Ocular surface disorders : current understanding and new trends in management

Abstract EN

Introduction : When functional and compositional factors that regulate the integrity of the ocular surface are compromised, ocular surface failure takes place.

Many disease entities are responsible for this failure.

Aim : to present a group of patients affected by ocular surface failure due to different disease entities, and to evaluate some of the recent surgical methods like amniotic membrane transplantation and limbal stem cells transplantation.

Patients and methods : 23 eyes of 14 patients are involved in the study.

There are two groups : bilateral ocular surface failure (ocular cicatricial pemphigoid) and unilateral ocular surface failure (persistent epithelial defect, resistant chronic corneal ulcer and descematocele primary and recurrent pterygia).

Ages ranged between 35 to 85 years (Average: 62.5, Std: 14.3 years).

Females: males ratio was 9: 5 (1.8:1), Patients were followed up for a mean time of 11 months (Std 3.3 months).

The following interventions were done : Electrolysis (13 %), Grey line splitting, penetrating wide horizontal tarsotomy and distal anterior rotation (21.7 %), Ankyloblepharon (13 %), Symblepharon lysis (30 %), Superficial lamellar keratectomy (26 %), Amniotic membrane transplantation (13 %), limbal stem cells transplantation (13 %), application of tissue adhesive cyanoacrylate and therapeutic penetrating keratoplasty (4.3 %), Extra capsular cataract extraction and IOL implantation (8.6 %) and Trabeculectomy with Mitomycin C.

(4.3 %).

Results : Vision improved significantly at the end of follow up period (p-value = 0.01769).

Eyes with non-ambulatory vision regained ambulatory vision.

Eyes with cicatricial pemphigoid, inspite of having better vision for long time after lamellar keratectomy, showed recurrent inflammation and symblepharon.

Pterygia did not recur.

The eye with chronic ulcer and descematocele was saved.

Persistent defect healed and vision improved but recurrence of opacity developed.

Conclusion : A variety of ocular surface disorders is introduced.

Different surgical methods are needed to correct variable presentations and complications in these cases.

Amniotic membrane graft and limbal stem cells transplantation proved efficacious in improving the ocular surface status and vision.