Ocular surface disease(OSD)can have a severe impact on patients as it can lead to visual impairment and persistent discomfort.Ocular surface reconstruction(OSR)is an approach to the management of ocular diseases that ...Ocular surface disease(OSD)can have a severe impact on patients as it can lead to visual impairment and persistent discomfort.Ocular surface reconstruction(OSR)is an approach to the management of ocular diseases that cause structural damage to the ocular surface.OSR encompasses both medical and surgical treatment options.In this review,we discuss the medical and surgical strategies used in OSR.Medical management often aims to treat tear insufficiency,inflammation,and keratinization.Surgical treatments may be employed for a variety of reasons,including failure of medical management.This may include improving the oculo-palpebral structures in order to improve lid positioning and tear film.Additional therapies focus on improving tear production,such as through salivary gland transplantation.In situations where the ocular surface is so severely damaged that there is loss of limbal stem cells,limbal stem cell transplant(LSCT)may be indicated.Other surgeries such as amniotic membrane transplant(AMT)and conjunctival flaps(CFs)can help promote corneal healing.Finally,in severe situations where the cornea is beyond salvage,corneal transplantation,such as a penetrating keratoplasty(PKP),can be considered.OSR often requires a combination of medical and surgical approaches targeted to each specific patient’s presentation in order to achieve optimal outcomes.展开更多
Conjunctival flaps have previously proven to be effective in preserving the globe for individuals with severe ocular surface disease.Infectious keratitis,neurotrophic keratitis,nontraumatic corneal melts,descemetocele...Conjunctival flaps have previously proven to be effective in preserving the globe for individuals with severe ocular surface disease.Infectious keratitis,neurotrophic keratitis,nontraumatic corneal melts,descemetoceles,perforations,and corneal burns are all indications for this procedure.The flaps promote nutrition,metabolism,structure,and vascularity,as well as reduce pain,irritation,inflammation,and infection.Furthermore,patients avoid the emotional and psychological repercussions of enucleation or evisceration,while requiring fewer postoperative medications and office visits.Currently,fewer flaps are performed due to the emergence of additional therapeutic techniques,such as serum tears,bandage lenses,corneal grafting,Oxervate,amniotic membrane,and umbilical cord grafting.However,despite newer conservative medical methods,conjunctival flaps have been demonstrated to be useful and advantageous.Moreover,future technologies and approaches for globe preservation and sight restoration after prior conjunctival flaps are anticipated.Herein,we review the history,advantages,and disadvantages of various surgical techniques:Gundersen’s bipedicle flap,partial limbal advancement flap,selective pedunculated conjunctival flap with or without Tenon’s capsule,and Mekonnen’s modified inferior palpebral-bulbar conjunctival flap.The surgical pearls and recommendations offered by the innovators are also reviewed,including restrictions and potential complications.Procedures for visual rehabilitation in selective cases after conjunctival flap are reviewed as well.展开更多
Although amniotic membrane transplantation(AMT)has long been used as an essential surgical technique for ocular surface reconstruction,its role continues to evolve and expand.In the management of numerous ocular surfa...Although amniotic membrane transplantation(AMT)has long been used as an essential surgical technique for ocular surface reconstruction,its role continues to evolve and expand.In the management of numerous ocular surface disorders,ranging from inflammatory to infectious,traumatic to neoplastic,the ability to perform AMT is a valuable addition to the skillset of any ophthalmologist.The purpose of this paper is to provide ophthalmologists with an updated,evidence-based review of the clinical indications for AMT in corneal and conjunctival reconstruction,reviewing its common and even experimental applications known to date.The methods of amniotic membrane preservation,the available commercial amniotic membrane products to date,and future directions for amniotic membrane use,including amniotic membrane extract eye drops(AMEED),are also discussed.It is paramount for ophthalmologists to stay up-to-date on the applications of AMT so as to effectively incorporate this versatile treatment modality into their practice,both in the operating room and in the clinic.By familiarizing the general ophthalmologist with its diverse applications,we hope to motivate general ophthalmologists to incorporate the use of AMT into their clinical practice,or provide guidance on how to recognize when referral to a corneal specialist for amniotic membrane application is prudent.展开更多
文摘Ocular surface disease(OSD)can have a severe impact on patients as it can lead to visual impairment and persistent discomfort.Ocular surface reconstruction(OSR)is an approach to the management of ocular diseases that cause structural damage to the ocular surface.OSR encompasses both medical and surgical treatment options.In this review,we discuss the medical and surgical strategies used in OSR.Medical management often aims to treat tear insufficiency,inflammation,and keratinization.Surgical treatments may be employed for a variety of reasons,including failure of medical management.This may include improving the oculo-palpebral structures in order to improve lid positioning and tear film.Additional therapies focus on improving tear production,such as through salivary gland transplantation.In situations where the ocular surface is so severely damaged that there is loss of limbal stem cells,limbal stem cell transplant(LSCT)may be indicated.Other surgeries such as amniotic membrane transplant(AMT)and conjunctival flaps(CFs)can help promote corneal healing.Finally,in severe situations where the cornea is beyond salvage,corneal transplantation,such as a penetrating keratoplasty(PKP),can be considered.OSR often requires a combination of medical and surgical approaches targeted to each specific patient’s presentation in order to achieve optimal outcomes.
文摘Conjunctival flaps have previously proven to be effective in preserving the globe for individuals with severe ocular surface disease.Infectious keratitis,neurotrophic keratitis,nontraumatic corneal melts,descemetoceles,perforations,and corneal burns are all indications for this procedure.The flaps promote nutrition,metabolism,structure,and vascularity,as well as reduce pain,irritation,inflammation,and infection.Furthermore,patients avoid the emotional and psychological repercussions of enucleation or evisceration,while requiring fewer postoperative medications and office visits.Currently,fewer flaps are performed due to the emergence of additional therapeutic techniques,such as serum tears,bandage lenses,corneal grafting,Oxervate,amniotic membrane,and umbilical cord grafting.However,despite newer conservative medical methods,conjunctival flaps have been demonstrated to be useful and advantageous.Moreover,future technologies and approaches for globe preservation and sight restoration after prior conjunctival flaps are anticipated.Herein,we review the history,advantages,and disadvantages of various surgical techniques:Gundersen’s bipedicle flap,partial limbal advancement flap,selective pedunculated conjunctival flap with or without Tenon’s capsule,and Mekonnen’s modified inferior palpebral-bulbar conjunctival flap.The surgical pearls and recommendations offered by the innovators are also reviewed,including restrictions and potential complications.Procedures for visual rehabilitation in selective cases after conjunctival flap are reviewed as well.
文摘Although amniotic membrane transplantation(AMT)has long been used as an essential surgical technique for ocular surface reconstruction,its role continues to evolve and expand.In the management of numerous ocular surface disorders,ranging from inflammatory to infectious,traumatic to neoplastic,the ability to perform AMT is a valuable addition to the skillset of any ophthalmologist.The purpose of this paper is to provide ophthalmologists with an updated,evidence-based review of the clinical indications for AMT in corneal and conjunctival reconstruction,reviewing its common and even experimental applications known to date.The methods of amniotic membrane preservation,the available commercial amniotic membrane products to date,and future directions for amniotic membrane use,including amniotic membrane extract eye drops(AMEED),are also discussed.It is paramount for ophthalmologists to stay up-to-date on the applications of AMT so as to effectively incorporate this versatile treatment modality into their practice,both in the operating room and in the clinic.By familiarizing the general ophthalmologist with its diverse applications,we hope to motivate general ophthalmologists to incorporate the use of AMT into their clinical practice,or provide guidance on how to recognize when referral to a corneal specialist for amniotic membrane application is prudent.
基金funded by the National Natural Science Foundation of China(82201153)the Natural Science Foundation of Shandong Province(ZR2022QH_(2)76)+3 种基金the National Key Research and Development Program of China(2023YFE0206700)the Key Research and Development Program of Shandong Province(2021ZDSYS14)the Academic Promotion Program of Shandong First Medical University(2019ZL001 and 2019RC008)the Taishan Scholar Program(20161059).
