Seminars in Ophthalmology最新文献

Objectives: To describe the use of oral mucosa overlay in Boston Keratoprosthesis surgery as an adjunct in complex cases.

Methodology: Retrospective case series on eyes that underwent Type I Boston keratoprosthesis where oral mucosa was used as an adjunct procedure.

Results: 30 eyes were identified. The oral mucosa may be used as a salvaging technique for an extruded Type I Boston Keratoprosthesis. In cases of severe dry eye where osteo-odontokeratoprosthesis cannot be performed for reasons like edentulia, or patient refusal due to cosmetic reasons, the Boston Keratoprosthesis with mucosa overlay may be performed as a simpler technique. It may also be used as a primary procedure in cases where there is high risk of melt or extrusion for a Type I Boston Keratoprosthesis such as autoimmune corneal opacity, severe chemical burn, congenital aniridia. Surgery can be performed either as a single stage or in two stages, three months apart, to ensure the development of a well-vascularized pedicle flap. Lastly, the mucosa may be used as an alternative covering to a Type II Boston Keratoprosthesis allowing for better cosmesis and easier access for possible future retina or glaucoma surgery.

Conclusion: The use of oral mucosa is widely accessible to corneal surgeons due to the ease of harvesting oral mucosa, and the availability of the Type I Boston KPro. The learning curve is less steeper than the modified osteo-odontokeratoprosthesis and the cosmesis is more acceptable.

Purpose: To review the current literature on the pathogenesis, diagnosis, and management of ocular surface squamous neoplasia (OSSN), and to evaluate the efficacy and safety of topical therapies-interferon alpha-2b (IFNα-2b), mitomycin-C (MMC), and 5-fluorouracil (5-FU)-in a retrospective cohort of patients with OSSN.

Method: A comprehensive literature review was conducted alongside a retrospective cohort study involving 43 patients diagnosed with OSSN. Treatment outcomes, recurrence rates, and toxicity profiles associated with IFNα-2b, MMC, and 5-FU were analyzed. Data on treatment duration, number of cycles required for tumor resolution, and associations with patient demographics were assessed.

Results: A mean of 2.56 treatment cycles was required for complete tumor resolution across the cohort. IFNα-2b led to tumor resolution in a shorter time frame compared to 5-FU. No significant correlation was identified between patient demographics and treatment response. However, a history of cancer was associated with larger tumor size and greater limbal involvement at presentation.

Conclusions: Topical agents are effective and well-tolerated treatments for OSSN, with IFNα-2b demonstrating faster response times in this cohort. The literature highlights a lack of prospective randomized trials comparing these therapies. Furthermore, limited understanding of the molecular mechanisms underlying OSSN pathogenesis continues to hinder individualized treatment strategies and risk stratification.

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis are rare but life-threatening mucocutaneous disorders, primarily triggered by adverse drug reactions. Although systemic manifestations have been extensively studied, ocular involvement remains a major cause of morbidity, often resulting in severe visual impairment or blindness.

Methods: This narrative review synthesizes current evidence regarding the clinical presentation, pathophysiology, and management strategies for ocular complications in SJS/TEN. A comprehensive literature search was conducted to highlight both acute and chronic ophthalmic manifestations and therapeutic interventions.

Results: Ocular involvement is reported in up to 75% of SJS/TEN patients during the acute phase, manifesting as conjunctivitis, pseudomembrane formation, corneal erosions, and eyelid abnormalities. Early interventions such as lubrication, topical corticosteroids, and amniotic membrane transplantation (AMT) have shown efficacy in mitigating long-term damage. Nonetheless, a substantial number of patients develop chronic complications including symblepharon, limbal stem cell deficiency, and severe dry eye syndrome. Long-term management involves scleral lenses and surgical procedures such as limbal stem cell transplantation, mucous membrane grafting (MMG), and keratoprosthesis. Innovations like ProKera® have improved epithelial healing, yet irreversible damage from the acute phase remains a persistent challenge.

Conclusion: Ocular complications of SJS/TEN are multifaceted and necessitate early and sustained multidisciplinary management. Timely ophthalmologic intervention is crucial in the acute phase, while chronic care aims to restore ocular surface stability and preserve vision. Further research is needed to develop standardized treatment protocols and explore emerging therapies that may enhance long-term outcomes and quality of life.

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe mucocutaneous reactions primarily triggered by drugs or infections. Although acute management focuses on systemic stabilization, chronic ocular sequelae remain a significant concern with vision-threatening complications arising in up to 75% of the affected patients. Ocular manifestations range from dry eye disease, lid margin keratinization (LMK), and conjunctival cicatrization to more severe complications like limbal stem cell deficiency (LSCD), cicatricial entropion, symblepharon, corneal perforation and scarring.

Purpose: This review aims to summarize the recent advances in understanding the pathophysiology and management strategies for chronic ocular sequelae of SJS.

Methods: A comprehensive literature search was conducted using PubMed database, identifying published studies addressing the roles of persistent immune dysregulation, autoantibodies, and microbiome alterations in perpetuating chronic ocular inflammation and scarring. The recent treatment modalities for such sequelae of SJS were also evaluated.

Conclusion: Elevated levels of pro-inflammatory cytokines, neutrophil predominance, and aberrant keratinization pathways have been identified as key contributors. Management strategies have evolved to include timely surgical interventions like mucous membrane grafting (MMG) for LMK, scleral lenses for ocular surface protection, and limbal stem cell transplantation for LSCD. The introduction of advanced therapies, such as topical autologous serum, platelet-rich plasma, and recombinant growth factors, has enhanced ocular surface rehabilitation. Emerging treatments, including simple oral mucosal epithelial transplantation (SOMET), cultivated oral mucosal epithelial transplantation (COMET), and keratoprostheses, offer hope for severe cases. Additionally, the integration of artificial intelligence (AI) in prognosis prediction and the development of targeted biologics highlight the potential for personalized care. Despite these advancements, challenges persist in early diagnosis, access to specialized care, and the high cost of novel therapies. Multidisciplinary collaboration and awareness are imperative for optimizing outcomes. Future directions emphasize the need for precision medicine approaches, AI integration, and nationwide registries to facilitate research and enhance patient support. Such comprehensive understanding and management approach aims to mitigate the long-term visual disability associated with chronic ocular sequelae of SJS/TEN, thereby improving quality of life.

Purpose: To provide a comprehensive overview of Pediatric ocular surface disorders (OSD), encompassing their epidemiology, pathogenesis, clinical manifestations, diagnostic modalities, and evolving management strategies.

Methods: A narrative review of current literature was conducted, synthesizing data from clinical studies, case series, and expert consensus on the diagnosis and treatment of Pediatric OSD. Emphasis was placed on recent therapeutic advancements and multidisciplinary approaches to care.

Results: Pediatric OSD comprises a heterogeneous group of infectious, inflammatory, allergic, and traumatic conditions. Management varies by severity, ranging from conservative approaches such as lubricants and antihistamines to advanced therapies including immunomodulators, amniotic membrane transplantation, and keratoprosthesis. Novel treatments such as cytokine-targeted biologics, stem cell-based therapies, and scleral contact lenses are expanding therapeutic options. Early and accurate diagnosis, alongside individualized care plans, are critical for preserving ocular surface integrity and preventing long-term complications.

Conclusions: Management of Pediatric OSD requires a multidisciplinary and personalized approach. Growing awareness among clinicians, along with the integration of novel therapeutics, holds promise for improved patient outcomes. Standardized management protocols and continued research into emerging therapies are essential to optimize ocular health and quality of life in children affected by OSD.

Purpose: Although microbial keratitis is a known complication in eyes with chronic ocular surface disease, literature on this subject is scarce. The primary objective of this review is to describe the various aspects of microbial keratitis in ocular surface disease, with an emphasis on a better understanding of risk factors, causative organisms, antimicrobial therapy, and prevention.

Methods: The literature was reviewed in detail using multiple keywords and articles describing microbial keratitis in eyes with limbal stem cell deficiency, Stevens-Johnson syndrome, mucous membrane pemphigoid, keratoconjunctivitis sicca, meibomian gland dysfunction, post-chemical injury, and other common ocular surface pathologies.

Results: Common risk factors identified include dry eyes, use of topical corticosteroids, soft contact lens wear, and eye lash abnormalities such as trichiasis and distichiasis. Gram-positive bacteria have been reported to be the most common causative agents. Sensitivity to Vancomycin was the highest among the gram-positive isolates. Non- healing or persistent epithelial defects or slowly healing epithelial defects were the most common complications in these eyes, warranting amniotic membrane grafting for faster epithelial healing.

Conclusion: Patients must be kept under regular monitoring, and indiscriminate use of topical antibiotics and corticosteroids must be avoided. Adequate patient education must be provided to enable patients to recognize warning signs early and seek immediate medical attention.