRPE lesions (3.5%) and types C and E lesions (23%). The cumulative sensitivities and specificities of CHRPE were 42 and 97%, respectively. CHRPE was most common among those with classical FAP, but no specific characteristic was associated with any particular FAP variant. Conclusions: Pigmented fundal lesions are highly pleomorphic and represent the variable expression of a common genetic defect of growth regulation. No association was found between CHRPE characteristics and specific FAP variants.

Prevalence of conjunctival shrinkage and its association with dry eye disease: results from a population-based study in Spain.

Purpose: The aim of this study was to describe the epidemiological characteristics of conjunctival shrinkage (CS) and the association between this disorder and dry eye disease (DED) in a general adult population in northwestern Spain. Methods: A total of 1155 subjects 40 years or older were selected using an age-stratified random sample procedure in O Salnés (Spain). A standardized DED symptom questionnaire was administered, and a comprehensive ophthalmic evaluation that included DED tests was carried out. Disappearance of half or more of any of the lacunar folds after maximum abduction was considered evidence of CS. The prevalence and associations of CS and its relationship with DED symptoms and signs were investigated. Results: From 937 eligible subjects, 622 (66.4%) participated [mean age (SD), 63.4 (14.5) years, range, 40–96, 37.0% males]. The prevalence of CS was 38.2% [95% confidence interval (CI), 35.0–41.5]. This prevalence increased with aging (P < 0.001) and was not associated with sex (P = 0.696). The prevalence of symptoms, abnormal tear breakup time, fluorescein and rose bengal staining was significantly higher among subjects with CS. After controlling for age and sex, outdoor activity was directly (adjusted odd ratio, 1.83) and high level of education was inversely (adjusted odd ratio, 0.43) associated with CS. No associations were found with ocular or systemic diseases. Conclusions: CS is a common pathological reaction that can be used as an indicator of moderate to severe DED. Aging and outdoor activity are strongly associated factors. The simplicity and reproducibility of this diagnosis recommend its inclusion in DED diagnostic and grading schemes.

Fluorescein Angiographic Features of the Congenital Hypertrophy of the Retinal Pigment Epithelium in the Familial Adenomatous Polyposis

PurposeTo asses the prevalence of fluorescein angiographic features in bilateral and multifocal Congenital Hypertrophy of the Retinal Pigment Epithelium (CHRPE) in patients with a diagnosis of familial adenomatous polyposis.MethodsWe performed prospective angiographic and clinical examination of 49 CHPRE lesions in 15 patients.ResultsAbout 77.5% of CHRPE lesions were close to retinal vessels. The retinal vascular changes observed overlying and surrounding the CHRPE were: capillary non-perfusion with an area greater than 0.5 disc diameters (41%), capillary microaneurysms (4%), chorioretinal anastomoses (6.2%), attenuation of retinal vessels (4%), choriocapillary vessels inside the lacunae (6.2%) and in the depigmented marginal halo (18.4%). Depigmented streaks in contact with one or both edges of the CHRPE were observed in 79.6% of the lesions. About 9.6% of the lesions were not seen on ophthalmoscopy and could only be detected by angiography.ConclusionsEven though the diagnosis of CHRPE is clinical, fluorescein angiography may be useful in confirming the diagnosis, as well as detecting additional lesions not seen by means of ophthalmoscopic examination.

Corneal Imaging with Pentacam After Descemet's Membrane Perforation During Deep Anterior Lamellar Keratoplasty.

The usefulness of Pentacam in the diagnosis and management of Descemets membrane perforation during deep anterior lamellar keratoplasty (DALK) was described and reported. A 59-year-old man with neurotrophic keratitis was operated on DALK procedure. The big-bubble technique was used without apparent complications. A double anterior chamber was observed on the first postoperative day. After days, sulphur hexafluoride (SF(6)) in isoexpansile concentration was successfully injected into the anterior chamber. The Pentacam (Oculus, Wetzlar, Germany) imaging was performed. Correlations between Pentacam findings and clinical signs were evaluated. Pentacam imaging is a useful technique to diagnose and document the progress of surgical complications after DALK.