Label-retaining cells are preferentially located in fornical epithelium: implications on conjunctival epithelial homeostasis

PURPOSE: To determine the cell kinetic properties of epithelial cells from various zones of the conjunctiva. METHODS: The morphology and cell kinetics of bulbar, fornical, and palpebral conjunctival epithelium were studied in neonatal and adult SENCAR mice. To examine the proliferative rate of the conjunctival epithelium, a single administration of tritiated thymidine (3H-TdR) was used to detect cells in "S" phase. Proliferative rates were also assessed by determining mitotic activity after an intraperitoneal injection of colchicine to arrest cells in mitosis. To detect slow-cycling cells, mice received 3H-TdR continuously for 1 week. After a 4-week chase, animals were sacrificed and eyes were surgically removed. All tissues were immediately fixed in formalin and processed for histology and autoradiography. RESULTS: Slow-cycling cells, detected as label-retaining cells (LRCs), were identified in bulbar, fornical, and palpebral epithelia, as well as in limbal epithelium. The greatest number of LRCs was found in fornical epithelium. In addition, we found a number of label-retaining goblet cells. This cell population was shown to incorporate 3H-TdR after a single pulse administration, and mitotic figures were seen in goblet cells after colchicine treatment, indicating that conjunctival goblet cells have proliferative capabilities. CONCLUSIONS: These findings are consistent with earlier in vitro data that the fornical epithelium may be a zone enriched in conjunctival epithelial stem cells. This has important implications in conjunctival epithelial development and is relevant in wound repair. Furthermore, the concept that goblet cells are slow-cycling cells with proliferative capabilities provides new insights into the area of conjunctival homeostasis.     

Single intraoperative application versus postoperative mitomycin C eye drops in pterygium surgery

PURPOSE: To determine the minimum effective dosage, most effective route of administration and long-term effects of mitomycin C for prevention of recurrence after pterygium surgery. METHODS: In a prospective, masked study, 227 patients undergoing surgery for primary pterygia were assigned randomly to five groups: group 1 received a single intraoperative application of 0.2 mg/ml mitomycin C for 3 minutes; group 2 received a single intraoperative application of 0.4 mg/ml mitomycin C for 3 minutes; group 3 received mitomycin C eye drops 0.2 mg/ml three times daily for 7 days; group 4 received mitomycin C eye drops 0.4 mg/ml three times daily for 14 days; group 5 acted as a control (surgery alone). RESULTS: After a mean follow-up time of 28 months, recurrence rates of 6.66%, 4.08%, 4.26%, 4.44%, and 29.27%, respectively, were observed. Statistical analysis showed significant differences between groups receiving mitomycin C and the control (P < or = 0.001). There was no statistical difference among treated groups (P > or = 0.0681). No complications of therapy were observed. CONCLUSION: These results support the efficacy and relative safety of a single, low-concentration, intraoperative application of mitomycin C in pterygium surgery together with the use of a conjunctival flap, avoiding excessive cauterization of the sclera and leaving bare sclera.     

Subconjunctival mitomycin C for the treatment of ocular cicatricial pemphigoid

PURPOSE: The authors performed a prospective evaluation of the efficacy of treating ocular cicatricial pemphigoid (OCP) with subconjunctival mitomycin C. DESIGN: Unmasked, prospective, internally controlled case series. METHODS: Patients were eligible for treatment with subconjunctival mitomycin C under three criteria: (1) significant complications of systemic immunosuppressant therapy; (2) markedly asymmetric conjunctival disease; and (3) end-stage OCP. All patients received monocular subconjunctival injections of 0.25 ml of 0.2 mg/ml mitomycin C to both the superior and inferior bulbar conjunctivae in the eye with the more severe disease. RESULTS: Nine eyes of nine patients (mean age, 74 years) were treated with subconjunctival mitomycin C to the more-involved eye and were followed for a mean of 23.5 months (range, 12-40 months). Eight of nine patients showed quiescence of their OCP in the treated eye based on serial evaluation of conjunctival cicatrization and grading of conjunctival erythema. Five of the nine untreated eyes showed progression of the conjunctival disease. One patient required concomitant systemic immunosuppressive therapy after subconjunctival mitomycin C. Two patients underwent successful visual rehabilitative surgery in the mitomycin C-treated eye. CONCLUSION: The use of subconjunctival mitomycin C may be effective in preventing progression of conjunctival cicatrization and erythema in patients with OCP. No complications of mitomycin C treatment were noted. Long-term follow-up and further investigation into the efficacy of subconjunctival mitomycin C in the management of OCP is warranted.     

Activation and detoxification of dinitropyrenes by cytosol and microsomes from Aroclor-pretreated rats in the Ames and umu assays

PURPOSE: To evaluate the efficacy of topical mitomycin C in treating conjunctival and corneal epithelial dysplasia and neoplasia. METHODS: Seven eyes of seven patients with conjunctival and corneal epithelial dysplasia and neoplasia were treated with one drop of topical mitomycin C 0.04% four times a day for 7 days in alternate weeks. The patients' charts were reviewed retrospectively. Patients with either multiple recurrences or extensive ocular surface involvement were treated. In all eyes, the diagnosis of epithelial dysplasia or neoplasia was confirmed by histopathology before the onset of therapy. Patients were examined at least every 14 days during treatment and examined at intervals after completion of treatment. RESULTS: With topical mitomycin C, six eyes of seven patients had complete clinical regression of their conjunctival and corneal epithelial dysplasia and neoplasia. One eye of one patient had partial clinical regression of conjunctival and corneal epithelial dysplasia. Follow-up after completion of topical mitomycin C therapy and excision of residual disease ranged from 2 to 16 months (mean, 9 months; SD, 4.3 months) and was without clinical sign of recurrence. Topical mitomycin C therapy was associated with transitory ocular discomfort, conjunctival injection, tearing, photophobia, and punctate epithelial keratopathy. CONCLUSION: In this small series of eyes, topical mitomycin C was effective as a treatment for conjunctival and corneal epithelial dysplasia and neoplasia.     

The utilization of a biological adhesive for wound treatment: comparison of suture, self-sealing sutureless and cyanoacrylate closure in the tensile strength test

We produced a measurement apparatus for testing the tensile strength of wounds during cataract surgery, and tested the tensile strength of treated wounds including wounds sutured with various methods, non-sutured and wounds treated with various bio-tissue adhesives. METHODS: In cataract surgery on white rabbits eyes, a corneoscleral incision 5 mm in length was made 2.5 mm from the limbus corneae, and entry into the anterior chamber was obtained 0.5 mm to the clear cornea. After treatment for closure, the corneoscleral piece was subjected to the tensile strength test. RESULTS: The tensile strengths just after surgery were (1) 0 gf/mm2 after self-sealing sutureless closure; (2) 114 gf/mm2 after vertical suture closure (one stitch with 10-0 nylon); (3) 125 gf/mm2 after horizontal suture closure (one stitch with 10-0 nylon); (4) 143 gf/mm2 after infinity suture closure (with 10-0 nylon); (5) 112 gf/mm2 after fibrin glue (Beriplast P) application (instilled on the surface of scleral incision); (6) 121 gf/mm2 after fibrin glue application (glued on corneoscleral wound); (7) 131 gf/mm2 after cyanoacrylate closure (instilled on the surface of scleral incision); (8) 139 gf/mm2 after cyanoacrylate closure (glued on corneoscleral wound). The respective strengths at four days after surgery were: (1) 86; (2) 131; (3) 137; (4) 175; (5) 109; (6) 43; (7) 138; and (8) 108 gf/mm2. At 28 days after surgery, the respective strengths were (1) 164; (2) 167; (3) 184; (4) 209; (5) 322; (6) 195; (7) 251; and (8) 175 gf/mm2. CONCLUSION: The use of fibrin glue in treatment of a wound in cataract surgery is beneficial in assisting this treatment.     

Effect of local administration of mitomycin C on intraocular pressure

BACKGROUND: Animal studies suggest that the decrease of intraocular pressure after application of mitomycin C is particularly mediated by toxic effects on the substance of ciliary body. Moreover it has been shown that the concentration of mitomycin C after topical application in the aqueous humour is as high when performing fistulating surgery. In this prospective study we wanted to investigate whether the topical application of mitomycin C would result in a significant decrease of intraocular pressure. PATIENTS AND METHODS: Forty-one eyes of 41 patients underwent pterygium surgery using a bare sclera technique. Afterwards phototherapeutic keratectomy with the excimer laser (193 nm) was performed in the area of the excision. In hospital mitomycin C eye drops (0.02%) were given twice daily for four days. The intraocular pressure of treated and untreated eyes was measured with applanation tonometry at least three times per day preoperatively, postoperatively at the fourteenth day and after 6 month. RESULTS: Mean intraocular pressure of the treated eyes was preoperatively 15.73 +/- 2.35 mm Hg, 14 days postoperatively 15.92 +/- 2.79 mm Hg and at the last examination 15.86 +/- 2.39 mm Hg. For untreated eyes the mean intraocular pressure was preoperatively 15.70 +/- 2.04 mm Hg, after 14 days 15.76 +/- 2.96 mm Hg and at the last examination 15.89 +/- 2.67 mm Hg. Consequently there was no statistically significant change of intraocular pressure in the eyes treated with mitomycin C. Furthermore there were no significant differences of intraocular pressure between treated and untreated eyes at any time of postoperative check-up. CONCLUSION: The short-term local application of mitomycin C did not result in a detectable change of intraocular pressure and is therefore probably an alternative to intraoperative application during filtration surgery.     

Conjunctival wound closure by saline injection in sutureless, scleral tunnel incision phacoemulsification

PURPOSE: To compare two methods of conjunctival closure in phacoemulsification. SETTING: Frimley Park Hospital NHS Trust, Surrey, England. METHODS: This prospective, randomized study comprised 40 patients (40 eyes) who had phacoemulsification via superior axis scleral tunnels and implantation of a poly(methyl methacrylate) intraocular lens with a 5.5 mm optic diameter. In 24 eyes, the conjunctival wound was closed manually with a Moorfields forceps (Group A). In 16, 0.5 ml of balanced salt solution was injected subconjunctivally to reappose the conjunctival wound (Group B). Conjunctival reapposition was assessed by measuring the maximum radial distance of bare sclera preoperatively and during outpatient clinic visits at 1, 7, and 28 days postoperatively. RESULTS: Follow-up was obtained on 38 eyes. One day after surgery, total wound closure was achieved in 15 of 16 eyes in Group B; however, closure was still incomplete in 13 of 22 Group A eyes. At 7 days postoperatively, the size of the conjunctival wound remained significantly smaller in Group B eyes (P < .01). CONCLUSION: The saline injection produced a faster rate of conjunctival wound closure than standard manual reapposition.     

In vitro activity of SCH 27899 (Ziracin) against Legionella species

PURPOSE: To report the efficacy of topical mitomycin C in preventing local recurrences after incomplete surgical excision of conjunctival squamous cell neoplasia. METHODS: Four patients presented with unilateral conjunctival tumors. Excisional biopsy results revealed conjunctival intraepithelial neoplasia with an intact basement membrane. Neoplastic cells were present in at least one of the surgical borders of the excised conjunctiva in all four cases. Patients were treated with topical mitomycin C 0.02% three times daily for 2 weeks to prevent recurrences. RESULTS: All four patients were free of clinically detectable tumors after a mean follow-up period of 20 months (range, 16-23 months). Side effects included mild discomfort, redness, photophobia, and punctate epithelial keratopathy that subsided on discontinuation of the medication. CONCLUSION: Postoperative topical mitomycin C application may be a useful adjunct to prevent recurrences in patients with incompletely excised conjunctival squamous cell neoplasia.     

Effect of a local nonsteroidal anti-inflammatory drug on postoperative irritation after squint surgeries. Prospective randomized double-blind study

BACKGROUND: Topical application of a nonsteroidal antiphlogistic drug (NSAD) is often recommended to minimize postoperative lid and conjunctival edema. However, the effectiveness of such therapy remains controversial. PATIENTS AND METHODS: The study presented included 100 patients aged 23.6 +/- 19.5 (5 to 77) years, who were randomly assigned to two treatment groups. Group 1 included 50 patients who underwent squint surgery, and who received Flurbiprofen ED twice a day from the first preoperative day to the third postoperative day. Group 2 served as a control group. These patients were treated with the same regimen using artificial tears. The extent of lid and conjunctival edema was assessed and scored from 1 to 4 on the fourth postoperative day. RESULTS: Squint surgery was performed on 129 eyes of 100 patients. In 32 eyes (24.8%) one muscle was operated on. In 79 eyes (61.2%) 2 muscles and in 18 eyes (14%) three muscles were operated on. The average postoperative conjunctival edema score was 2.08 +/- 0.62 (Flurbiprofen group) and 2.04 +/- 0.67 (control group), respectively. The scoring values for lid edema were 1.90 +/- 0.54 and 1.82 +/- 0.43. The differences between the two groups were not statistically significant (P = 0.21 and 0.39; Mann-Whitney test). No influence of the patient's age on the development of lid and conjunctival edema could be detected (P > 0.08). However, the number of muscles that were operated on had a significant influence on both parameters (P = 0.01 and 0.028). Single muscle operations revealed the lowest scaling values (P < 0.02 and P < 0.04). No difference was found whether 2 or 3 muscles were operated on (P = 0.24 and 0.12). CONCLUSIONS: No beneficial effect of topical application of NSAD on postoperative lid and conjunctival edema could be found in this controlled study.     

Morphological differentiation of the conjunctival goblet cells in the chick (Gallus domesticus)

BACKGROUND: These is no consensus in the literature regarding the differentiation of conjunctival goblet cells in vertebrates. METHOD: The conjunctival epithelium of the chick was studied before and after hatching in order to demonstrate the morphological evolution of the goblet cells. The entire conjunctiva was processed for light microscopy either on semithin sections stained with toluidine blue-pironine or on traditional sections stained with Alcian blue pH 2.5-PAS. RESULTS: It was possible to demonstrate that goblet cells underwent remarkable changes in their secretory activity. At 12 h after hatching, isolated Alcian blue-positive cells were present in the fornix. At 24 h after hatching, cells positive for both Alcian blue and PAS were scattered among epithelial cells. Two days after hatching, cells which reacted positively only to PAS were also present. CONCLUSION: It is suggested that the differentiation of conjunctival goblet cells occurs first in the fornix, probably due to the particular vascular environment of this region, and then spreads all over the conjunctiva.     

The phylogenetic position of alpha- and beta-tubulins from the Chlorarachnion host and Cercomonas (Cercozoa)

The purpose of this study was to investigate the effect of acid conditioning of root surfaces during recombinant human bone morphogenetic protein-2 (rhBMP-2) induced periodontal regeneration in vivo. The buccal aspect of molar roots were denuded of their periodontal ligament through a bony window created in the mandible of 34 Wistar rats under general anesthesia. Three groups of 11 or 12 animals received either 10 microL of 50 g/mL rhBMP-2 in a collagen gel over the surgical defect (BMP) or 10 microL of collagen gel only (COL) or were left untreated (UN). Each of the 3 groups were further subdivided into those that received prior root acid conditioning with 35% phosphoric acid gel and those without acid conditioning. Animals were sacrificed 10 days after surgery and the tissues processed for histological examination. The BMP groups with and without acid conditioning developed significantly more bone over the second molar (3.89+/-0.86% and 7.62+/-0.93%, respectively; mean+/-SE), compared with the respective COL (1.24+/-0.26% and 2.77+/-0.52%) and UN groups (1.34+/-0.35% and 3.69+/-0.37%) (P <0.05). Furthermore, significantly more bone was found in the BMP non-acid conditioned group compared with all other groups (P <0.05). Acid conditioning promoted significantly more ankylosis (50%) compared with non-acid conditioning (6.3%) (P=0.007). New cementum formation was greatest in the BMP acid conditioned group (628.4+/-253.8 microm2) and lowest in the non-acid conditioned UN group (207.6+/-36.4 microm2) (P <0.05). This is the first known report evaluating the effects of root acid conditioning after a single application of rhBMP-2 in vivo. Results suggest that root conditioning agents operating at low pH administered into the periodontal wound impairs early BMP-induced osteogenesis while simultaneously promoting BMP-induced cementogenesis.     

Confocal microscopic characterization of wound repair after photorefractive keratectomy

PURPOSE: Development of postoperative corneal haze and regression of refractive effect are unfavorable clinical complications of excimer laser photorefractive keratectomy (PRK). Although exact mechanisms remain to be elucidated, these outcomes have been attributed to post-PRK corneal wound healing. The purpose of this study was to evaluate corneal wound repair quantitatively after PRK in a rabbit model using a newly developed in vivo technique, termed confocal microscopy through focusing (CMTF). METHODS: Twelve rabbit corneas received a monocular, 6-mm diameter, 9.0-diopter PRK myopic correction. Animals were evaluated sequentially up to 6 months after surgery by in vivo CMTF, which uses an image-intensity depth profile to measure epithelial and stromal thickness and uses corneal light reflectivity as an objective estimate of corneal haze. At differing temporal intervals, in vivo morphology was correlated with ex vivo histology using fluorescence microscopy. RESULTS: One week after PRK, an acellular layer of 86 +/- 24 microns was found anteriorly in the remaining stroma, which demonstrated surgically induced keratocyte death. Underlying keratocytes became activated and migrated toward the wound bed; repopulation was completed within 3 weeks. One week after PRK, there was a significant increase (P < 0.001) in light reflections detected from the photoablated stromal surface (1745 +/- 262 U) and from the underlying activated fibroblasts (713 +/- 607 U). Corneal reflectivity peaked at 3 weeks (4648 +/- 1263 U) and decreased linearly to 889 +/- 700 U by 6 months after the PRK; this corresponded to a reflectivity six times greater than the level seen in unoperated corneas. Two weeks after PRK, initial corneal edema had resolved, revealing an actual ablation depth (maximal stromal thinning) of 118 +/- 8 microns. Starting at 2 weeks after surgery, the stroma underwent gradual rethickening that reached 98% of the preoperative thickness at 6 months after PRK; at that time, only 6% of the initial photoablation depth persisted. By contrast, the central corneal epithelium showed no significant postoperative hyperplasia. CONCLUSIONS: Rabbit corneas treated by PRK showed a remarkable stromal wound-healing response that ultimately led to the restoration of the original stromal thickness by 6 months after surgery, demonstrating complete regression of the initial photoablative effect. Additionally, corneal wound healing was associated with increased light reflections from both the photoablated stromal surface and the activated wound-healing keratocytes underlying this area. Based on these findings, the authors hypothesize that the development of clinically observed corneal haze in PRK patients may be related, in part, to activation of corneal keratocytes and to putative changes in the extracellular matrix.     

N-linked glycoside and glucuronide conjugates of the retinoid, acitretin, are biologically active in cornea and conjunctiva

The purpose of this study was to test two water-soluble, synthetic retinoids, glucoseamido acitretin and glucuronamido acitretin, for biological activity in cells of the cornea and conjunctiva. Vitamin A-deficient, xerophthalmic rats were treated topically with these retinoids, and corneas were examined histologically for effects on epithelial keratinization. The effect of these retinoids on the proliferation of rabbit conjunctival fibroblasts in culture was also investigated. Glucoseamido acitretin treatment restored a normal cornea after eight to nine days of treatment, while no improvement was observed in the vehicle-treated corneas. Likewise, glucuronamido acitretin application restored a normal corneal surface and reversed keratinization after eight to ten days of treatment. These retinoids caused no irritation of the eye or ocular adnexa. In culture, exposure of conjunctival fibroblasts to glucoseamide acitretin inhibited cell proliferation. Cultures exposed to glucoseamido acitretin at 10(-8) M or 10(-6) M had cell densities 77.3% and 51.9% of control, respectively, after seven days. Glucuronamido acitretin also inhibited cell proliferation. Cultures exposed to glucuronamido acitretin at 10(-8) M had a cell density of 69.2% of control at day seven, while at 10(-6) M this retinoid completely inhibited cell proliferation. These results show that glucoseamide acitretin and glucuronamido acitretin are biologically active in the cornea and conjunctiva, and may be considered for ophthalmic use in diseases involving abnormalities of ocular surface cell differentiation or hyperproliferation of fibroblasts.     

Effect of mitomycin C on aqueous humor flow, flare and intraocular pressure in eyes with glaucoma 2 years after trabeculectomy

BACKGROUND: The purpose of this study was to determine the intraocular pressure (IOP), aqueous humor flow, flare and ocular side effects in eyes with a history of hypotony after trabeculectomy with adjunctive mitomycin C (MMC). METHODS: Thirty-six eyes with primary or secondary open-angle glaucoma and IOP < or = 8 mmHg during the postoperative period were studied 745 +/- 315 days after surgery. MMC (0.2 or 0.5 mg/ml) was applied to the episclera with a cellular sponge. Flare was studied with the Kowa Laser Flare Meter 500. Aqueous humor flow was measured in the afternoon (Fluorotron Master II). IOP, visual fields and best corrected visual acuity were also examined. Twenty-two contralateral eyes without surgical intervention served as controls. RESULTS: The mean age of patients was 44.5 +/- 16.8 years. The mean IOP was significantly lower in the MMC group than in the control group: 9.6 +/- 6.4 mmHg vs 18.0 +/- 13.6 mmHg at 2 years (P < 0.001). Aqueous flow was significantly lower in subjects treated with MMC than in controls (P < 0.001). The flare values were significantly higher in the MMC-treated group, with a mean of 12.0 +/- 7.7 photon counts/ms, than in the control group, mean 7.9 +/- 4.6 photon counts/ms (P < 0.019). CONCLUSION: Our data suggest that MMC is a useful ocular hypotensive agent which seems to participate in a change in aqueous humor dynamics when applied topically as an aqueous solution.     

New model of conjunctival scarring in the mouse eye

AIMS: To establish a simple model of conjunctival wound healing in the mouse eye. METHODS: 4 week old BABL/c mouse eyes were studied over a 14 day period. Surgical procedure under general anaesthesia involved a blunt dissection of the conjunctiva performed by injection of 25 microliters of PBS via a 27 gauge needle into one eye, while the contralateral eye was used as control. Mice were assessed clinically and sacrificed at 1, 2, 3, 7, and 14 days after surgery. Enucleated eyes were prepared for histological analysis. Development of scar tissue was studied with haematoxylin and eosin, oxidation aldehyde fuchsin, and van Gieson stains, with assessment of cellularity, extracellular matrix formation, and wound characterisation. RESULTS: Histological analysis revealed a marked and characteristic healing response initiated by a predominantly granulocytic inflammatory reaction at day 1 with peak fibroblast activity 3 days after surgery. Oxytalan fibres and newly laid collagen fibres were detected early in the subconjunctival wound area and up to 7 days after surgery. Remodelling and complete organisation of scar tissue was evident by day 14. CONCLUSION: A single subconjunctival injection in the mouse eye results in a marked and consistent healing response. This represents a simple, inexpensive, and reliable animal model of conjunctival scarring. The mouse is a biologically well characterised animal model and allows the use of a wide variety of molecular tools. There are potentially significant clinical applications, in particular in investigating the effects of modulating agents such as antimetabolites, growth factors, and their antagonists on conjunctival scarring.     

TGF-beta1 influences early gingival wound healing in rats: an immunohistochemical evaluation of stromal remodelling by extracellular matrix molecules and PCNA

The effect of topically applied transforming growth factor beta1 (TGF-beta1) on the rat gingival wound healing process after flap surgery was evaluated by immunohistochemistry for extracellular matrix molecules (ECM), such as tenascin, heparan sulfate proteoglycan (HSPG) and type IV collagen, and for proliferating cell nuclear antigen (PCNA) in fibroblasts. TGF-beta1 solution was applied to the surgical wound experimental sites. Two microg/microl were applied at the time of the operation, and 1 microg/microl at days 1 and 2 after surgery, with contralateral control sites receiving the vehicle alone. Periodontal tissues were histologically examined at 3 and 7 days post-surgery. Tenascin was found to be more strongly stained in the granulation tissue from experimental sites at 3 days post-surgery. At 7 days postsurgery, HSPG-positive areas in granulation tissue had become smaller and there was a prominent proliferation of PCNA-positive fibroblast-like cells and type IV collagen-positive blood vessels. These results suggest that TGF-beta1 applied to surgical wounds influences early proliferation of gingival fibroblast-like cells, the formation of blood vessels, and ECM remodelling. In conclusion, TGF-beta1 application appears to promote granulation tissue formation in periodontal wound healing.     

Mercury-induced renal immune complex deposits in young (NZB x NZW)F1 mice: characterization of antibodies/autoantibodies

PURPOSE: To observe the effect of intraoperative mitomycin C on the size of the osteotomy site after dacryocystorhinostomy.: METHODS: A total of 15 eyes of 14 patients diagnosed with primary acquired nasolacrimal duct obstruction were assigned randomly to either a mitomycin C group or a control group. The surgical procedures in both groups were exactly the same, except that in the patients in the mitomycin C group, a piece of neurosurgical cottonoid soaked with 0.2 mg/ml mitomycin C was applied to the osteotomy site and then after 30 minutes was removed transnasally. Nasoendoscopic findings were recorded at the completion of the surgery and at 1 month, 3 months, and 6 months after surgery for the two groups. A computer-aided digitizer was used to calculate the surface area of the osteotomy site, and a Student's t test was used to compare the difference between the two groups. RESULTS: All patients in the mitomycin C group remained symptom free after removal of their silicone tube (100% success), and there was one patient in the control group who had recurrent epiphora (87.5% success). Septo-osteotomy adhesion was found in two patients in the control group (25%), but there was no such adhesion found in the patients in the mitomycin C group. In the mitomycin C group, the average final surface area of the osteotomy at the end of the sixth postoperative month was 27.10 +/- 5.78 mm2, whereas that of the control group was only 10.83 +/- 3.37 mm2. Although the immediate postoperative surface area of the osteotomy showed no significant difference between the two groups, a statistically significant difference was noted at 6 months. CONCLUSION: Intraoperative mitomycin C is effective in maintaining a larger osteotomy size. This modification may possibly improve success rates over the traditional dacryocystorhinostomy procedure.     

Radial keratotomy. III. Relationship between wound gape and corneal curvature in primate eyes

The relationship between changes in wound gape and corneal curvature after radial keratotomy (RK) was evaluated in five primates. Four-incision RK was performed using a diamond knife set to 100% of central corneal thickness with a 3-mm optical zone. In vivo measurements of wound gape were obtained using tandem scanning confocal microscopy at 3, 7, 14, and 45 days after surgery. The changes in corneal contour were measured at the same time points using a corneal modeling system with a specially designed primate cone. Wounds progressively increased in width to a maximum of 38 +/- 1 microns (n = 5) at day 7. After day 7, wounds showed increasing fibrosis which correlated with decreasing wound gape to 20 +/- 1 microns at day 45. A similar temporal change was detected in central corneal curvature (K), with maximum flattening occurring at day 7 (delta K = -3.17 +/- 0.90 diopters, n = 5), and progressive regression of effect to -1.32 +/- 0.61 diopters (n = 5) at day 45. Although there was interanimal variation, the mean temporal changes in corneal curvature significantly paralleled the changes in wound gape (r = -0.96, n = 4, P < 0.05). Based upon these findings, a simple geometric model was proposed which provides a hypothetic foundation for the relationship between corneal curvature and wound gape after RK. Calculations of wound gape made from this analytic model (using the measured topographic data) showed significant correlation with the actual wound gape measurements (r = 0.96, n = 4, P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of tripeptide-copper complexes on the process of skin wound healing and on cultured fibroblasts

The effects of Gly-His-Lys-Cu and of three synthetic analogues (I, II and III) on wound healing of the guinea-pig dorsal skin, as well as on cultured fibroblasts, were examined. Gly-His-Lys-Cu and peptide I-Cu were tested in vivo. Hydroxyproline, proteins, DNA and semicarbazide-sensitive amine oxidase, with a high affinity for benzylamine, were measured, and the histology of the wounds was observed after staining with hematoxylin/eosin. Another set of wounds was treated in parallel with equivalent amounts of copper acetate. Gly-His-Lys-Cu and the analogues caused a decrease of the activity of semicarbazide-sensitive amine oxidase, with a high affinity for benzylamine, 4-8 days after surgery, followed by an increase on day 11 that was higher than in the control group. No significant difference was found between the two peptides. A slower reorganization of the skin and a delayed activation of fibroblasts are the main effects observed with these peptides-Cu complexes. Preliminary studies on cultured fibroblasts were monitored to see whether these peptides had a direct effect on fibroblasts. The products studied at a concentration of 10(-7) M, decreased cell reproduction and increased collagen expression.     

Non-penetrating deep sclerectomy combined with a collagen implant in primary open-angle glaucoma. Medium-term retrospective results

PURPOSE: To evaluate the middle term tonometric results of a new filtering procedure, the non penetrating deep sclerectomy with collagen device, in primary open-angle glaucoma. This technique aims to eliminate or minimize the complications of classical trabeculectomy. MATERIAL AND METHOD: This procedure has been developed by Koslov et al. Under a limbal-base conjunctival flap and a superficial scleral flap, the ablation of a deep scleral flap takes away the external wall of Schlemm's canal, leaving only the Descemet membrane. A visible filtration across the opened Schlemm's canal and Descemet membrane is obtained. To improve the aqueous filtration, a cylindric collagen device, made from biocompatible porcine scleral tissue, known for its high water content, is fixed in the deep scleral bed with a 10/0 nylon suture. This device provides a support for the elimination route of aqueous humor and acts like a sponge, carrying the liquid by capillary action. It is sterilized by irradiation. Full guarantee against viral contamination is provided. This procedure ends in one suture (40/0 nylon) of superficial scleral flap and conjunctival closing suture. We conducted a retrospective study. Our material included 159 patients (92 males, 65 females), 2/9 eyes. The mean age was 65 years (11-91). The mean follow-up : 8 months (3-20). The types of glaucoma were: POAG: 183 eyes; juvenile POAG: 18 eyes: pigmentary glaucoma: 11 eyes; capsular glaucoma: 7 eyes, 58 eyes (40 patients) presented one or several risk factors of failure for filtering surgery. RESULTS: The mean pre-operative IOP was 24 mmHg +/- 6.60; 15.7 +/- 5.30 at the end of the follow-up (delta average IOP: 9.1 +/- 7.1). The probability success rate (IOP < or = 20 mmHg), according to the Kaplan-Meier Method, was 89% at six months, 75.6% at 16 months. With monotherapy with beta blockers, 79% at 16 months. It was better in the without risk factors group. The mean change in visual acuity was inferior to 0.1 at the end of the follow-up. Except several hyphemas, no complications of the trabeculectomy were observed. The reelevation of IOP was due to an internal obstruction (goniosynechiae or bad filtration), it was treated with Nd-Yag laser with a 2/3 of success rate. External obstruction was treated by 5FU injections into the bleb. CONCLUSION: Non penetrating deep sclerectomy with collagen device can be an excellent alternative to trabeculectomy in open and wide angles. It does not modify visual actuity. It carries less complications than trabeculectomy and the use of antimitotic agents is safer.