AM Joussen, G Funke, (Univ. of Aachen, Germany, Gaertner and Colleagues Laboratories, Weingarten, Germany)
Corynebacterium macginleyi: a conjunctiva specific pathogen.
Br.J Ophthalmol, 2000; 84: 1420-1422
Non-diphtherial corynebacteria are ubiquitous and commonly colonise the skin and mucous membranes of humans. However, they rarely account for clinical infection.
Ten patients with unilateral conjunctivitis are described, in whom corynbacterium macginleyi was isolated.
This species which has recently been reported to be exclusively isolated from ocular surfaces, is uniformly susceptible to topical antibiotics commonly used in ophthalmic practice.
CML Chan, PTK Chew, et al (Singapore National Eye Centre)
Vascular patterns in pterygium and conjunctival autografting : a pilot study using indocyanine green anterior segment angiography.
Br. J Ophthal, March 2001, 85: 350-353.
Indocyanine green (ICG) anterior segment angiography was performed on 9 patients with pterygium. Angiography was repeated at 1-2 weeks and 2 months after conjunctival autografting in these patients. It was found that a single feeder vessel from the anterior conjunctival cirulation, branches to form radial vessels in pterygium. Reperfusion of the conjunctival autografts occurs one week postoperatively
Ahmed M Abu, EI-Asrar, Sofie Struyf et al [King Saud Univ, Riyadh, Saudhi Arabia]
Chemokines in the Limbal Form of Vernal Ketatoconjunctivitis
BJO 2000; 84: 1360-1366
Chemokines are a family of low molecular weight cytokines that attract and activate leucocytes. The CC chemokines play an important part in allergic diseases.
The aim of the study was to investigate the expression of CC chemokines, in the conjunctiva of patients with vernal keratoconjunctivities.
The results demonstrated a definite increase in the expression of chemokines in the conjuctiva of patients with vernal keratoconjunctivities [VKC] suggesting a potential role for chemokines in the pathogenesis of VKC.
Antagonists of chemokine receptors may provide new therapeutic modalities in VKC.
D. Paridaens, H Beekhuis, et al (Rotterdam Eye Hospital, Oculoplastic Service, Netherlands)
Amniotic membrane transplantation in the management of conjunctival malignant melanoma and primary acquired melanosis with atypia.
Br.J Ophthal, June 2001; 85:658-661.
Four consecutive patients with histologically proved invasive, primary conjunctival malignant melanoma were treated with wide surgical excision and amniotic membrane transplantation (AMT).
The authors found AMT to be a useful technique for reconstruction of both small and large surface defects resulting from the surgical excision of conjunctival melanoma and primary acquired melanosis (PAM).
This method facilitates wide conjunctivectomy. The transparency and superior cosmesis of amniotic membrane are advantages over thicker mucous membrane grafts.
A. M. A. El-Asrar, I. V. Aelst, et al (Department of Ophthalmology, College of Medicine, King Abdulaziz University Hospital, Riyadh, Saudi Arabia)
Gelatinase B in Vernal Keratoconjunctivitis
Arch Ophthalmol., October 2001, Vol. 119(10) Pg. 1505-1511
Conjunctival biopsy specimens from 12 patients with active vernal keratoconjunctivitis (VKC) and 12 control subjects were studied using immunohistochemical techniques and a monoclonal antibody against gelatinase B.
Gelatinase B was detected in a few polymorphonuclear cells in 8 control specimens. All VKC specimens showed gelatinase B immunoreactivity in the epithelial and stromal inflammatory infiltrate. Compared with control specimens, VKC specimens showed significantly more gelatinase B- positive cells.
These findings suggest overexpression of gelatinase B by eosinophils in VKC specimens and participation of gelatinase B in the pathologic changes in VKC.
Control of the release and/or activation of gelatinase B in eosinophils may provide a new therapeutic strategy in the management of VKC.
A. Leonardi, G. DeFranchis, et al (University of Padova, Italy)
Effects of Cyclosporin A on Human Conjunctival Fibroblasts
Arch Ophthalmol., October 2001, Vol. 119(10) Pg. 1512-1517
Fibroblast cultures derived from normal subjects and patients with vernal keratoconjunctivitis and pemphigoid were exposed to different concentrations of Cyclosporin A (CsA) for either 24 hours or 30 days.
Effects were evaluated by colorimetric MTT test to assess cell proliferation, and by the measurement of procollagen I (PIP) and procollagen III (PIIIP) cytokines and total protein in culture medium. CsA-induced apoptosis was assessed by fluorescence-activated cell sorter analysis.
It was found that CsA exposure induced apoptosis in a time and dose dependent manner. This ability to accelerate apoptosis in clinically fibrotic tissues may prove to be therapeutic and useful in hyperproliferative conjunctival disorders.
Stevenson D, and The Cyclosporin A Phase 2 Study Group (Mercy Hosp Professional Bldg, New Orleans, La; et al)
Efficacy and Safety of Cyclosporin A Ophthalmic Emulsion in the Treatment of Moderate-to-Severe Dry Eye Disease: A Dose-Ranging, Randomized Trial.
Ophthalmology 107: 967-974, 2000
Recent, population-based surveys have reported millions of people throughout the world affected by Kerato Conjunctivitis Sicca (KCS) or dry eye disease. As many as 17 to 25% of patients report symptoms of KCS.
Patients with uncontrolled KCS are more susceptible to endophthalmitis resulting from ocular infections. Chronic KCS results from an underlying cytokine and receptor mediated inflammatory process, which affects the lacrimal gland acini and ducts.
This leads to abnormalities in the tear film and disruption of the homeostasis of the ocular surface.
Topical treatment with cyclosporin A (0.05 to 0.1%) has been shown to reduce cell-mediated inflammatory responses in inflammatory ocular surface diseases.
In a study of 162 patients, 129 patients received cyclosporin A emulsion in various concentrations ranging from 0.05 to 0.4%, while 33 patients received vehicle only. A post treatment observation period of 4 weeks revealed that cyclosporin A emulsions were safe and effective (maximally 0.05 and 0.1%) in improving ocular manifestations of KCS.
Toshihiko Matsuo, Masako Itami, et al (Dept. of Opthal, Okayama Univ, Med School, Okayama City, Japan).
The incidence and pathology of conjunctival ulceration in Behçets syndrome
BJO, Feb.2002, 86: 140-143.
152 patients with Behçets syndrome seen at the uveitis service of Okayama Univ. Hospital were retrospectively reviewed.
Criteria to diagnose Behçets syndrome in this study required the presence of oral aphthous ulceration plus any 2 of 3 other manifestations (i) genital ulcerations (ii) eye lesions like iridocyclitis and uveoretinitis (iii) skin lesions like erythema nodosum.
Only 4 of 152 patients (2.6%) developed conjunctival ulceration when there was exacerbation of systemic symptoms. Histopathological examination of a conjunctival biopsy specimen in one patient showed intraepithelial and perivascular infiltration with neutrophils and lymphocytes.
The conjunctival ulcerations showed good response to topical corticosteroids.
The authors recommend that Behçets syndrome should be included in the list of differential diagnosis for patients with conjunctival ulceration.
Pasquale Aragona, Vincezo Papa et al (Univ.of Messina, Italy)
Long-term treatment with Sodium hyaluronate containing artificial tears reduces ocular surface damage in patients with dry eye.
BJO, Feb.2002, 86: 181-184.
A randomized double-blind study was undertaken in 86 patients with medium to severe dry eye. Patients were treated with either preservative free sodium hyaluronate or saline for 3 months at a dose of one drop, 4 to 8 times per day. Impression cytology was considered the primary efficacy parameter of this study.
The medication was well tolerated and without adverse reaction.
The basic disorders in a patient with dry eye are : substantial abnormalities of the ocular surface, in particular of the epithelial morphology, and goblet cell distribution with a shift towards squamous metaplasia.
H.S. Dua, A J King, Annie Joseph (Univ. Hospital, Queen’s Medical Centre, Nottingham, UK)
A new classification of ocular surface burns.
BJO, 2001; 85: 1379-1383
Thermal and chemical burns represent potentially blinding ocular injuries.
Thermal burns results from (i) firework explosions (ii) steam (iii) boiling water (iv) molten metal (commonly aluminium).
Chemical burns may be from alkaline or acidic agents. Alkaline agents include (i)Ammonium hydroxide (fertilizer production) (ii) Sodium hydroxide (for cleaning drains and pipes) and (iii) calcium hydroxide (found in lime plaster and cement).
Alkaline agents have both hydrophilic and lipophilic properties and hence rapidly penetrate cell membranes and enter the anterior chamber.
The hydroxyl ion causes saponification of cell membranes, cell death and disruption of the extracellular matrix.
Acidic agents causing injury are sulphuric acid found in car batteries, sulphurous acid found in some bleaches, and hydrochloric acid (swimming pools).
Recovery of ocular surface burns depends upon :
(i) causative agent
(ii) Extent of damage to (a) corneal, (b) limbal and (c) conjunctival tissues at the time of injury.
Understanding and clinical application of the concept of limbal stem cells of the corneal epithelium and forniceal stem cells of the conjunctival epithelium has significantly improved the outcome of treatment.
Limbal based epithelial stem cells provide a steady supply of daughter cells which maintain a constant epithelial cell mass during normal epithelial cell turnover and during epithelial wound healing.
Conjunctival stem cells are located in the forniceal region and migrate away from the fornices to cover bulbar and tarsal conjunctiva.
New developments in the management of severe ocular surface burns include (i)autolimbal transplantation or (ii) allolimbal transplantation with or without amniotic membrane graft.
This is combined with systemic immuno suppression and topical instillation of autologous serum.
The authors have evolved a new classification ranging from grade I (very good) to grade VI (very poor prognosis), based on the following parameters.
(a) Clock-hours of limbal involvement
(b) Percentage of conjunctival involvement.
The presence of any surviving conjunctival epithelium, is a favourable prognostic indicator (when compared with eyes with total loss of corneal, limbal and conjunctival epithelium).
The authors stress the important concept of conjunctivalisation of the cornea which protects against progressive melting and perforation. The ensuing vascularisation promotes healing and facilitates repair, which provides an opportunity to perform restorative procedures later.
The new classification is based on the authors’ experience of 67 cases of ocular surface burns managed over several years (35 retrospective and 32 prospective).
In Grade II of this new classification (when < 3 clock hours of limbus are involved and < 30% adjacent conjunctiva is involved) a good prognosis may be expected with medical management.
(i)copious irrigation soon after injury
(ii) topical vitamin C drops,
(iii) topical citrate drops
(iv) Acetylcysteine drops.
(v) Judicious steroids and
As long as there is even one clock hour of limbal epithelium surviving, there is a chance to re-establish corneal epithelial cover, over at least the visual axis.
When attributing a grade, the extent of the limbal involvement takes precedence over the extent of conjunctival involvement.
E G Kemp, A N Harnett, et al (Gartnavel Gen Hospital, Glasgow, UK)
Preoperative Topical and Intraoperative Local Mitomycin C Adjuvant Therapy in the Management of Ocular Surface Neoplasias
BJO, January 2002; 86(1); 31-34
The authors reviewed case notes of 11 patients receiving mitomycin C adjuvant therapy as 0.04% drops, four times daily in 2 weekly courses preoperatively and/or a single intraoperative appplication of 0.4 mg/ml of mitomycin C.
The histopathology of the cases
(1) conjunctival primary acquired melanosis,
(2) conjunctival melanomas
(3) sebaceous cell carcinomas with conjunctival intraepithelial spread, and
(4) conjunctival intraepithelial squamous neoplasias. Seven patients had limited local excision of the residual tumor mass and one had cryotherapy.
All 11 patients showed a favorable response to mitomycin C adjuvant therapy. The therapy was well tolerated.