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PubMed2000

TGF-beta1, -beta2, and -beta3 in vitro: biphasic effects on Tenon's fibroblast contraction, proliferation, and migration.

PURPOSE: To compare the effects of the three human transforming growth factor-beta (TGF-beta) isoforms and different concentrations of TGF-beta on human Tenon's capsule fibroblasts (HTF), with a view to delineating the role of this growth factor in the subconjunctival scarring response after glaucoma filtration surgery. METHODS: Application of recombinant human TGF-beta1, -beta2, and -beta3 (range 0-10(-8) M) was assessed using several assays of HTF function: fibroblast-mediated collagen contraction, proliferation, and migration. RESULTS: All three isoforms of TGF-beta behaved in a similar manner in vitro. They each stimulated HTF-mediated collagen contraction, proliferation, and migration with a characteristic concentration-dependent response, with peak activities at 10(-9), 10(-12), and 10(-9) M, respectively, that were significantly different from control (P<0.05). At concentrations above and below peak activities, HTF activity was reduced, demonstrating biphasic effects of TGF-beta. CONCLUSIONS: TGF-beta1, -beta2, and -beta3 have similar actions in vitro; this is demonstrated by their effects on several HTF-mediated functions. TGF-beta induces a response in HTF that is concentration-dependent, with different functions being maximally stimulated at different concentrations. This biphasic response highlights the significance of the concentration profile of TGF-beta at the wound site. These findings are important in filtration surgery, where constant changes in the local environment occur due to the passage of aqueous and the wound healing process. The varying levels of TGF-beta in the aqueous and subconjunctival tissues may thus significantly modify the conjunctival scarring response.

Cell Division↗
PubMed2000

Inhibition of conjunctival scarring and contraction by a porous collagen-glycosaminoglycan implant.

PURPOSE: To study the healing processes of full-thickness wounds in the adult rabbit conjunctiva after grafting with a porous collagen-glycosaminoglycan (CG) copolymer matrix. METHODS: A 7-mm trephine was used to produce lesions of the bulbar conjunctiva down to the level of the bare sclera. Full-thickness removal of the conjunctiva and Tenon's capsule created a reproducible wound bed. Wounds either remained ungrafted (control) or were grafted with CG matrix. In previous studies, this CG matrix has induced partial regeneration of the dermis in the human, the swine, and the guinea pig. Healing of the conjunctival epithelium and underlying stroma was evaluated by histology, immunohistochemistry, and measurement of wound contraction kinetics. RESULTS: By 28 days, ungrafted wounds had closed by contraction (26.4% +/- 5.0% fornix shortening) and the formation of scarlike tissue comprising an aligned array of dense collagen populated with occasional fibroblasts. Grafting of identical defects with CG copolymer matrix resulted in inhibition of wound contraction (6.8% +/- 3.2% fornix shortening) and the formation of a tissue that resembled normal conjunctival stroma, being composed of a loose network of collagen fibers and fibroblasts. Contractile fibroblasts (myofibroblasts) were identified at the edge of both ungrafted and grafted wounds during the period of active contraction. Both ungrafted and grafted wounds were completely re-epithelialized by 28 days. CONCLUSIONS: Implantation of CG copolymer matrix drastically reduced contraction and promoted the formation of a nearly normal subconjunctival stroma.

Animals↗
PubMed1975

[Covering of fistulae after operations of glaucoma (author's transl)].

It is recommended to use a certain method to cover cystic oozing cushions after filtering operations of glaucoma. To this effect a lamellar scleral flap is formed which is laid over the previously exposed scleral fissure. An impediment of the filtration of aqueous humour is avoided by means of suitable fixation of Tenon's capsule.

Eye Diseases↗
PubMed1975

[Use of muscle surgery sutures in retinal detachment operations (author's transl)].

In cases of surgery in retinal detachment, borrowing of techniques employed in strabismus surgery is recommended. The opening of the conjunctiva and Tenon's capsule and careful placement of the final suture as published by Cüppers avoids or at least diminishes postoperative cicatrization, retraction, and resulting disturbances of motility and double images. In case where one are several muscles have to be cut, the exact strabismic muscle surgery helps this treatment. In these cases, statistical results are mentioned. Furthermore in cases of high myopia and especially those combined with nystagmus, the so called Cüpper's "Fadenoperation" gives excellent results. Three cases operated on by this technique, in which no other method succeeded, are demonstrated.

Cicatrix↗
PubMed2001

Giant ocular nerve neurofibroma of the cavernous sinus: a series of 5 cases.

Five cases of giant cavernous sinus neurofibroma arising from the ocular cranial nerves are reported. These patients collected over a period of 5 years consisted of 3 males and 2 females with an age range of 9 to 40 years and a mean of 20.6 years. Clinically, all patients presented with ocular palsies over a long period (mean 3.4 years). All of them underwent a frontotemporal craniotomy along with an orbito-zygomatic osteotomy and excision of the tumour. In patients with extension of the tumour into the orbit, the superior orbital fissure was drilled, the tenon's capsule was cut and the intraorbital portion was excised. The management of these tumours is discussed and the literature reviewed.

Abducens Nerve Diseases↗
PubMed1975

Surgical treatment of exotropia after surgically produced pseudoparalysis of the medial rectus muscle.

The characteristic clinical findings of pseudoparalysis of the medial rectus muscle include exotropia in primary position, widened medial fissure on the affected side, limitation of adduction on the affected side, an A-pattern exotropia, and a paradoxical forced-traction test. We have devised a surgical technique to restore good movement of the eye in adduction. The priniciple behind the technique is that all adhesions between Tenon's capsule covering the muscle and conjunctiva, and between muscle and sclera must be found and cut posterior to the fornix. This will allow the muscle to be brought forward easily so that it can be resected and advanced for restoration of function.

Adolescent↗
PubMed2000

Reporter LacZ gene transfer into cultured ocular cells of human eyes in vitro.

OBJECTIVE: To investigate whether a reporter LacZ gene could be transferred into cultured ocular cells of human eyes in vitro. METHODS: Fibroblast cells of Tenon's capsule, trabecular meshwork cells, and muscle cells in the ciliary body of human eyes were cultured and the pcDNA3-LacZ gene was transferred into these cells using a cationic liposome delivery system. The cells were subsequently fixed with 4% paraformaldehyde, mixed with X-gal, then observed under a microscope. RESULTS: Blue stain was seen in the cytoplasm of the cultured cells under the microscope, demonstrating the successful transfer of the LacZ gene into these cells. CONCLUSION: Reporter LacZ gene was easily transferred into the cultured ocular cells in vitro. This provides insights into the transfer of the genes into these cells to study the pathogenesis and therapy of glaucoma.

Cells, Cultured↗
PubMedDate not supplied

[Encapsulated filtering blebs--incidence and methods of treatment].

Encapsulation of the filtering bleb occurs as a complication of glaucoma filtering surgery in 8.3-28% of all eyes filtered, often between 2-4 weeks after surgery. It has a characteristic clinical appearance--highly elevated localized bleb, prominent surface vessels and patent sclerostomies on gonioscopy. This study retrospectively reviewed the results of 100 filtering operations, performed in the Prof. Dr. I. Stankovitsh Eye Department, focused on the incidence, possible risk factors and management of encapsulated filtering blebs. Trabeculectomy was done in all patients with limbus-based conjunctival flap, rectangular scleral flap 4 x 4 mm, and sclerostomy 2 x 2 mm. Two or three interrupted 10-0 nylon sutures were used to tether the flap, the conjunctiva with Tenon's capsule was closed with a running suture. All eyes received topical dexamethasone drops, mydriatics-homatropin or tropicamide and antibiotic ointment for three weeks. Possible risk factors were considered: sex, age, other eye or systemic disease, type of glaucoma, previous ocular procedure and antiglaucoma medical therapy, early postoperative complications, postoperative and final intraocular pressure (IOP). All eycs with encapsulated filtering bleb were given topical beta-blocker initially and carbonic anhydrase inhibitor, and if IOP continued to be uncontrolled incisional surgical management was performed. Success was defined as IOP maintained at less than 22 mmHg, with or without medication. An encapsulated filtering bleb developed in 9% of eyes. Previous argon laser trabeculoplasty was associated with an increased frequency of bleb encapsulation. The mean postoperative IOP was 11.30 +/- 1.90. Encapsulation of filtering bleb was developing at mean time of 19.9 +/- 3.0 after surgery. Six eyes returned to IOP below 21 (mean IOP was 20.17 +/- 0.90) within 4 weeks, and 4 of them continued on a topical beta-blocker. Four eyes required incisional surgery. A week after surgery mean IOP was 18 mmHg. Haemophthalmus occurred after one incision performed in a patient suffering from diabetes mellitus. Late scarring of the filtering bleb was developed in 2 eyes. Seven months and 2 years after filtration surgery mean IOP was 21.30 +/- 4.00 mmHg. The cause of bleb encapsulation is not known. Male patients, surgical glove powder, topical corticosteroids, previous argon laser trabeculoplasty and beta-blockers are some of potential risk factors for the development of encapsulated filtering bleb. This study suggests the association between development of encapsulated bleb and previous argon laser trabeculoplasty--40% in the eyes with encapsulation and 18% in the eyes without encapsulation. The optimal management of bleb encapsulation has not been defined. In this study topical antiglaucoma therapy achieved IOP control and cyst's remodeling in 60% of cases. Forty percent of all cysts required incisional surgical management. Encapsulation of the filtering bleb is not an uncommon complication of glaucoma filtration surgery. It is important to examine postoperative eyes frequently during the first 2 months to detect this complication. Fortunately, most eyes have their IOPs controlled with antiglaucoma therapy.

Adrenergic beta-Antagonists↗
PubMed1975

[Some clinical aspects concerning diplopia after retinal detachment surgery with cryopexy and episcleral silastic sponge (author's transl)].

The aetiology of diplopia following retinal detachment surgery after the Lincoff-Custodis method is examined. Of 140 patients operated, 16 (i.e. 11.4%) developed diplopia. The authors believe that this diplopia is due to a fixation of the eyeball at the point of the silastic sponge placement. As responsible factors, which depend on the manner of sponge fixation and the size of the sponge, they regard: Alteration of the bulb curvature, shortening of the Tenon's capsule placed over the sponge, and changes in the conditions of muscular action.

Adolescent↗
PubMed1992

Dermis-fat orbital implantation and complex socket deformities.

Autogenous dermis-fat grafts implanted within the orbit survive best, with little loss of volume, when they are placed within Tenon's capsule immediately following the removal of the globe; when the rectus muscles (and anterior ciliary arteries) are anastomosed to the dermal edge of the graft; when no cautery has been applied to the recipient bed; and when the anterior diameter of the graft is no larger than 22 mm. Primary grafting in patients without systemic vascular disease is more effective than secondary procedures, performed on patients with fibrotic, compromised recipient beds and without direct apposition of the rectus muscles to the graft.

Adipose Tissue↗
PubMed2003

[Ipsilateral surgery of primary pterygium, sensory esotropia and conjunctival autotransplantation in a single procedure].

The purpose of this study was to find out whether a conjunctival autograft over the recessed bulbomotor muscle can prevent a recidive of an inflammatory internal pterygium associated with strabismus. The fast growing internal pterygium (crossing corneoscleral limbus of the right eye 3-4 mm towards the centre of the cornea) in a 42 years old patient, was removed by superficial keratectomy, while strabismus was corrected by the recession of the internal rectus muscle and covered with an autograft of the upper bulbar conjunctiva. Neither collagen vascular diseases, nor dry eye were present. Horizontal deviation was lessened from +12 to +6, after surgery, and the regrowth of the inflammatory pterygium was not observed during a five years follow up. The risk of the reappearance of pterygium at the site of muscle surgery for strabismus might have been avoided by creating a smooth ocular surface over a thin conjunctival autograft without Tenon's capsule. We believe that conjunctival autograft in such eyes, carrying a higher risk for pterygium regrowth, may help in the avoidance of the use of cytostatic drugs and on their untoward effects.

Adult↗
PubMed2004

[Nodular faciitis--rare localization on the eye (a case report)].

GOAL: To contribute to differential diagnosis of changes of the outer segment of the eye. CASE REPORT: A 43-years old woman with three weeks long history of fast growing painless focus in the nasal part of the sclera of the left eye, which caused, except of visible tubercle and moderate feeling pressure, no problems. It is an unusual localization of non-malignant disease of unknown etiology originating from the Tenon's capsule. The literature quotes the same histological finding in different organs; the localization in the eye is rare. The author considers difficulties of the differential diagnosis in the unusual ocular diagnosis. CONCLUSION: The diagnosis was specified on the basis of the ocular and following histological findings. The treatment is surgical.

Adult↗
PubMed1992

The long-term effects of 5-fluorouracil and sodium butyrate on human Tenon's fibroblasts.

The use of subconjunctival 5-fluorouracil (5-FU) in the first weeks after filtration surgery may ensure long-term bleb survival despite a continuing proliferative stimulus such as in eyes with neovascular glaucoma. In addition, long-term side effects may occur, such as increasing bleb thinning. To ascertain the long-term effects of 5-FU and sodium butyrate, an agent with differentiating and antiproliferative properties, we exposed proliferating human Tenon's capsule fibroblasts to different concentrations of the drugs. The cells were exposed to 5-FU for 1-12 d. The cells were subsequently observed for up to 30 d. Cell proliferation was assessed using cell counting and bromodeoxyuridine uptake, and cell viability was assessed with trypan blue uptake. 5-FU and sodium butyrate inhibited fibroblast proliferation during the treatment period. Higher concentrations of 5-FU (100 and 1000 micrograms/ml) for as little as 1 d resulted in no significant increase in the number of fibroblasts for at least 29 d after treatment was stopped, despite continued stimulation with serum. When treatment with sodium butyrate was stopped, there was greater recovery of proliferation. At a constant concentration of 1000 micrograms/ml of 5-FU for 3 or more days, or a concentration of 100 mmol/l sodium butyrate for 12 d, the entire fibroblast population gradually died over the 30 d period. Thus, short-term treatment with 5-FU may result in long-term inhibition of proliferation of fibroblasts. Long-term inhibition depends on the duration of treatment or on the concentration of 5-FU. Short-term treatment may be affecting the ability of the tissues at the bleb site to heal in the long term. Different dosage regimens may have advantages and are discussed.

Adolescent↗
PubMed1992

Transsclerally-fixated posterior chamber intraocular implants without capsular support in penetrating keratoplasty.

The results of 36 patients who underwent penetrating keratoplasty with transscleral fixation of a posterior chamber intraocular lens are reviewed. A 13.75-millimeter "Revlens," which has the configuration of an open-loop anterior chamber lens, was used in all of the cases and gave good stability in the ciliary sulcus. The 10-0 Prolene sutures used to secure the implants were burrowed through the sclera and exited sufficiently far from the limbus to be adequately covered by Tenon's capsule and conjunctiva. No sutures eroded through the conjunctiva or needed to be removed. Two grafts became opaque, one from rejection and the other from uncontrolled glaucoma. No vitreous hemorrhage or retinal detachment occurred. Ten patients (27.8%) had cystoid macular edema diagnosed either before or after surgery; three had age-related macular degeneration; and two had traumatic macular scars. Sixteen eyes (44.4%) had final visual acuities of 20/40 or better and 25 (69.4%) saw 20/200 or better. Mean follow up was 16.8 months (range, 9 to 36 months).

Adult↗
PubMed1992

Effects of timolol, betaxolol, and levobunolol on human tenon's fibroblasts in tissue culture.

Evidence has been found suggesting that long-term therapy with topical antiglaucoma medications may decrease the success of glaucoma filtering surgery. To investigate this question further, the antiproliferative effects of the preservative benzalkonium chloride and three pure and commercially available beta-adrenergic antagonist preparations (timolol, betaxolol, and levobunolol) were studied on tissue cultures of human Tenon's capsule fibroblasts. Each drug preparation was tested on three different cell lines. Fibroblast growth was measured with tritiated thymidine uptake and hexosaminidase assays. Trypan blue uptake was used to assess cell viability microscopically. The commercially available preparations containing benzalkonium chloride and those of betaxolol and levobunolol without the preservative had similar inhibitory doses for 50% of cells. The timolol preparation without preservative was significantly less toxic than its commercially available one. The three tested beta-adrenergic blockers did not stimulate fibroblast proliferation directly in this in vitro model. Even when the cultures were washed free of the drugs, growth continued to be suppressed, suggesting that the inhibition was not reversible. An increase in fibroblasts and inflammatory cells after long-term antiglaucoma medical therapy thus may be caused not by a direct stimulation of cell proliferation but by chronic inflammation from the irritating effects of antiglaucoma medications and/or their preservatives.

Benzalkonium Compounds↗
PubMed2006

[Our approach in the treatment of exposed hydroxyapatite orbital implant].

PURPOSE: To present our approach in the treatment of exposed hydroxyapatite (HA) orbital implant. PATIENTS AND METHODS: Seven patients with HA orbital implant exposure presented for treatment, all primary implants, postevisceration. All patients were operated by the same surgeon. The size of implant was based on preoperative axial length measurement (ax-2 mm, subtract 1 mm for evisceration and hyperops) except for two patients with buphthalmus where 20 mm implant was used. HA implant was wraped in sclera papillar area turned anteriorly. It was pushed as far as possible into the orbit but unfortunately without using plastic drape or malleable retractors. Extraocular muscles were sutured in their anatomic position. Exposure occurred at 5-7 years of implantation. Six patients wore glass orbital prostheses, and one silicone orbital prosthesis. The size of dehiscence of conjunctiva and Tenon's capsule varied from 5 to 15 mm. A woman with 15 mm exposure presented first with 6 mm exposure. However, she declined immediate surgery and continued to wear glass epiprosthesis. She returned a year later when she could not wear epiprosthesis anymore, and the size of the defect increased to 15 mm. Two-step procedure was performed in local anesthesia. Conjunctival edges were freshened, undermined and the anterior surface of the HA implant was shaved to the depth of at least 2 mm. Tarsoconjunctival flap was tailored from the central part of the lid. Care was taken that at least four millimeters of the marginal height of the tarsal plate were kept intact to avoid lid notching. Conjunctiva was undermined superiorly to include conjunctiva and Müllers muscle into the flap. No donor sclera was available. Raw surface of the flap faced the defect. Interrupted 6-0 Vicryl sutures were put on the flap, 360 degrees around. In two patients with exposure measuring 9 and 11 mm tarsoconjunctival pedicle flap from lax lower lid was incorporated. Upper and lower lid tarsoconjunctival flaps were sutured together. Central temporary tarsorrhaphy was performed so that postoperative local antibiotic (Tobrex) could be applied through the lateral third of the palpebral opening. At four weeks, flap was divided under local anesthesia. In two patients with lower lid flaps, horizontal shortening of the lower lid for the size of the flap was perfomed. In one patient with a 15-mm defect, third surgery was required. A crescent defect starting from superonasally to inferotemporally, horizontal diameter of 4 mm, was covered with conjunctival pedicle flap, base located inferotemporally. The harvest area was covered with oral mucosa membrane graft. Follow-up varied from 2 months to 5 years. RESULTS: Two patients experienced thick mucous discharge starting two weeks after the first step of the surgery. Bacteria and fungi were not isolated. After a 10-day course of systemic antibiotics the discharge subsided and the flap had taken nicely. Two patients had granuloma prior to pedicle division, which was removed and the area healed. There was no evidence of further exposure in any patient and all were able to wear orbital epiprosthesis. CONCLUSION: Tarsoconjunctival pedicle flap is a safe procedure to cover the exposure of hydroxyapatite orbital implant. A limited size of the flap and the need of temporary tarsorrhaphy are the only disadvantages of the procedure.

Aged↗
PubMedDate not supplied

[Copper metabolism in scleral tissue and possibilities of its correction in myopia].

Copper measurements in scleral tissue of 14 cadaveric emmetropic eyes and in 10 eyes with myopia of various degrees have shown a significant reduction of these levels in the equatorial and posterior segments of myopic sclera and abnormal distribution of copper in the tissue, this indicating disordered metabolism of this trace element. A method for drug correction of the detected disorder has been experimentally tried, consisting in administration under the Tenon's capsule of a copper coordination compound on a foam composition base, used for sclera-fortifying injections in progressive myopia. This resulted in elevation of scleral copper concentration, activization of collagen biosynthesis processes, and improvement of scleral tissue elasticity.

Adult↗