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Background and Aims: There is a paucity of data in the literature on the surgical management of conjunctival dermolipoma. In this study, we report outcomes of a partial mass excision technique (excision of the portion visible when eyes open) and free conjunctival autograft., Methods: Medical records of 13 patients with dermolipoma who had undergone partial mass excision at Seoul National University Hospital from January 1999 to May 2014 were retrospectively reviewed. After resection of the visible part of tumour, including the overlying thick surface conjunctiva, the conjunctival defects were reconstructed with free conjunctival autograft harvested from the contralateral superior bulbar area., Results: The median postoperative follow-up period was 5 months (range 1-84 months). The cosmetic surgical results were satisfactory in all 13 patients. Three patients showed thick texture on the grafted surgical area postoperatively, but there was no significant scar formation resulting in restrictive symblepharon or eye movement limitation. There were no other significant complications, such as blepharoptosis, diplopia or keratoconjunctivitissicca during the follow-up period., Conclusions: Partial mass (visible part only) excision, including that of the overlying thick conjunctiva, and free conjunctival autograft from the opposite eye, is a relatively simple and effective technique for the surgical management of conjunctival dermolipoma., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Purpose: To evaluate the efficacy of combined trabeculectomy (TLE) and 25-gauge transconjunctival sutureless vitrectomy (TSV-25) for uveitis patients., Methods: Combined TSV-25/TLE was performed in 9 eyes of 6 patients with vitreoretinal complications and intractable glaucoma. Visual acuity, intraocular pressure (IOP), inflammatory control, and number of hypotensive medications were evaluated., Results: Visual acuity improved in 7 of 9 eyes and inflammation was controlled with a decreased oral anti-inflammatory agent dosage in all eyes. Mean IOP, which was 28.11 ± 4.83 mmHg preoperatively, was significantly reduced (15.77 ± 2.68 mmHg) 5 years after surgery (p = 0.008). The mean number of IOP-lowering medications was 3.33 ± 0.71 before surgery and 1.11 ± 0.92 5 years after surgery (p = 0.007). Two eyes required implant of an Ahmed drainage valve during the follow-up period., Conclusion: Combined TSV-25/TLE can be effective in managing vitreoretinal complications and elevated IOP in uveitis patients.

Dry eye syndrome (DES) is one of the most common ocular diseases affecting nearly 10% of the US population. Most of the currently available treatments are palliative, and few therapeutic agents target biological pathway of DES. Although DES is a multifactorial disease, it is well-known that inflammation in the ocular surface plays an important role in the pathogenesis of DES. Mesenchymal stem/stromal cells (MSCs) have been shown to repair tissues by modulating excessive immune responses in various diseases. Therefore, we here investigated the therapeutic potential of MSCs in a murine model of an inflammation-mediated dry eye that was induced by an intraorbital injection of concanavalin A. We found that a periorbital administration of MSCs reduced the infiltration of CD4(+) T cells and the levels of inflammatory cytokines in the intraorbital gland and ocular surface. Also, MSCs significantly increased aqueous tear production and the number of conjunctival goblet cells. Subsequently, corneal epithelial integrity was well-preserved by MSCs. Together, the results demonstrate that MSCs protect the ocular surface by suppressing inflammation in DES, and suggest that MSCs may offer a therapy for a number of ocular surface diseases where inflammation plays a key role.

Purpose: To assess the efficacy of autologous serum eye drops (AS) in enhancing conjunctivalization over a scleral patch graft on exposed porous polyethylene orbital implant (Medpor(®))., Methods: Eighteen rabbits were underwent evisceration, implantation of Medpor(®) and homologous scleral patch graft. The conjunctival edge was sutured leaving 5 mm-diameter circular defect. In group A, 20% AS were applied 8 times a day and only balanced salt solution was applied in group B. Digital anterior segment photography was obtained 1, 3, 7, 10, 14, and 21 days after surgery and analyzed with Image Pro Plus(®) software., Results: In the early postoperative period, the average conjunctival growth rate (mm(2)/day) was faster in group A, but failed to show statistical significance (3.79 vs. 3.03, p = 0.26 in 1~3days, 2.39 vs. 1.80, p = 0.59 in 4- days, 0.03 vs. -0.02, p = 0.94 in 7-10 days, Mann-Whitney test). The complete healing rate was higher (67% vs. 56%, p = 0.5, Fisher's exact test) and the mean elapsed time for complete healing (days) was shorter in group A (17.3 vs. 18.2, p  = 0.83, Mann-Whitney test), but did not show a statistically significant difference., Conclusion: In a rabbit model, 20% AS did not appear to facilitate the healing of small conjunctival defects of exposed porous orbital implant.

Purpose: To evaluate the cytologic features of conjunctival epithelium in anophthalmic sockets with an ocular prosthesis, using an impression cytology technique and to determine the clinical factors associated with these changes., Methods: In a prospective case-controlled study, 40 consecutive unilateral anophthalmic patients who wore an ocular prosthesis were recruited. A questionnaire on the care of the prosthesis included total wearing period, frequency of cleaning, frequency of polishing, cleaning solution, and eye drop use. The degree of inflammation of the anophthalmic conjunctival socket was evaluated. Impression cytology specimens were taken from the upper tarsal conjunctiva, the bulbar conjunctiva, and the lower tarsal conjunctiva of each socket, and from the contralateral eye (to serve as an internal matched control). The goblet cell density and the nucleus-to-cytoplasm ratio of the epithelial cells were measured. The relevance of these conjunctival cytologic features to the various factors of prosthesis care or conjunctival inflammation was analyzed., Results: In the anophthalmic sockets, the conjunctiva showed squamous metaplasia at all 3 areas sampled. The goblet cell density was significantly decreased and the nucleus-to-cytoplasm ratio of the epithelial cells was significantly increased compared with the control eyes (p<0.05, on all 3 areas sampled, Wilcoxon signed rank test). These conjunctival cytologic changes were not significantly associated with total wearing time, frequency of polishing, cleaning solution, or eye drops use (p>0.05, Spearman's correlation test)., Conclusions: Squamous metaplasia with decreased goblet cell density and increased nucleus-to-cytoplasm ratio occurred in anophthalmic conjunctival sockets but was not associated with particular aspects of prosthesis care.

Although the clinical activity score (CAS) is a validated scoring system for identifying disease activity of thyroid-associated orbitopathy (TAO), it may produce differing results depending on the evaluator, and an experienced ophthalmologist is required for accurate evaluation. In this study, we developed a machine learning (ML)-assisted system to mimic an expert's CAS assessment using digital facial images and evaluated its accuracy for predicting the CAS and diagnosing active TAO (CAS ≥ 3). An ML-assisted system was designed to assess five CAS components related to inflammatory signs (redness of the eyelids, redness of the conjunctiva, swelling of the eyelids, inflammation of the caruncle and/or plica, and conjunctival edema) in patients' facial images and to predict the CAS by considering two components of subjective symptoms (spontaneous retrobulbar pain and pain on gaze). To train and test the system, 3,060 cropped images from 1020 digital facial images of TAO patients were used. The reference CAS for each image was scored by three ophthalmologists, each with > 15 years of clinical experience. We repeated the experiments for 30 randomly split training and test sets at a ratio of 8:2. The sensitivity and specificity of the ML-assisted system for diagnosing active TAO were 72.7% and 83.2% in the test set constructed from the entire dataset. For the test set constructed from the dataset with consistent results for the three ophthalmologists, the sensitivity and specificity for diagnosing active TAO were 88.1% and 86.9%. In the test sets from the entire dataset and from the dataset with consistent results, 40.0% and 49.9% of the predicted CAS values were the same as the reference CAS, respectively. The system predicted the CAS within 1 point of the reference CAS in 84.6% and 89.0% of cases when tested using the entire dataset and in the dataset with consistent results, respectively. An ML-assisted system estimated the clinical activity of TAO and detect inflammatory active TAO with reasonable accuracy. The accuracy could be improved further by obtaining more data. This ML-assisted system can help evaluate the disease activity consistently as well as accurately and enable the early diagnosis and timely treatment of active TAO. [ABSTRACT FROM AUTHOR]

Purpose: To assess the efficacy of autologous serum eye drops (AS) in enhancing conjunctivalization over a scleral patch graft on exposed porous polyethylene orbital implant (Medpor®®). Methods: Eighteen rabbits were underwent evisceration, implantation of Medpor®® and homologous scleral patch graft. The conjunctival edge was sutured leaving 5 mm-diameter circular defect. In group A, 20% AS were applied 8 times a day and only balanced salt solution was applied in group B. Digital anterior segment photography was obtained 1, 3, 7, 10, 14, and 21 days after surgery and analyzed with Image Pro Plus®® software. Results: In the early postoperative period, the average conjunctival growth rate (mm2/day) was faster in group A, but failed to show statistical significance (3.79 vs. 3.03, p == 0.26 in 1~3days, 2.39 vs. 1.80, p == 0.59 in 4--7days, 0.03 vs. -0.02, p == 0.94 in 7--10 days, Mann-Whitney test). The complete healing rate was higher (67% vs. 56%, p == 0.5, Fisher''s exact test) and the mean elapsed time for complete healing (days) was shorter in group A (17.3 vs. 18.2, p == 0.83, Mann-Whitney test), but did not show a statistically significant difference. Conclusion: In a rabbit model, 20% AS did not appear to facilitate the healing of small conjunctival defects of exposed porous orbital implant. [ABSTRACT FROM AUTHOR]