MyMedR

Fulltext Topical insulin for healing of diabetic epithelial defects?: A retrospective review of corneal debridement during vitreoretinal surgery in Malaysian patients

Bastion ML, Ling KP

Med J Malaysia, 2013 Jun;68(3):208-16.

PMID: 23749008 MyJurnal

PURPOSE: To investigate whether topical insulin improves healing rate of corneal epithelial erosions induced during vitreoretinal surgery in diabetics.
METHODS: We retrospectively reviewed case notes and serial post-operative photographs of 15 eyes of 14 patients who had corneal epithelial debridement performed during various vitreoretinal surgeries to improve one surgeon's view over a 10 month period in 2010.
RESULTS: Three groups were identified: DTI, comprising diabetics who received topical insulin 1 unit qds postoperatively (n=5); DCT comprising diabetics treated with conventional post-operative medications only (n=5) and NDCT comprising non diabetic patients on conventional post operative therapy (n=5). Only eyes in which the corneal epithelial defect had been serially photographed at time, t= 0, 12, 24, 36, 48, 60, 72 and 120 hours following commencement of topical medications were included. The size of the defect was calculated using local software. DTI eyes had a significantly smaller defect size at t= 24 (p=0.009), 36 (p=0.009), 48 (p=0.015) and 60 hours (p=0.005) compared to DCT eyes and had no statistical difference from NDCT eyes at all times in the Mann Whitney U analysis (p>0.05). In the diabetic operated bilaterally, the insulin treated eye re-epithelialised by 48 hours whereas fellow eye treated conventionally re-epithelialised in 72 hours.
CONCLUSIONS: Topical insulin or insulin eye drops 1 unit qds may be applied to the corneal surface to normalize the rate of healing of epithelial defects in diabetic patients undergoing epithelial debridement to improve the surgeon's view.

Matched MeSH terms: Corneal Diseases/surgery

Fulltext Iatrogenic corneal perforation in Terrien Marginal Degeneration

Mohd Razali K

Med J Malaysia, 2013 Apr;68(2):173-4.

PMID: 23629570 MyJurnal

This case report is about a rare disease with unusual presentation. Failure to recognise atypical presentation may lead to error in managing the patient and cause disastrous complications. Here we highlight a case of Terrien Marginal Degeneration in both eyes with atypical presentation; namely pseudopterygium. A 22 year old man was referred to our centre for iatrogenic right eye corneal perforation after having an atypical pterygium removed at another hospital. On arrival, his vision was 1/60 in both eyes with bilateral cornea Terrien Marginal Degeneration. His right eye anterior chamber was deep with a conjunctival flap covering the perforation site which was located from the 2.30 - 3.30 clock position nasally with no aqueous leak. However after a day his right eye anterior chamber became flat and there was fast aqueous leak from the perforation site. An emergency C shaped peripheral corneal lamellar keratoplasty was performed to seal the perforation. Post operatively his right eye improved to 6/24.

Matched MeSH terms: Corneal Diseases/surgery

Fulltext Osteo-odonto-keratoprosthesis for end-stage cornea blindness

Wong HS, Then KY, Ramli R

Med J Malaysia, 2011 Oct;66(4):369-70.

PMID: 22299563 MyJurnal

We report the first case of Osteo-odonto-keratoprosthesis (OOKP) who successfully underwent surgery in Malaysia following a grade 4 (severe) chemical injury in both eyes in 2006. The patient's left eye was eviscerated and his right eye underwent penetrating keratoplasty. However, the corneal graft failed and became opaque. His right eye could only perceive light. The OOKP was offered to him hoping to recover some functional vision. He underwent a 2-stage surgery to implant the OOKP into his right eye. However, 2 months post-operation, he developed vitreous haemorrhage. A successful pars plana vitrectomy (PPV) was performed via the limited view through the lens. He attained a final visual acuity of 6/60 (N36). He was able to mobilize more independently, feed, dress himself and read large print.

Matched MeSH terms: Corneal Diseases/surgery*

Primary corneal myxoma

Soong T, Soong V, Salvi SM, Raynor M, Mudhar H, Goel S, et al.

Cornea, 2008 Dec;27(10):1186-8.

PMID: 19034139 DOI: 10.1097/ICO.0b013e31817a5d0b

Primary corneal myxoma is extremely rare. It has only been reported on 2 previous occasions. Secondary corneal myxomas are more common, arising from corneal diseases such as infective keratitis, keratoconus, and bullous keratopathy. Myxomas occur commonly in other soft tissues such as the heart, paranasal sinuses, and muscles but can rarely present in periocular structures including the conjunctiva, orbit, and eyelid. Ours is only the third case of primary corneal myxoma reported in the literature and illustrates several unusual features. These include an inferonasal location between the corneal epithelium and Bowman layer and with no relationship to the corneal stroma, rapid tumor growth over a 3-month period, and no previous ocular trauma or conjunctival pathology. The histology of this lesion has an important part to play in the management of this condition as it determines the cellular origin, establishes a benign or malignant state, and helps with treatment and prognosis. One reported case of primary corneal myxoma recurred within 2 months after local resection. This was treated with bandage soft contact lens, and no recurrence had been reported since. Our case is now 12 months post op and has had no recurrence.

Matched MeSH terms: Corneal Diseases/surgery*

Ex vivo growth of rabbit bulbar, fornix and palpebral conjunctival epithelia in a serum-free and feeder layer-free culture system

Nizam MH, Ruszymah BH, Chua KH, Ghafar NA, Hamzah JC

Med J Malaysia, 2008 Jul;63 Suppl A:111-2.

PMID: 19025010

This study was conducted to explore the feasibility of culturing conjunctiva epithelial cells in serum-free and feeder layer-free culture system with regard to the cell morphology and immunocytochemistry of the rabbit bulbar, fornix and palpebral conjunctiva epithelia. The results showed that epithelium cells from all the three conjunctiva regions can be cultured in a serum-free and feeder layer-free environment. We obtained highest epithelial growth from fornix region with minimum invasion of fibroblast cells compared to other area. All cultured cells were stained positive for cytokeratin 19 and MUC5AC and negative for cytokeratin 3. These findings suggested that fornix was a better source of cells for the development of tissue engineered conjunctiva for future clinical application.

Matched MeSH terms: Corneal Diseases/surgery*

Scanning electron microscopy of cornea re-epithelization after transplanted with bilayered corneal construct

Masrudin SS, Ghafar NA, Saidi M, Aminuddin BS, Rahmat A, Ruszymah BH, et al.

Med J Malaysia, 2008 Jul;63 Suppl A:109-10.

PMID: 19025009

The present work was to determine the development and re-epithelization of bilayered corneal construct (BCC) in vitro and in vivo using scanning electron microscopy (SEM). The in vitro BCC was transplanted to the rabbit's eye and after 90 days the BCC was harvested and analyzed. The corneas were processed for morphology studies. The result indicates that the BICC that was transplanted for 90 days showed good development and re-epithelization of epithelial layer similar to the normal cornea.

Matched MeSH terms: Corneal Diseases/surgery*

Fulltext Determinants of posterior corneal biometric measurements in a multi-ethnic Asian population

Ang M, Chong W, Huang H, Wong TY, He MG, Aung T, et al.

PLoS One, 2014;9(7):e101483.

PMID: 25006679 DOI: 10.1371/journal.pone.0101483

To describe the corneal and anterior segment determinants of posterior corneal arc length (PCAL) and posterior corneal curvature (PCC).

Matched MeSH terms: Corneal Diseases/surgery

Fulltext Ocular injuries and severe ocular surface diseases in Malaysia

Tan AK, Pall S

Med J Malaysia, 2011 Oct;66(4):284-5.

PMID: 22299542 MyJurnal

Matched MeSH terms: Corneal Diseases/surgery*

Current progress and challenges in ocular surface reconstruction using cultivated epithelial sheet transplantation

Inatomi T, Nakamura T, Koizumi N, Sotozono C, Kinoshita S

Med J Malaysia, 2008 Jul;63 Suppl A:42.

PMID: 19024975

The cultivated epithelial transplantation is a new surgical modality for treating a variety of severe ocular surface disorders. This type of tissue-engineered epithelial sheet provides a rapid epithelial coverage on the corneal surface that reduces inflammation and postoperative complications. Although cultivated corneal epithelial transplantation is an effective surgical strategy, autologous transplantation is limited to unilateral cases. Autologous cultivated oral mucosal epithelial transplantation (COMET) enables surgeons to reconstruct the ocular surface using autologous, non-ocular surface cells, and has opened a new pathway for treating severe, bilateral ocular surface disorders.

Matched MeSH terms: Corneal Diseases/surgery*

Corneal regeneration by induced human buccal mucosa cultivated on an amniotic membrane following alkaline injury

Man RC, Yong TK, Hwei NM, Halim WHWA, Zahidin AZM, Ramli R, et al.

Mol Vis, 2017;23:810-822.

PMID: 29225457

Various clinical disorders and injuries, such as chemical, thermal, or mechanical injuries, may lead to corneal loss that results in blindness. PURPOSE: The aims of this study were to differentiate human buccal mucosa (BMuc) into corneal epithelial-like cells, to fabricate engineered corneal tissue using buccal mucosal epithelial cells, and to reconstruct a damaged corneal epithelium in a nude rat model.

Methods: BMuc were subjected to 10 d of induction factors to investigate the potential of cells to differentiate into corneal lineages.

Results: Corneal stem cell markers β1-integrin, C/EBPδ, ABCG2, p63, and CK3 were upregulated in the gene expression analysis in induced BMuc, whereas CK3 and p63 showed significant protein expression in induced BMuc compared to the uninduced cells. BMuc were then left to reach 80% confluency after differential trypsinization. The cells were harvested and cultivated on a commercially available untreated air-dried amniotic membrane (AM) in a Transwell system in induction medium. The corneal constructs were fabricated and then implanted into damaged rat corneas for up to 8 weeks. A significant improvement was detected in the treatment group at 8 weeks post-implantation, as revealed by slit lamp biomicroscopy analysis. The structure and thickness of the corneal layer were also analyzed using histological staining and time-domain optical coherence tomography scans and were found to resemble a native corneal layer. The protein expression for CK3 and p63 were continuously detected throughout the corneal epithelial layer in the corneal construct.

Conclusions: In conclusion, human BMuc can be induced to express a corneal epithelial-like phenotype. The addition of BMuc improves corneal clarity, prevents vascularization, increases corneal thickness and stromal alignment, and appears to have no adverse effect on the host after implantation.

Matched MeSH terms: Corneal Diseases/surgery*

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