Unlocking the versatile potential:Adipose-derived mesenchymal stem cells in ocular surface reconstruction and oculoplastics

This review comprehensively explores the versatile potential of mesenchymal stem cells(MSCs)with a specific focus on adipose-derived MSCs.Ophthalmic and oculoplastic surgery,encompassing diverse procedures for ocular and periocular enhancement,demands advanced solutions for tissue restoration,functional and aesthetic refinement,and aging.Investigating immunomodulatory,regenerative,and healing capacities of MSCs,this review underscores the potential use of adipose-derived MSCs as a cost-effective alternative from bench to bedside,addressing common unmet needs in the field of reconstructive and regenerative surgery.

Fat or fillers:The dilemma in eyelid surgery

The aging of the periocular region has always aroused great interest.A fresh,young,and attractive sight determined an ever-greater attention to surgical and non-surgical techniques to obtain this result.In particular,the change in the concept of a young look,considered then“full”,led to the increasing use of surgical(fat grafting)or medical(hyaluronic acid)filling techniques.Eyelid rejuvenation became increasingly popular in the field of cosmetic treatments,with a focus on achieving a youthful and refreshed appearance.Among the various techniques available,the choice between using fat grafting or fillers presented a clinical dilemma.In particular,what surgery considered of fundamental importance was a long-lasting result over time.On the other hand,aesthetic medicine considered it fundamental not to have to resort to invasive treatments.But what was the reality?Was there one path better than the other,and above all,was there a better path for patients?The minireview aims to explore the physiopathology,diagnosis,treatment options,prognosis,and future studies regarding this dilemma.We analyzed the literature produced in the last 20 years comparing the two techniques.Current literature reveals advancements in biomaterials,stem cell research and tissue engineering held promise for further enhancing the field of eyelid rejuvenation.The choice between fat grafting and fillers in eyelid cosmetic treatments presented a clinical dilemma.Understanding physiopathology,accurately diagnosing eyelid aging,exploring treatment options,assessing prognosis,and conducting future studies were essential for providing optimal care to patients seeking eyelid rejuvenation.

Measuring quality of life in oculoplastic patients

AIM: To investigate if there is any published evidence of impaired quality of life in conditions which are corrected by oculoplastic surgery and whether there is proven benefit in the quality of life such procedures. ·METHODS: We searched a number of databases to determine the level of evidence available for common conditions amenable to oculoplastic surgery. Search terms concentrated on quality of life measures rather than anatomical correction of deformities. ·RESULTS: The level of evidence available for different conditions was very variable. Certain conditions had extensive research documenting reduction in quality of life,with some evidence for improvement after surgery. Some other common conditions had little or no evidence supporting of reduction in quality of life to support the need for surgery. ·CONCLUSION: The evidence is sparse for quality of life improvement after some of our most commonly performed procedures. Many of these procedures are now being identified by primary care trusts(PCTs) as of "low clinical value",and are no longer being routinely commissioned in certain parts of the UK. There is a need to address this lack of evidence to determine whether oculoplastic surgery should continue to be commissioned by PCTs.

In vitro adherence of conjunctival bacteria to different oculoplastic materials

AIM: To investigate the resistance to bacterial adhesion of materials used in oculoplastic surgery, particularly materials used in the manufacture of orbital implants.METHODS: Seven organisms of conjunctival flora(two strains of Staphylococcus epidermidis and one strain each of Staphylococcus aureus, Staphylococcus hominis, Corynebacterium amycolatum, Acinetobacter calcoaceticus, and Serratia marcescens) were selected. A lactic acid bacterium(Lactobacillus rhamnosus) was also included as positive control because of its well-known adhesion ability. Eight materials used to make oculoplastic prostheses were selected(glass, steel, polytetrafluoroethylene, polymethylmethacrylate, silicone from orbital implants, commercial silicone, porous polyethylene, and semismooth polyethylene). Materials surfaces and biofilms developed by strains were observed by scanning electron microscopy. Kinetics of growth and adhesion of bacterial strains were determined by spectrophotometry. Each strain was incubated in contact with plates of the different materials. After growth, attached bacteria were re-suspended and colony-forming units(CFUs) were counted. The number of CFUs per square millimetre of material was statistically analyzed.RESULTS: A mature biofilm was observed in studied strains except Staphylococcus hominis, which simply produced a microcolony. Materials showed a smooth surface on the microbial scale, although steel exhibited 1.0-μm-diameter grooves. Most organisms showed significant differences in adhesion according to the material. There were also significant differences in thetotal number of CFUs per square millimetre from each material(P=0.044). CFU counts were significantly higher in porous polyethylene than in silicone from orbital implants(P=0.038).CONCLUSION: Silicone orbital implants can resist microbial colonization better than porous polyethylene implants.

Oculoplastic publication trends in general ophthalmology journals

AIM: To examine the publication trend of oculoplastic articles throughout the last decade in general ophthalmology journals.METHODS: A review of all abstracts published between Januar y 2010 to December 2019 in general, clinical ophthalmic journals was conducted. Articles that were categorized as original articles in general and clinical journals were included in the study.RESULTS: Totally 10 281 abstracts were included. Of them 465(4.5%) were oculoplastic publications. The mean number of annual-publications was 46.5 and the mean annual-rate of oculoplastic publications was 4.51%. A significant decreasing trend in the number of oculoplastic publication in the last decade was found(P<0.01, R^(2)=0.770). However, there was no significant change in the annual-rate of oculoplastic publications during the last decade(P=0.191, R2=0.203). From the 465 oculoplastic articles: 179(38.5%) were articles about eyelid diseases, 160(34.40%) were about orbit diseases, 92(19.80%) were about lacrimal diseases and 34(7.30%) were about thyroid eye disease(TED). A significant decreasing trends in the number of orbital and eyelids publications were found(P<0.01, P<0.01). However, there were no significant changes in the annual-rate of orbital, eyelids, TED and lacrimal-diseases publications throughout the last decade.CONCLUSION: Oculoplastic subspecialty deals with a wide range of pathologies in different ages. However, less than 5% of the articles in general, clinical, high impact factor ophthalmology journals are about oculoplastic diseases. One of the best way for ophthalmologists from different subspecilties, nowadays, to be updated, is to read highimpact-factor, general ophthalmology journals. Therefore, it is important that those journals will include articles about breakthroughs in oculoplastic.

Bioengineered dermal substitutes for periocular defects

Bioengineered materials are used as a substitute in many fields of medicine,especially in plastic surgery and in burns.In ophthalmic plastic surgery they can be used for covering large tissue defects or as a tarsal plate substitute,in cases when it is not possible to use conventional surgical techniques.We have searched PubMed and Web of Science scientific databases.We can generally categorize skin substitutes by the type of tissue used-we distinguish autografts,allografts,and xenografts.There are also completely synthetic substitutes.The aim of our article was to summarize the current state of knowledge and to sum up all the clinical applications of bioengineered materials in the periocular region.There are only a few scientific articles about this topic and lack of prospective randomized studies aimed on use of bioengineered materials in periocular region.Nevertheless,there are many articles describing successful case reports or case reports series.According to literature,bioengineered materials are the most commonly used in big traumas or large surgical defects,especially in oculoplastic tumour surgery.Bioengineered dermal substitutes are not frequently used in the periocular region.Dermal substitutes are useful,when it is not possible to close the defect with any other conventional surgical technique.