Ocular Surface Reconstruction: Recent Innovations, Post-op Management
Ocular Surface Reconstruction: Recent Innovations, Post-op Management
Intricate homeostasis maintains the rich complexity and functionality of the ocular surface. Severe ocular surface diseases cause significant morbidities, including blindness. Ocular surface reconstruction strategies restore this homeostasis. Patients with limbal deficiency may benefit from limbal stem cell transplantation to alleviate persistent epithelial defects, maintain conjunctivalization regression and corneal avascularity, and restore vision. Amniotic membrane and other substrates function as tissue surrogates and substrates for expansion of stem cells. Maximum graft survivability necessitates aggressive and comprehensive preoperative management of inflammation, infection, microtrauma, dry eye conditions and HLA compatibility. Restoration of lacrimal gland function is important, as is implementation of aggressive immunosuppression. Future advancements in stem cell biology, tissue engineering, bioartificial microsystems or regenerative medicine will supplement the therapeutic armamentarium. The next decade will be an exciting time for corneal surgeons.
The ocular surface is exceptionally rich in complexity and functionality. Severe ocular surface disorders/conditions, such as chemical or thermal injuries, Stevens-Johnson syndrome (SJS), ocular cicatricial pemphigoid, neurotrophic keratopathy, chronic limbitis, and severe microbial keratitis cause significant morbidities and even corneal blindness. Over the last 30 years, tremendous clinical and scientific advancements have evolved for the management of severe ocular surface diseases (OSD). These contributions herald a paradigm shift in management and treatment of OSD.
Previously, most patients with severe OSD had dismal prognoses with only temporizing managements, such as tarsorrhaphy, artificial tears, or penetrating keratoplasty, to alleviate their symptoms. Recent scientific advancements in our understanding of the ocular surface and the development of promising therapeutic and surgical strategies such as amniotic membrane (AM) graft, stem cell research, tissue engineering and transplantation, bioartificial microsystems, or prosthetic devices provide us with new and potent tools in the armamentarium of therapies available for OSD to maintain our patients' eyesight.
Ocular surface reconstruction (OSR) has emerged as the treatment modality for OSD refractory to conventional medical therapies. Recently, we provided a system-based literature review on recent relevant clinical and surgical data regarding treatment options for ocular surface disorders. In this communication, we will emphasize ocular surface reconstruction, surgical candidate selection criteria and pre- and postoperative management. Furthermore, recent findings using animal models will also be presented. The contributions of animal models to advancements of science and development of surgical techniques and clinical management are enormous, as many experiments are not feasible with human subjects and animal experimentation has translational values that may guide our clinical decisions. We endeavor to assist the corneal surgeon to ensure excellent surgical outcomes and patient satisfaction.
Abstract and Introduction
Abstract
Intricate homeostasis maintains the rich complexity and functionality of the ocular surface. Severe ocular surface diseases cause significant morbidities, including blindness. Ocular surface reconstruction strategies restore this homeostasis. Patients with limbal deficiency may benefit from limbal stem cell transplantation to alleviate persistent epithelial defects, maintain conjunctivalization regression and corneal avascularity, and restore vision. Amniotic membrane and other substrates function as tissue surrogates and substrates for expansion of stem cells. Maximum graft survivability necessitates aggressive and comprehensive preoperative management of inflammation, infection, microtrauma, dry eye conditions and HLA compatibility. Restoration of lacrimal gland function is important, as is implementation of aggressive immunosuppression. Future advancements in stem cell biology, tissue engineering, bioartificial microsystems or regenerative medicine will supplement the therapeutic armamentarium. The next decade will be an exciting time for corneal surgeons.
Introduction
The ocular surface is exceptionally rich in complexity and functionality. Severe ocular surface disorders/conditions, such as chemical or thermal injuries, Stevens-Johnson syndrome (SJS), ocular cicatricial pemphigoid, neurotrophic keratopathy, chronic limbitis, and severe microbial keratitis cause significant morbidities and even corneal blindness. Over the last 30 years, tremendous clinical and scientific advancements have evolved for the management of severe ocular surface diseases (OSD). These contributions herald a paradigm shift in management and treatment of OSD.
Previously, most patients with severe OSD had dismal prognoses with only temporizing managements, such as tarsorrhaphy, artificial tears, or penetrating keratoplasty, to alleviate their symptoms. Recent scientific advancements in our understanding of the ocular surface and the development of promising therapeutic and surgical strategies such as amniotic membrane (AM) graft, stem cell research, tissue engineering and transplantation, bioartificial microsystems, or prosthetic devices provide us with new and potent tools in the armamentarium of therapies available for OSD to maintain our patients' eyesight.
Ocular surface reconstruction (OSR) has emerged as the treatment modality for OSD refractory to conventional medical therapies. Recently, we provided a system-based literature review on recent relevant clinical and surgical data regarding treatment options for ocular surface disorders. In this communication, we will emphasize ocular surface reconstruction, surgical candidate selection criteria and pre- and postoperative management. Furthermore, recent findings using animal models will also be presented. The contributions of animal models to advancements of science and development of surgical techniques and clinical management are enormous, as many experiments are not feasible with human subjects and animal experimentation has translational values that may guide our clinical decisions. We endeavor to assist the corneal surgeon to ensure excellent surgical outcomes and patient satisfaction.