tretinoin and Postoperative-Complications

Reduction of posterior capsule opacification (PCO) after cataract surgery has been achieved since the general acceptance of posterior chamber intraocular lens implantation 30 years ago. Attention to surgical technique on the one hand and changes in lens design and materials on the other have synergistically reduced the incidence of PCO to less than 5% at 5 years. But lens epithelial cells still proliferate and pharmacological prevention has been largely unsuccessful so far. Any agent must be toxic to these lens epithelial cells without being toxic to the corneal endothelium. This review looks at many substances that have been tried and a few that have been partly successful without yet entering clinical practice. Possibilities for future clinical research are canvassed.

Topics: Animals; Cataract Extraction; Corneal Opacity; Dexamethasone; Diclofenac; Disease Models, Animal; Humans; Lens Capsule, Crystalline; Lens Implantation, Intraocular; Postoperative Complications; Tretinoin

Endothelial progenitor cells (EPCs) play a critical role in neovascularization, which enhances proliferation under all-trans retinoic acid (ATRA) treatment. However, the effects of ATRA on the skin flap survival in diabetic flap ischemia remains unknown.. Ischemic random skin flaps were made in 40 diabetic Sprague-Dawley rats with 20 normal rats used as control in this study. At 7 days postoperatively, the surviving area of each skin flap was measured. Immunofluorescence staining was used to analyze capillary density and EPCs recruited to the flaps. The expression of ANG2 and VEGF was determined by Western blotting. Circulating EPC number was determined by flow cytometry. In vitro tube formation experiment was used to analyze the function of EPCs.. The flap survival rate and capillary density of ATRA-treated flap were significantly increased. Fluorescence-activated cell sorting (FACS) analysis demonstrated a marked increase in systemic CD34+/Flk-1+ EPCs in ATRA-treated rat. The expression of ANG2 and VEGF was increased in diabetic flap tissues under ATRA administration. Furthermore, ATRA administration restored the impaired function of diabetic EPCs in tube formation.. ATRA could notably exert preventive effects against skin flap necrosis and promote neovascularization in diabetic rats, which may partially through elevating the expression of ANG2 and VEGF, and augmenting EPC mobilization.

Topics: Animals; Diabetes Mellitus, Experimental; Disease Models, Animal; Ischemia; Male; Mice; Neovascularization, Physiologic; Postoperative Complications; Rats; Rats, Sprague-Dawley; Surgical Flaps; Tretinoin

To determine the effect of 9-cis retinoic acid (9-cis RA) on postsurgical lymphedema.. 9-cis RA promotes lymphangiogenesis in vitro and in vivo and has promise as a therapeutic agent to limit the development of postsurgical lymphedema.. Lymphedema was induced in the right hind limb after a single fraction of 20 Gy radiation, popliteal lymphadenectomy, and lymphatic vessel ablation. Postoperatively, mice were randomly divided in to 2 groups that received daily intraperitoneal injections of either (1) an oil-based vehicle solution (control) or (2) 0.08 mg/kg of 9-cis RA dissolved in a vehicle solution. Outcome measures included paw thickness, lymphatic drainage, and lymphatic vessel density as measured by podoplanin immunohistochemistry and whole mount skin analysis.. Using our combined injury protocol, postsurgical lymphedema was observed 89% of the time. 9-cis RA-treated animals had less early postsurgical edema and significantly less paw lymphedema compared with vehicle-treated animals at all time-points (P < 0.001). 9-cis RA-treated animals had significantly faster lymphatic drainage as measured by indocyanine green clearance and increased lymphatic vessel density as measured by podoplanin immunohistochemistry (P < 0.001) and whole mount skin analysis (P < 0.05).. We have developed a highly reproducible model of secondary lymphedema and have demonstrated that 9-cis RA significantly prevents postsurgical lymphedema. Treatment with 9-cis RA is associated with increased lymphatic clearance and lymphangiogenesis. Because 9-cis RA (alitretinoin) is already approved for clinical use by the US Food and Drug Administration for other conditions, it has the potential to be repurposed as a preventative agent for postsurgical lymphedema in humans.

Topics: Alitretinoin; Animals; Antineoplastic Agents; Disease Models, Animal; Lymphangiogenesis; Lymphedema; Male; Mice; Mice, Transgenic; Postoperative Complications; Tretinoin

Topics: Antineoplastic Combined Chemotherapy Protocols; Arsenic Trioxide; Arsenicals; Carcinoma, Squamous Cell; Humans; Immunocompromised Host; Kidney Transplantation; Leukemia, Promyelocytic, Acute; Lung Transplantation; Male; Middle Aged; Neoplasms, Second Primary; Oxides; Postoperative Complications; Skin Neoplasms; Tretinoin

The safety of chronic implantation of a retinal prosthesis in the suprachoroidal space has not been established. This study aimed to determine the safety of a wide-field suprachoroidal electrode array following chronic implantation using histopathologic techniques and electroretinography.. A platinum electrode array in a wide silicone substrate was implanted unilaterally in the suprachoroidal space in adult cats (n = 7). The lead and connector were tunneled out of the orbit and positioned subcutaneously. Postsurgical recovery was assessed using fundus photography and electroretinography (ERG). Following 3 months of passive implantation, the animals were terminated and the eyes assessed for the pathologic response to implantation.. The implant was mechanically stable in the suprachoroidal space during the course of the study. The implanted eye showed a transient increase in ERG response amplitude at 2 weeks, which returned to normal by 3 months. Pigmentary changes were observed at the distal end of the implant, near the optic disc. Histopathologic assessment revealed a largely intact retina and a thin fibrous capsule around the suprachoroidal implant cavity. The foreign body response was minimal, with sporadic presence of macrophages and no active inflammation. All implanted eyes were negative for bacterial or fungal infections. A midgrade granuloma and thick fibrous buildup surrounded the extraocular cable. Scleral closure was maintained in six of seven eyes. There were no staphylomas or choroidal incarceration.. A wide-field retinal prosthesis was stable and well tolerated during long-term suprachoroidal implantation in a cat model. The surgical approach was reproducible and overall safe.

Topics: Animals; Cats; Choroid; Electrodes, Implanted; Electroretinography; Foreign-Body Reaction; Fundus Oculi; Models, Animal; Postoperative Complications; Prosthesis Implantation; Time Factors; Tretinoin; Visual Prosthesis

Lymphedema is mainly caused by lymphatic obstruction and manifested as tissue swelling, often in the arms and legs. Lymphedema is one of the most common post-surgical complications in breast cancer patients and presents a painful and disfiguring chronic illness that has few treatment options. Here, we evaluated the therapeutic potential of interleukin (IL)-8 in lymphatic regeneration independent of its pro-inflammatory activity. We found that IL-8 promoted proliferation, tube formation, and migration of lymphatic endothelial cells (LECs) without activating the VEGF signaling. Additionally, IL-8 suppressed the major cell cycle inhibitor CDKN1C/p57(KIP2) by downregulating its positive regulator PROX1, which is known as the master regulator of LEC-differentiation. Animal-based studies such as matrigel plug and cornea micropocket assays demonstrated potent efficacy of IL-8 in activating lymphangiogenesis in vivo. Moreover, we have generated a novel transgenic mouse model (K14-hIL8) that expresses human IL-8 in the skin and then crossed with lymphatic-specific fluorescent (Prox1-GFP) mouse. The resulting double transgenic mice showed that a stable expression of IL-8 could promote embryonic lymphangiogenesis. Moreover, an immunodeficient IL-8-expressing mouse line that was established by crossing K14-hIL8 mice with athymic nude mice displayed an enhanced tumor-associated lymphangiogenesis. Finally, when experimental lymphedema was introduced, K14-hIL8 mice showed an improved amelioration of lymphedema with an increased lymphatic regeneration. Together, we report that IL-8 can activate lymphangiogenesis in vitro and in vivo with a therapeutic efficacy in post-surgical lymphedema.

Topics: Animals; Cell Proliferation; Cells, Cultured; Cyclin-Dependent Kinase Inhibitor p57; Down-Regulation; Embryonic Development; Endothelial Cells; Homeodomain Proteins; Humans; Interleukin-8; Lymphangiogenesis; Lymphatic Vessels; Lymphedema; Mice; Mice, Transgenic; Neovascularization, Physiologic; Postoperative Complications; Receptors, Interleukin-8; Receptors, Interleukin-8A; Receptors, Interleukin-8B; Regeneration; Tretinoin; Tumor Microenvironment; Tumor Necrosis Factor-alpha; Tumor Suppressor Proteins

All-trans retinoic acid (ATRA), a vitamin A derivative, is prescribed for induction of chemotherapy in patients with acute promyelocytic leukemia. Like other chemotherapy agents, ATRA has an adverse effect known as retinoic acid syndrome. The case of a 22 year old woman with acute promyelocytic leukemia, who received ATRA and subsequently developed retinoic acid syndrome, is presented. The patient's symptoms resolved after administration of dexamethasone, allowing the completion of chemotherapy without further complications.

Topics: Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Dexamethasone; Female; Glucocorticoids; Humans; Hypotension; Intraoperative Complications; Leukemia, Promyelocytic, Acute; Lung Diseases; Postoperative Complications; Syndrome; Tooth Extraction; Tretinoin; Young Adult

A 39-yr-old woman underwent general anesthesia for laparoscopic sterilization. We used adhesive tapes to close her eyelids and to secure the tracheal tube. Removal of the tapes caused patchy areas of skin loss. We later discovered that the patient had fragile facial skin from cosmetics containing skin exfoliants. We recommend taking a detailed drug history before anesthesia and avoiding adhesive tapes to the patient's face under general anesthesia.

Topics: Adhesives; Aged; Cosmetics; Face; Female; Humans; Keratolytic Agents; Laparoscopy; Postoperative Complications; Skin; Sterilization, Tubal; Tretinoin

Renal function was monitored in 20, living-related kidney donors before and after uninephrectomy. Urinary protein excretion and retinoid metabolism respectively were studied in 10 and 6 of these donors. The functional adaptation was characterized by an increase in glomerular filtration rate and tubular function, which began in the first two days after uninephrectomy. Changes in tubular function were also demonstrated by significant increases in the urinary excretion of beta 2 microglobulin (beta 2M), retinol binding protein (RBP), kappa and lambda light chains of immunoglobulins. In addition, a protein identical to or homologous to cellular retinoic acid binding protein (CRABP), appeared in the urine after nephrectomy. We did not find CRABP in serum samples either before or after nephrectomy, suggesting that urinary CRABP was synthesized by the remaining kidney. Increases in serum levels of Vitamin A and RBP were also observed in the post-nephrectomy period. These modifications in retinol metabolism suggest that these substances could have a role as renotropic growth factors in compensatory hypertrophy.

Topics: Adult; beta 2-Microglobulin; Carrier Proteins; Creatinine; Female; Glomerular Filtration Rate; Humans; Immunoglobulin kappa-Chains; Immunoglobulin lambda-Chains; Kidney Function Tests; Kidney Transplantation; Male; Middle Aged; Nephrectomy; Postoperative Complications; Receptors, Retinoic Acid; Tissue Donors; Tretinoin

Despite the diverse causes of dry-eye disorders, the ocular surface epithelia in these diseases all undergo squamous metaplasia, manifested by loss of goblet cells, mucin deficiency, and keratinization. These changes account for tearfilm instability, which leads to various ocular symptoms and corneal complications. This article reviews research in the use of topical tretinoin to treat severe dry-eye disorders. To classify squamous metaplasia into stages, a modified impression cytology technique was used to monitor the therapeutic effect of topical tretinoin ointment (0.01% or 0.1%, w/w) in 22 patients. This population had severe dry-eye disorders, including keratoconjunctivitis sicca, Stevens-Johnson syndrome, inactive ocular pemphigoid, drug-induced pseudopemphigoid, and surgery- or radiation-induced dry eyes. After treatment, clinical improvements were correlated with the reversal of squamous metaplasia as evidenced by the impression cytology technique. Tretinoin may also be effective in treating conjunctival keratinization without dry eyes, as illustrated by a case study. This may represent the first reported attempt to treat ocular surface disorders by reversing diseased epithelium.

Topics: Administration, Topical; Adolescent; Eye Diseases; Female; Humans; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Pemphigoid, Benign Mucous Membrane; Postoperative Complications; Radiotherapy; Skin Diseases, Vesiculobullous; Stevens-Johnson Syndrome; Tretinoin

We evaluated the clinical efficacy of treating various dry-eye disorders using 0.01% and 0.1% (weight/weight) topical all-trans retinoic acid ointment. Twenty-two patients were selected and classified into four major groups: keratoconjunctivitis sicca (6 patients; 11 eyes), Stevens-Johnson syndrome (9 patients; 17 eyes), ocular pemphigoid or drug-induced pseudopemphigoid (3 patients; 6 eyes), and surgery or radiation-induced dry eye (4 patients; 4 eyes), based on the criterion that they remained symptomatic even under maximum tolerable conventional medical and/or surgical therapies. The results indicated that squamous metaplasia with mucin deficiency secondary to goblet cell loss and keratinization may be the basis for the development of clinical symptoms and morbidities, as these epithelial abnormalities were invariably present before treatment. After treatment, all patients demonstrated clinical improvements in symptoms, visual acuity, rose Bengal staining, or Schirmer test. Most importantly, this topical vitamin A treatment caused the reversal of squamous metaplasia as evidenced by impression cytology. Therefore, this treatment may represent the first nonsurgical attempt to treat these disorders by reversing diseased ocular surface epithelium.

Topics: Administration, Topical; Adolescent; Adult; Aged; Child; Child, Preschool; Eye; Female; Humans; Keratoconjunctivitis; Lacrimal Apparatus Diseases; Male; Metaplasia; Middle Aged; Ointments; Pemphigoid, Benign Mucous Membrane; Postoperative Complications; Radiotherapy; Stevens-Johnson Syndrome; Tretinoin; Visual Acuity; Xerophthalmia