orabase and Corneal-Diseases

The so-called ocular pemphigus is an oculocutaneomucosal disease, the clinical manifestations of which have been recognized for over a century while its recognition as a nosological and histopathological unit is quite recent. The clinical picture in the eye consists essentially of progressive scar contraction which, preceded by a transient bullous phase, leads to symblepharon, entropion and trichiasis. Corneal complications, such as bullous eruption, erosions, proliferation of vasculoconnective tissue, supervene later. The final appearance is that of complete xerosis with total symblepharon producing a typical 'statute eye'. This local process may be accompanied by bullous lesions of the skin and mucous membranes but the general condition of the patient invariably remains good. In the advanced stages of the disease the appearance is described as 'pemphigoid facies'. The nosological place of ocular pemphigus has been a matter of debate. At various times it has been identified with pemphigus vulgaris, dermatitis herpetiformis of Duhring-Brocq, erythema multiforme of Hebra, Stevens-Johnson syndrome, syphilitic dermatitis bullosa and other bullous dermatoses. At present the condition is universally recognized as a clinical entity, referred to as chronic mucosynechial pemphigoid (CMSP). The anatomopathological picture is quite peculiar. The elementary lesion is a sub-epidermic bulla, hence easily distinguished from that of pemphigus vulgaris, which is situated in the Malpighian layer. This difference applies to the lesions of the skin as well as to those of the mucous membranes including the conjuctiva. In the conjunctiva, epithelial changes suggestive of its epidermization were demonstrated. The Malpighian layer shows a high glycogen and DNA content with overall reduction in enzyme activity. The dermis shows infiltration by lymphocytes, histiocytes and plasma cells, and a considerable increase in hyaluronic acid content. There are many areas of dermoepidermal separation with formation of bullae and the basal membrane is often missing. In some cases, in the centre of the bullae, we were able to demonstrate one or more lumps, consisting almost exclusively of hyaluronic acid, probably filtered in from the dermis across the altered basal membrane. Similar changes are met with also in other mucous membranes, that of buccal cavity in particular, even in ostensibly healthy areas. The histological and histochemical findings are sufficiently typical to justify early d

Topics: Adrenal Cortex Hormones; Aged; Biopsy; Carboxymethylcellulose Sodium; Chronic Disease; Corneal Diseases; Eye Diseases; Female; Glycosaminoglycans; Humans; Male; Middle Aged; Skin Diseases, Vesiculobullous

To identify the prevalence of corneal ulceration in dogs receiving prophylactic gel lubrication under general anesthesia (GA).. An ophthalmic examination was performed before premedication and 24 h after GA in 100 dogs (199 eyes) undergoing nonophthalmic procedures. Individuals with known pre-existing ocular surface conditions were excluded. An ocular lubricating gel containing carmellose sodium was applied by the anesthetist at induction and every 2-4 h until extubation. Logistic regression analysis was used to calculate risk factors for ulcerative disease, including signalment, length of GA, patient position, procedure performed, pre-, and post-GA ophthalmic examination findings and admitting service. A Wilcoxon rank sum test compared pre- and post-GA Schirmer tear test-1 (STT-1) values.. One dog (0.5% of total eyes) developed fluorescein stain uptake consistent with superficial corneal ulceration that resolved within 48 h with supportive treatment. Twenty-five (18.6% of total eyes) developed a faint, patchy corneal uptake of stain in the axial cornea that was consistent with epithelial erosion. All erosions resolved with lubrication 24 h later. The decrease in STT-1 readings at 24 h post-GA was statistically significant from those pre-GA (P < 0.001). No significant risk factors for corneal erosion/ulceration were identified.. The results of this study show that a basic protocol of prophylactic lubrication during GA was associated with a low prevalence of corneal ulceration but a higher prevalence of epithelial erosion. In addition, the study supports the need for post-GA corneal examination.

Topics: Anesthesia, General; Animals; Carboxymethylcellulose Sodium; Corneal Diseases; Dog Diseases; Dogs; Lubricant Eye Drops; Postoperative Complications; Prevalence; Prospective Studies; Risk Factors; Ulcer

Use of polyhexanide based multipurpose solutions (MPSs) for contact lens disinfection has been linked to low-grade corneal staining. In vitro data suggest that carboxymethylcellulose (CMC) may neutralize polyhexanides. The purpose of this investigation was to determine whether a pre-application drop of CMC reduces polyhexanide staining in vivo.. Thirty adapted soft contact lens (SCL) wearers participated in this investigator-masked, randomized, two-way cross-over study. Subjects wore a new Group II lens (alphafilcon A, 66% water) daily for 4 weeks and disinfected lenses using a MPS containing 0.0001% polyaminopropyl biguanide. A lens lubricant containing either CMC or povidone as the primary viscolyzer was applied to the lens each day before lens wear. Biomicroscopic signs and symptomatology were assessed. The difference in scores, 0 to 4 weeks and the difference between lubricants were analyzed.. The cumulative fluorescein staining scores for combined eyes demonstrated a significant increase over time (e.g., cumulative staining score; p=0.004 and p<0.001 for CMC and povidone, respectively, matched pairs t-test, two-tailed), suggesting that for both lubricants the staining worsened with wear. This effect was expected and likely driven by the MPS. However, the mean cumulative staining scores for CMC and povidone were 2.8 and 2.6 out of 20 possible at baseline, increasing to 4.9 and 7.1 at 4 weeks, respectively. The increases were significantly different (p=0.003, matched pairs t-test, two-tailed) suggesting a greater increase in corneal staining for the povidone lubricant. The symptom scores were not significantly different, 0 to 4 weeks by regimen or between preinstillation drops.. These results suggest that a CMC-containing preapplication drop can reduce corneal staining resulting from disinfection with a polyhexanide MPS. This result is consistent with a proposed mechanism for CMC to neutralize cationic disinfectants and may offer clinicians another means to reduce this type of corneal staining.

Topics: Adult; Biguanides; Carboxymethylcellulose Sodium; Contact Lens Solutions; Contact Lenses, Extended-Wear; Cornea; Corneal Diseases; Cross-Over Studies; Female; Follow-Up Studies; Humans; Male; Ophthalmic Solutions; Refractive Errors; Treatment Outcome

This study aimed to evaluate the efficacy and safety of transplantation with human corneal limbal epithelial (HCLE) cell sheets cultured on carboxymethyl cellulose (CMC)-dopamine (DA)-coated substrates and harvested via enzymatic digestion of CMC with cellulase in a rabbit animal model of limbal stem cell deficiency (LSCD). Synthesized CMC-DA was pretreated onto the surface of culture plates. Then, HCLE cells were cultured on precoated CMC-DA and HCLE cell sheets were harvested using cellulase-containing cell culture medium. HCLE cell sheets were evaluated using a live/dead assay, histological examination, and immunofluorescence staining. For in vivo assessment, HCLE cell sheets were transplanted in a rabbit model of LSCD for 2 weeks to determine the effectiveness of the repair. Primary culture of HCLE cells stained positively for p63, cytokeratin (CK)15, and CK12. HCLE cell sheets were generated with a well-preserved morphology and transparency ranging in size from 15 to 19 mm after cellulase-assisted cell sheet generation. HCLE cell sheets uniformly stained positively for human mitochondria, p63, CK15, CK12, CK3/2p, and zonula occludens (ZO)-1. HCLE cell sheet transplantation in a rabbit model of LSCD improved the corneal opacity and neovascularization scores. Transplanted HCLE cell sheets stained positively for p63 and CK12. Transplantation of HCLE cell sheets harvested on CMC-DA coating combined with cellulase is a safe and efficient procedure for corneal epithelial regeneration in a rabbit model of LSCD. This system could enable a promising strategy to regenerate corneal epithelium by transplantation in ocular surface disorders.

Topics: Animals; Carboxymethylcellulose Sodium; Cornea; Corneal Diseases; Disease Models, Animal; Dopamine; Epithelial Cells; Epithelium, Corneal; Heterografts; Humans; Limbus Corneae; Rabbits; Stem Cells

To evaluate the incidence of epithelial defects that occur with laser in situ keratomileusis (LASIK) using nonpreserved carboxymethylcellulose sodium 0.5% solution (Refresh Plus(R)) intraoperatively.. Community-based refractive center.. This retrospective study comprised 105 patients (210 eyes) who had primary bilateral LASIK by 1 of 2 surgeons between October 1 and December 1, 2000. The 114 eyes treated subsequent to November 1, 2000, received Refresh Plus intraoperatively, and the 96 eyes treated before this date did not. The incidence of epithelial defects and diffuse lamellar keratitis (DLK) in both groups was recorded. The preoperative keratometry measurements of all cases were also recorded.. There was a statistically significant decrease in the incidence of epithelial defects in the group that received Refresh Plus intraoperatively (P =.02). No statistically significant between-group difference in the incidence of DLK was detected. Analysis of the keratometry measurements revealed no statistically significant association between the amount or axis of astigmatism and the incidence of epithelial defects or DLK.. The intraoperative use of nonpreserved Refresh Plus significantly decreased the rate of epithelial defects that occurred during LASIK.

Topics: Carboxymethylcellulose Sodium; Corneal Diseases; Epithelium, Corneal; Humans; Incidence; Intraoperative Care; Keratitis; Keratomileusis, Laser In Situ; Ophthalmic Solutions; Retrospective Studies