Dissertations / Theses on the topic 'Corneal transplantation'
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Parekh, Mohit. "Human corneal endothelial cell culture and corneal transplantation." Doctoral thesis, Università degli studi di Padova, 2017. http://hdl.handle.net/11577/3422398.
Full textLa cornea è quel tessuto trasparente che riveste la superficie anteriore dell'occhio, e che consente di avere una visione ottimale e chiara. La trasparenza di questo tessuto è fondamentale e non può essere compromessa. La cornea umana è costituita da più strati,tra cui lo strato posteriore o “endotelio” è responsabile della trasparenza della cornea. L’ endotelio è un monostrato di cellule che permettono agli ioni ed ai soluti di essere trasportati dall’ umor acqueo alla cornea e viceversa, e che a sua volta mantiene la trasparenza della cornea conservando l'omeostasi tra la cornea anteriore e posteriore. L’endotelio non possiede capacità rigenerative. Attualmente, l'unico metodo di trattamento è la sostituzione dell'endotelio danneggiato con l'endotelio di un donatore sano. La cheratoplastica perforante, che prevede trapianti di cornea a tutto spessore,rappresentava l'unica soluzione terapeuticafino ad un decennio fa. Tuttavia, con i nuovi progressi nel campo dei trapianti di cornea, sono state identificate specifiche tecniche chirurgiche, come DMEK e DSAEK, che sostituiscono solo una parte (o uno strato) della cornea. Sono I risultati ottenuti, in termini di riabilitazione visiva, si sono rivelati vantaggiosi grazie all’utilizzo di queste procedure chirurgiche specifiche. Tuttavia, la DMEK è più impegnativarispetto alla DSAEK in quanto non è ancora completamente standardizzata. La DMEK ha diversi vantaggi in termini di tasso di riabilitazione e risultati visivi post-operatori e quindi è necessario standardizzare questa tecnica per una maggiore diffusione di tali interventi e anche considerando che questo è l'unico trattamento possibile per la cura di pazienti affetti da disfunzioni endoteliali. Sebbene il trapianto di cornea sia in fase avanzata, a causa di una quantità limitata di cornee da donatori ai fini di trapianto, approcci alternativi come la coltura di endotelio corneale in vitro svolgono un ruolo importante. La coltura di endotelio non è l'unico problema nel trapianto di endotelio (EK)dal momento che trapiantare un innesto di 20 micron di spessore all'interno dell'occhio destinatario rappresenta una sfida ulteriore. Inoltre, la disponibilità dei donatori per la coltura di endotelio corneale è inferiore, rendendo questa strategia ulteriormente più complicata. La tesi è quindi strutturata in modo da mettere in evidenza due questioni molto importanti nell’ attuale scenario della cheratoplastica endoteliale, 1) trapianto di cornea posteriore o EK, che è l'attuale metodo di trattamento per la cheratoplastica endoteliale e 2) coltura delle cellule endoteliali della cornea umana, che rappresenta il futuro della cheratoplastica endoteliale. Il Capitolo 1 è un'introduzione sul mondo dell’ Eye Banking, sulle sue caratteristiche attuali, sullo sviluppo nel mondo moderno e sul supporto per i chirurghi, non solo in termini di nuove tecniche, ma anche di dispositivi per interventi selettivi. Si evidenzia anche la conservazione dei tessuti corneali, che è un elemento importante nel campo dell’Eye Banking. Le banche degli occhi svolgono un ruolo significativo nel settore dei trapianti di cornea, dal momento cheraccolgono le cornee umane e le analizzano per ilsuccessivo trapianto. Le cornee non idonee per il trapianto possono essere utilizzate per la ricerca e quindi lo sviluppo dell’Eye Bankinge la ricerca possono influenzare il campo del trapianto di cornea. Il Capitolo 2 introduce l’argomento delle colture cellulari corneali e le tecniche attuali che sono utilizzate per la coltura ed il trapianto di cellule coltivate. Per capire il motivo e l'esigenza dell’ingegnerizzazione dei tessuti, è importante studiare la cornea umana, la sua matrice extracellulare ed il suo comportamento in diversi mezzi di coltura. Il comportamento biomeccanico di un tessuto sottile (DM) in condizioni diverse rappresenta una parte rilevante di questo studio per la futura ingegnerizzazione,che viene descritta nel Capitolo 3. E’ inoltre importante standardizzare il trattamento attualmente disponibile allo scopo di ridurre in futuro l’onere di pazienti con endotelio compromesso ed evitare danni o sprechi di tessuto, che attualmente avvengono nelle sale chirurgiche, fornendo tessuti standardizzati in terreni di conservazione validati, come descritto nel Capitolo 4. La DMEK è considerata il futuro della cheratoplastica endoteliale, dal momento che presenta vantaggi quali la velocità dei tempi di riabilitazione ed i risultati visivi. Il Capitolo 5 mette in evidenza l'importanza della nuova tecnica che consiste nell’arrotolare il tessuto DMEK per consentire un facile inserimento per poi dispiegarlo nell'occhio ricevente, rispetto alla tecnica attualmente utilizzata con endotelio arrotolato in senso opposto. Attualmente, i tessuti DMEK sono o preparati in sala operatoria o allestiti in Banca degli Occhi e spediti ai chirurghi. Tuttavia, non vi è alcuna procedura standardizzata che possa contribuire ad ottenereun lembo endoteliale validato prima dell'intervento e fornire un innesto ready-to-use ai chirurghi. Il Capitolo 6 descrive una nuova tecnica di pre-caricamento di un lembo endoteliale in una cartuccia IOL disponibile in commercio che può essere utilizzato come dispositivo di conservazione, trasporto e trapianto. Questa tecnica consentirà di ridurre ulteriormente gli sprechi nei trapianti e fornirà ai chirurghi un innesto pre-convalidato,riducendo ulteriormente il tempo complessivo in sala operatoria edi relativi costi. Quindi nella prima fase della tesi, sono stati analizzati i diversi approcci per standardizzare la tecnica DMEK. Le HCECs sono attualmente coltivate usando cornee di donatori giovani. Ci sono due aspetti importanti, in primo luogo la disponibilità di tessuti di donatori giovani è minore rispetto a quella di donatori anziani, ed in secondo luogo non vi è, ad oggi, alcun metodo standardizzato di coltura delle HCECs. Pertanto, per ridurre la domanda di tessuti a livello mondiale, vi è una forte necessità di coltivare leHCECsderivanti da cornee di donatori anziani, che sono meno proliferative e meno resistenti in natura, ma per le quali vi è una elevata disponibilità della fonte donatrice. Il Capitolo 7 descrivelo studio sull'isolamento delle HCECs e la successiva coltura di tali cellule ottenute da cornee di donatori anziani. Una volta stabilito il protocollo, è stato eseguito uno studio completocon un alto campionamento, per dimostrare la coerenza di questa tecnica,come evidenziato nel Capitolo 8. Nel frattempo si è anche osservato che le cellule da donatori anziani possono essere coltivate utilizzando l’inibitore ROCK in combinazione con acido ialuronico (HA). HA induce una forza meccanica alle cellule per far sì che siano saldamente attaccate alla base e consentire così una maggiore proliferazione,come descritto nel Capitolo 9. La seconda parte della tesi indaga quindi la tecnica di coltura delle HCECs da cornee di donatori anziani. Tuttavia, una volta che le cellule sono coltivate, un'altra sfida è trapiantarle nella camera anteriore dell'occhio. Ciò può essere eseguito utilizzando due strategie: la prima è quella di ad impiantare le cellule in forma di sospensione nella camera anteriore, tecnica che è già stata proposta, ma che non ha ancora fornito un’evidenza clinica; la secondaè quella di sviluppare un substrato per il trasporto delle cellule coltivate. Nel Capitolo 10, si identifica la colla di pesce (FSS)come una grande fonte di collagene e quindi come un potenziale scaffold da utilizzare per la cultura HCECs e successivo trapianto. E’ inoltre importante capire le norme che regolano gli studi scientifici ed il loro uso nelle applicazioni cliniche. Pertanto, nel Capitolo 11, viene descritta l’identificazione dell’ rHSA come sostitutodell’ FCS per la conservazione di cornee umane. Questo contribuirà anche a creare un terreno di coltura sintetico che potrebbe essere utilizzato per la cultura HCECs in condizioni GMP in futuro. In conclusione, si è osservato che il pre-caricamento di tessuti con endotelio rivolto verso l'interno e conservati in un terreno con destrano, potrebbe rappresentare una possibile soluzione per fornire un lembo per DMEK validato e standardizzato per il trattamento delle disfunzioni endoteliali. Le banche degli occhi svolgono un ruolo importante nello sviluppo di queste tecniche chirurgiche e relativi dispositivi, che potranno cambiarele modalità del trapianto di cornea in futuro. Una tecnica alternativa come la coltura di HCECs ha in sèil potenziale per il trattamento di disturbi endoteliali e substrati come FSS potrebbero essere utilizzati per la coltura edil trapianto di queste cellule. Tuttavia, l'efficacia di queste cellule potrà essere validata solo dopo uno studio clinico. Considerando le questioni regolatorie, il terreno sintetico potrebbe aiutare le banche degli occhi sia per la conservazione delle cornee e dei i nuovi prodotti come DMEK pre-caricati sia, in futuro, per le colture.
Brice, Sarah Louise, and sarahlbrice@gmail com. "Regional Immunosuppression for Corneal Transplantation." Flinders University. Medicine, 2010. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20100811.113448.
Full textArancibia, Carcamo Carolina Virgina. "Class II MHC on corneal endothelium : implications for corneal transplantation." Thesis, Imperial College London, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.395028.
Full textElzawia, Omar Rajab. "Corneal graft outcome, endothelial monolayer survival following corneal grafting : a prospective and retrospective study." Thesis, University of Bristol, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.322567.
Full textTorres, Paulo Francisco de Ancede Aires de Sousa. "The Role of cytokines during corneal transplantation : Studies on immunopathological mechanisms of corneal rejection." Doctoral thesis, Universidade do Porto. Reitoria, 1999. http://hdl.handle.net/10216/10584.
Full textTorres, Paulo Francisco de Ancede Aires de Sousa. "The Role of cytokines during corneal transplantation : Studies on immunopathological mechanisms of corneal rejection." Tese, Universidade do Porto. Reitoria, 1999. http://hdl.handle.net/10216/10584.
Full textTsang, K. "Prioritization preferences for corneal transplantation allocation in Hong Kong." Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B31972226.
Full textRayner, Sandra Anne. "Tumour necrosis factor and gene transfer in corneal transplantation." Thesis, Imperial College London, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.248143.
Full textWinton, Helen Louise. "Inflammation related genetic variants in high risk corneal transplantation." Thesis, University of Bristol, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.617796.
Full textTsang, K., and 曾光. "Prioritization preferences for corneal transplantation allocation in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B31972226.
Full textParker, Douglas George Anthony, and park0290@flinders edu au. "Lentivirus-mediated gene expression in corneal endothelium." Flinders University. Medicine, 2008. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20081204.094431.
Full textKatami, Mustsuo. "The extent of immunological privilege of orthotopic corneal crafts in the rat." Thesis, University of Cambridge, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.358660.
Full textKerouedan, Christelle. "Adhesion molecule expression in corneal transplantation : a target for therapy?" Thesis, Imperial College London, 2003. http://hdl.handle.net/10044/1/11792.
Full textDuguid, I. G. M. "Prevention of corneal graft rejection with monoclonal antibodies." Thesis, University of Aberdeen, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387460.
Full textYang, Juan. "Universal corneal epithelial-like cells derived from human embryonic stem cells in a defined, xeno-free, and albumin-free condition for cellularization of a corneal scaffold." Thesis, University of Macau, 2018. http://umaclib3.umac.mo/record=b3953938.
Full textLiu, Lei. "Immunology of herpes simplex keratitis and its treatment by corneal transplantation." Thesis, Available from the University of Aberdeen Library and Historic Collections Digital Resources. Online version available for University member only until Sep. 7, 2010, 2009. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?application=DIGITOOL-3&owner=resourcediscovery&custom_att_2=simple_viewer&pid=33585.
Full textComer, Richard Michael. "The effect of adenovirally derived and recombinant CTLA4-Ig protein in corneal transplantation." Thesis, Imperial College London, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.401275.
Full textSeow, Wei Yang. "Development of novel non-viral vectors for use in the immunomodulation of corneal transplantation." Thesis, Imperial College London, 2011. http://hdl.handle.net/10044/1/9119.
Full textOkanobo, Andre 1979. "Qualidade de vida dos pacientes antes e após realização de transplante penetrante de córnea = The quality of life before and after corneal transplantation." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312762.
Full textDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Avaliação da qualidade de Vida dos Pacientes Antes e Após Realização de Transplante Penetrante de Córnea. OBJETIVO Verificar o impacto do transplante de córnea sobre a qualidade de vida dos indivíduos submetidos à cirurgia no serviço de Oftalmologia HC-UNICAMP no período de outubro de 2005 a outubro de 2006. METODO: O estudo foi aprovado pelo comitê de ética e pesquisa da FCM-UNICAMP. Foram inclusos indivíduos com indicação de transplante de córnea do ambulatório de Doenças Externas da Oftalmologia do HC UNICAMP no período de outubro de 2005 a outubro de 2006 e que aceitaram em participar do estudo. Foram incluídos 32 indivíduos. Os critérios de exclusão foram transplante tectônico, indivíduos com déficit visual importante causado por outra afecção ocular além das alterações corneanas. Realizou-se exame oftalmológico assim como aspectos demográficos e história ocular dos pacientes incluídos no estudo. Métodos objetivos como claridade do transplante e melhor acuidade visual corrigida e método subjetivo, a qualidade de vida, através do questionário SF-36 adaptado. RESULTADOS: Houve diferença significativa de satisfação entre gêneros com maior escore no sexo masculino (p = 0.0319). No método objetivo como a acuidade visual corrigida teve aumento significativo do olho transplantado (p<0.0001); A AV média antes do transplante era de 0,98 ± 0,1 logMAR e após 0,48 ± 0.38 logMAR. Quanto o escore de qualidade de vida (SF-36), método subjetivo, após o transplante houve um aumento significativo (p<0.0001). O escore do SF-36 antes do transplante foi de 49,11% ± 19,28 (média ± DP) e após o transplante de 71, 98% ± 24,28 (média ± DP) com uma melhora de 22, 87% (p<0.0001).Os indivíduos mais satisfeitos foram aqueles que tiveram a pontuação mais alta no SF-36 (r = 0.60; P = 0.0002). A satisfação parece não estar correlacionada com a melhora da AVCC no olho transplantado (r = 0.3186; P = 0.0755). Ocorreu uma fraca correlação entre a melhora da AVCC no olho transplantado e a melhora do SF-36 (r=0.28382; p=0.1154). Não houve diferença significativa do SF-36 nos indivíduos com visão baixa nos dois olhos quando comparado com os pacientes com visão boa em um dos olhos (p=0.2998 ) CONCLUSÃO: O transplante penetrante de córnea proporcionou melhora na pontuação dos métodos subjetivo e objetivos. Os indivíduos com maior satisfação foram melhor avaliados através do método subjetivo (SF-36). Não houve diferença significativa na qualidade de vida dos indivíduos com pior acuidade visual no olho contralateral quando comparado com os indivíduos com boa visão no olho contralateral, mas análise de um maior número de indivíduos é necessária
Abstract: Purpose: To assess and measures the patient satisfaction before and after penetrating keratoplasty. Methods: The study of approved by the ethics committee of FCM-UNICAMP. Data were collected from 32 patients who underwent penetrating keratoplasty (PK) between October 2005 and October 2006. Demographic, ocular history, objective treatment outcome measures such as clarity of the graft and best-corrected visual acuity (BCVA) of both eyes were collected prospectively. In addition to assessment of quality of life were obtained by an interview before the PK and after at least one year of postoperative. Results: The average age of subjects was 42 ± 22 (mean ± SD) years and 68.75 % were women. On average, men were most satisfied. BCVA was 0,98 ± 0,1 logMAR before and 0,48 ± 0.38 logMAR after PK showing a significant improvement on BCVA (P < 0.0001). SF-36 score was 49.11% ± 19.28% before and 71.98% ± 24.28% after PK showing a significant improvement after the PK (p< 0.0001). The most satisfied patients where those who had a better score on SF-36 (r = 0.60; p = 0.0002). Satisfaction seems not to be correlated to improvement in BCVA at the transplanted eye (r = 0.3186; p = 0.0755). There was weak correlation between improvement in BCVA on the transplanted eye and improvement of SF-36 score (r = 0.28382; p=0.1154). There was no significant improvement in SF-36 in patients with worse BCVA in the other eye (p = 0.2998). Conclusions: Penetrating keratoplasty has a positive effect on objective and subjective outcome measures. Patient satisfaction is better predicted by subjective outcomes. There is no significant difference in quality of life in patients with worse BCVA in the contralateral eye when compared to eye with good BCVA in the contralateral eye, but analysis of a larger number of patients is necessary to confirm that
Mestrado
Oftalmologia
Mestre em Ciências Médicas
Ghoubay-Benalloua, Djida. "Traitement des pathologies cornéennes par thérapie cellulaire et bioingénierie tissulaire." Thesis, Paris 6, 2017. http://www.theses.fr/2017PA066445/document.
Full textCornea, the outer part of the eye, features high transparency crucial for good vision. The maintenance of a healthy cornea is linked to the presence of corneal stem cells in the limbus (peripheral region of the cornea). Several diseases can lead to its opacification requiring transplantation of donor tissue to restore vision. Although corneal transplantation has achieved clinical success, there is a shortage of donor corneas worldwide. To solve this problem, cell therapy and tissue-engineered artificial cornea are promising approaches that could eventually outperform current treatment. Corneal epithelial stem cells (LSC) and stromal stem cells (SSC) were isolated in feeder free and xeno free medium. The therapeutic effect of SSC was investigated in vivo by their injection in mouse cornea treated with liquid nitrogen. SSC have the ability to restore the extracellular matrix organization and corneal transparency. Transparent collagen I fibrillated matrices have been synthesized and were evaluated for fibril organization, transparency, mechanical properties and their ability to be repopulated by corneal stromal stem cells and to support limbal epithelial stem cell growth. We show that the matrices were organized and transparent. SSC and LSC were able to repopulate and to grow into the collagen matrix. These cells present a potential for stem cell-based treatment of corneal blindness
Bairaktaris, George. "Ultrastructural investigation of matrix and cell surface factors in corneal transplantation, refractive surgery and stem-cell grafting." Thesis, Lancaster University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.340515.
Full textPedemonte, Sarrias Eduard. "Tècnica de Muraine per a DMEK: anàlisi comparativa amb la tècnica estàndard." Doctoral thesis, Universitat Autònoma de Barcelona, 2017. http://hdl.handle.net/10803/405259.
Full textDescemet’s membrane endothelial keratoplasty (DMEK) is the current gold standard treatment for irreversible corneal oedema. After Melles developed this technique in 2006, Muraine proposed in 2013 an alternative technique for the dissection and implantation of the graft. Its main contributions were: hidrodissecting the graft from a partially trephined, inverted donor tissue, and folding the graft over the endothelial side, which favoured the protection of endothelial cells and the graft’s natural tendency to unfold in the receptor’s anterior chamber. The purpose of this doctoral thesis is to compare Muraine’s technique to the Standard through analysis of the postoperative endothelial cell density (ECD) and visual acuity (VA), surgical time, and intraoperative and postoperative complications. An observational, multicentric, prospective, cohorts trial was carried out in Hospital Universitari MútuaTerrassa and Institut de Microcirurgia Ocular in a daily praxis basis. There were follow-up controls over the six months following the surgery, at least at day one, first week and first, third and sixth months. Twenty-seven eyes from 20 patients were included in the Standard technique group. Forty-two eyes from 40 patients were included in the Muraine’s technique group. The ECD at six months was 1488 (1337-1679) cells/mm2 for the Standard group and 1170 (734-1614) cells/mm2 for Muraine’s group. The mean VA at six months was 0.89 for the Standard group and 0.79 for Muraine’s group, in the decimal scale (P=0.19). Around 80% of the eyes reached a VA of 0.5 or higher and 50-70%, 0.8 or higher. The ECD and the percentage of ECD loss with Muraine’s technique at the first month after surgery were equivalent to the Standard technique’s. The percentage of ECD loss at six months was higher with Muraine’s technique, although the ECD was clinically comparable. The VA achieved at six months was equivalent. Muraine’s technique was as safe as the Standard technique for the graft dissection. The incidence of intraoperative complications among the eyes with uncomplicated phacoemulsification was not statistically higher with Muraine’s technique. The graft dissection with Muraine’s technique was slower. Conversely, the unfolding was slightly faster. Both techniques had a high graft survival rate. The most frequent postoperative complication in both groups was cystoid macular oedema. The grafts dissected with Muraine’s technique had a higher incidence of need for rebubbling.
Al, Abdulsalam Najla Khaled S. "Evaluation of silk fibroin as a scaffold for cultured corneal endothelial cell implants." Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/122231/1/Najla%20Khaled%20S_Al%20Abdulsalam_Thesis.pdf.
Full textAsi, Fatema [Verfasser]. "Routine donor tomography in the eye bank as a sterile screening method for improved graft selection in corneal transplantation / Fatema Asi." Saarbrücken : Saarländische Universitäts- und Landesbibliothek, 2019. http://d-nb.info/1222973782/34.
Full textShortt, A. J. "The limbal epithelial stem cell niche and its relevance to ex-vivo culture and transplantation of corneal limbal epithelial stem cells." Thesis, University College London (University of London), 2009. http://discovery.ucl.ac.uk/18929/.
Full textLima, Mário Henrique Camargos de. "Avaliação da função visual de pacientes submetidos a transplante de córnea lamelar anterior profundo utilizando dissecção com fio." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/5/5149/tde-05012016-154155/.
Full textObjective: Evaluate the visual function of patients undergoing deep anterior lamellar keratoplasty (DALK) using a manual spatula and a wire dissection. Methods: Thirty three keratoconus patients were included, meeting the following inclusion criteria: BCVA logMAR <=0,60, myopia and astigmatism between 8.00 and 10,00D, K central average > 53.00D, no corneal scars and minimal corneal thickness between 300 and 400 um. Complete ocular evaluation was performed preoperatively and postoperatively in 6-8 months. These assessments were supplemented by topographical survey of the cornea, specular microscopy to evaluate the density of corneal endothelial cells, corneal wavefront analysis and examination of optical coherence tomography of the anterior segment (Visante). The BCVA variables, UCVA and the total amounts of corneal higher-order aberrations were correlated with the the residual stromal bed thickness. Results: Patients that undergone to DALK with the described technique presented a BCVA of 0.68 ± 0.27 logMAR which represents a BCVA of more than 20/40 at 60% of the analyzed sample. There were no micro or macroperforations. We observed a small decrease in the endothelial cell count from 2702.87 ± 548.87 cells per mm2 to 2282.10 ± 525.66 cells per mm2. The dissection of the deep stroma with a wire facilitated the posterior stromal tissue removal, thus the measured stromal bed thickness was 49.18 ± 18.36 ?m in the central region and less than 80 ?m in the majority of the studied patients. As regards the dissection regularity, we showed a tendency to higher values of residual thickness at the periphery (60.09 ± 17.70 ?m). There was no correlation of the BCVA, UCVA and total corneal higher-order aberrations with the residual stromal bed thickness. Conclusion: The assessment of the study data showed that the described technique achieved a topographical and functional result similar to other techniques consecrated by literature. The shallow learning curve, the ease to perform the dissection of the deep stroma, the postoperative stromal regularity and the presence of very low conversion rate for penetrating keratoplasty are encouraging
Sá, Flávia Batista Barbosa de. "De potenciais a reais doadores: uma análise das variáveis que influenciam o processo de doação de córneas." Universidade Federal de Juiz de Fora, 2012. https://repositorio.ufjf.br/jspui/handle/ufjf/1617.
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Objetivo: Analisar os fatores que influenciam o processo de doação de córneas entre os potenciais doadores de um Hospital Público e de um Hospital Privado de Juiz de Fora. Métodos: estudo seccional do tipo descritivo. Foram rastreados os óbitos ocorridos em um Hospital Público e um Hospital Privado de Juiz de Fora no período de 01 janeiro de 2010 a 31 de dezembro de 2010, identificados os potenciais doadores de córneas, verificado se os óbitos foram notificados à Central de Notificação, Captação e Distribuição de Órgãos (CNCDO) da Zona da Mata de Juiz de Fora e se esta notificação resultou ou não em doação. Caso não tenha ocorrido doação, foi justificada a causa da não efetivação da mesma, e caso tenha ocorrido, foi analisado o destino da córnea captada (transplante ou perda). Os dados foram processados e discutidos utilizando-se a análise estatística feita através do Programa SPSS (Statistical Package for the Social Sciences), versão 13.0. Resultados: A população em estudo se caracteriza por serem em sua maioria pacientes do sexo masculino (53,1%), com idade entre 2 a 80 anos (69,1%), com causas mortis que não contraindicaram o transplante de córneas (59,1%). Dos 863 óbitos, 138 (16%) não foram notificados à CNCDO-Zona da Mata e destes, 54 eram potenciais doadores. Do total de óbitos, 210 (24,3%) foram classificados como potenciais doadores. O percentual de captação efetiva dos casos entrevistados foi de 34,9%. Foram realizadas 30 doações de córneas (19,2%). Observou-se que das 60 córneas captadas (30 doadores), 75,0% (45) foram descartadas. A não efetivação da doação foi justificada pela recusa familiar em 58 casos (7,0%), pelos problemas logísticos ou estruturais em 125 casos (15,0%) e pelas contraindicações médicas registradas na CNCDO-Zona da Mata em 650 casos (78,0%). Conclusão: Da população estudada, 24,3% eram potenciais doadores de córneas. A contraindicação médica foi a maior justificativa para a não efetivação da doação de córneas, correspondendo a 78,0% das causas. Considerando que apenas 25% das córneas captadas foram transplantadas, conclui-se que há uma grande desigualdade entre o número de doadores potenciais e o número de doadores reais para o transplante de córneas, pois muito se perde durante todo o processo de doação.
Objective: To analyze factors that influence the process of cornea donation among potential donors for a Public Hospital and a Private Hospital in Juiz de Fora. Methods: A descriptive cross sectional study. We traced the deaths occurred in a Public Hospital and a Private Hospital in Juiz de Fora in the period from January 1, 2010 to December 31, 2010, identified the potential donors of corneas, checked whether the deaths were reported to the Central Notification, Procurement and Distribution organs (CNCDO) from Zona of Mata in Juiz de Fora and whether or not this notification resulted in donation. If there were no donation, it was justified the cause of not being done, and if it has occurred, we analyzed the fate of the captured cornea (transplantation or loss). The data were analyzed and discussed using the statistical analysis performed using the SPSS (Statistical Package for Social Sciences) version 13.0. Results: The mortality profile of the institutions under study is characterized by being mostly male (53.1%), aged from 2 to 80 years (69.1%), with cause of death that did not prevent corneal transplantation to be done (59.1%). Of the 863 deaths, 138 (16%) were not notified to CNCDO-Zona of Mata and of these, 54 were potential donors. Of the total deaths, 210 (24.3%) were classified as potential donors. The percentage of effective capture of the cases surveyed was 34.9%. 30 donations of corneas were performed (19.2%). It was observed that from 60 corneal grafts (30 donors), 75.0% (45) were discarded. The effectiveness of the donation was not justified by family refusal in 58 cases (7.0%), by logistical or structural problems in 125 cases (15.0%) and recorded in the medical contraindications CNCDO-Zona da Mata in 650 cases (78.0 %). Conclusion: The study population, 24.3% were potential donors of corneas. The medical contraindication was the biggest reason for not effecting the donation of corneas, corresponding to 78.0% of the causes. Whereas only 25% of corneal grafts were transplanted, it is concluded that a considerable difference between the number of potential donors and the number of actual donors for transplantation of corneas, since much is lost during the donation process.
Marcon, Alexandre Seminoti. "Influência da espessura corneana na acuidade visual corrigida após transplante de córnea endotelial lamelar profundo (TCELP)." Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/5/5149/tde-16102014-085907/.
Full textPurpose: To analyze the influence of central corneal thickness in the corrected visual acuity (VA) after deep lamellar endothelial corneal keratoplasty (DLEK). Methods: Retrospective study of 155 eyes of 127 patients 6 months post-op DLEK between March 2000 and March 2005. These patients had been previously diagnosed with either bullous keratopathy or Fuch\'s endothelial dystrophy. Patients with other ophthalmic conditions that could cause loss of vision were excluded. All patients underwent ophthalmic evaluation to determine corrected VA by means of refraction and central corneal thickness by means of ultrasonic pachymetry. Eyes were grouped according to visual acuity into 4 groups: I (20/20 - 20/30), II (20/40 - 20/50), III (20/60 - 20/80), IV (20/100 - 20/400). For statistical analysis and corelation with pachymetry, VA measurements were converted to logMAR. Categorical variables were created to express normal range corneal thickness status (from 495 to 651 um) using values published on the literature. Results: Mean and standart deviation pachymetry values were: group I (n=38) 571 ±80 ?m, ranging from 408 to 784 um; group II (n=79) 598 ±80 um, ranging from 437 to 816 ?m; group III (n=30) 605 ±99 um, ranging from 454 to 945 um and group IV (n=8) 607 ±120 um, ranging from 410 to 781 ?m. Analyzing the VA results and the percentage of cases with corneal thickness above 651 um, a significant linear correlation between higher pachymetry and worse VA was observed (P=0.037; linear trend). Analyzing the association between the different groups and the percentage of cases with corneal thickness bellow 495 um, there was no statistical significance (P=0.92; Pearson\'s x2). When analyzing the visual results of group I compared to groups II+III+IV together, it was observed that only 13% of group I cases and 30% of cases from the other groups presented corneal thickness greater then 651 um. This correlation showed borderline statistical significance (P=0.066; Pearson\'s x2 with Yates\' correction). Conclusions: A significant linear correlation between increased corneal thickness and worse VA was observed. When analyzing only cases bellow normal pachymetry, there was no correlation between corneal thickness and worse VA
Almeida, Hirlana Gomes. "Transplante de córnea no Brasil: progresso e dificuldades em 16 anos." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/5/5149/tde-28092018-104410/.
Full textIntroduction: Corneal diseases account for about 5% of reversible blindness in the world and Corneal Transplantation (CT) is important for the treatment of these diseases. From official and public data sources, the progress and difficulties related to CT in Brazil in the last 16 years were analyzed, as well as regional inequalities, expenses for the Unified Health System (SUS) and quality indicators of ocular tissue banks (OTBs). Methods: A retrospective and analytical study with data on CT and OTB in Brazil, from January 2001 to December 2016, published by the National Transplantation System (SNT), the Brazilian Organ Transplantation Association (ABTO) and the National Surveillance Agency Sanitary (ANVISA). The Cochran-Armitage test, the Analysis of Variance and the Duncan\'s multiple comparisons were used to verify the existence of trend, comparison of means between regions and verification of the mean difference, respectively. A significance level of 5% was used in all tests. Results: In Brazil, there was an increase: of 2.4 times in the number of CTs (from 6,193 - 35.2 pmp to 14,641 - 71.0 pmp - p < 0.001); of 50.7% in the efficacy of meeting the population demand for CTs (from 35.3% to 53.2% - p < 0.001); of 27.8% in the number of donated globes and corneas in situ (from 24,608 - 127.1 pmp to 31,450 - 152.6 pmp - p < 0.001); of 31.7% in preserved corneas (from 21,012 to 27,674); of 2.4 times in the total finance expense with CTs (from R$ 9,179,688 to R$ 22,060,973); and 2.2 times the unit expense with CT (from R$ 716 to R$ 1,603). The waiting list for CT decreased by 45.4% (from 23,549 - 123.0 pmp to 12,865 - 62.4 pmp - p < 0.001). The two main causes for non-donation were medical contraindications (mean of 42.5%) and family refusal (mean of 36.6%). The main causes of corneal discard were positive serology for hepatitis B (mean of 33%), tissue validity (mean of 30.9%) and inadequate tissue quality (16.8%). Efficacy in Corneal Preservation (EPC), Corneal Discarding Coefficient (CDC) and Efficacy Supply of Corneas for Transplantation (ECT) averaged 88%, 37%, and 63% over the years, respectively. The best indexes were presented in the South, Midwest and Southeast regions and the worst in the North and Northeast. Conclusion: In Brazil, the small number of donations and the high rate of discard of corneas are the main difficulties to the adequate attendance to the population demand by CTs. However, the country increased the ability to transplant corneas and reduced waiting lists in 16 years
Gurajada, Deepthi. "Transplantation of Human Embryonic Stem Cells to a damaged Human Cornea an in vitro study." Thesis, Södertörn University College, School of Life Sciences, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-3672.
Full textCorneal dystrophies are commonly referred to as an congenital condition. Surgical complications are usually worse then the primary dysfunction and patients need to go through large surgical process. Only 25 % of the patients reach driving licence vision after a surgery. The aim of this study was to investigate if the application of human embryonic stem cells (hESc) could replace epithelial cells of the human cornea. Corneal markers such as cytokeratins CK3, CK15, CK19 and Pax - 6 were analysed by immunohistochemistry. HES - Cellect was used as indication of stem cell potential of the transplanted cells. hESc transplanted onto the cornea could be seen to attach and expand dominantly towards Bowman’s membrane. Human embryonic stem cells in culture were relatively positive for markers, contradictionally stem cells in the epithelial trails lost their stem differentiation potential and appeared to be negative for all markers used in these trails. Optimization of stem cells differentiation into epithelial which may in the future may gives us the ability to perform clinical applications with successful outcome.
Harfuch, Bruno [UNESP]. "Eficácia e segurança da ceratoplastia endotelial no tratamento da ceratopatia bolhosa pseudofácia e afácia: revisão sistemática e metanálise." Universidade Estadual Paulista (UNESP), 2015. http://hdl.handle.net/11449/128072.
Full textIntrodução: A córnea é uma túnica transparente responsável por 60% do poder refrativo do olho. Segundo a Organização Mundial da Saúde (OMS), doenças que afetam a transparência da córnea são responsáveis por 5,1% do total de cerca de 45 milhões de cegos. O Brasil é o país que mais realiza transplantes de córnea na América Latina. A taxa de perda endotelial gira em torno de 0,6/ano em pessoas normais. Essa taxa é acelerada após cirurgias oculares ou glaucoma. Essa perda, após o transplante penetrante devido trauma inicial, reação imune, glaucoma secundário, interação celular entre o doador e receptor, seria de 7,8%/ano nos primeiros cinco anos e 4,2%/ano após 10 anos. Alguns estudos sugerem perda endotelial maior no Descemet's stripping automated endothelial keratoplasty/Ceratoplastia endothelial automatizada stripping de Descemet (DSAEK) (34% após seis meses) do que no transplante penetrante (11%) enquanto outros mostram que a perda endotelial após um ano é maior no transplante penetrante. A sobrevida do enxerto em ambas as técnicas foram semelhantes e o resultado óptico superior na técnica DSAEK. Há quase um século o transplante penetrante tem sido a técnica cirúrgica de escolha no manejo de alterações corneais. Apesar das vantagens de procedimentos lamelares, como menor risco de complicações intra-oculares e rejeição do enxerto, o transplante penetrante ainda mostra ser a técnica de preferência da maioria dos transplantadores mundiais. Entretanto, nos últimos anos, várias técnicas de ceratoplastia lamelar têm sido desenvolvidas, modificadas ou melhoradas, principalmente técnicas para substituição da porção posterior para correção da ceratopatia bolhosa. A escolha de ceratopatia bolhosa pós facectomia foi por esta ser a principal causa de transplantes relacionados a disfunções endoteliais. Objetivo: Avaliar a eficá cia e a seguranç a d a ceratoplastia endotelial quando...
Introduction: The cornea is a transparent organ responsible for 60% of the refractive power of the eye. According to the World Health Organization (WHO), diseases affecting the transparency of the cornea are responsible for 5.1% of total of about 45 million blind. Brazil is the country that performs corneal transplants in Latin America. Endothelial loss rate is around 0.6 / year in normal people. This rate is accelerated after eye surgery or glaucoma. This loss after penetrating keratoplasty because initial trauma, immune reaction, secondary glaucoma, cell interaction between donor and recipient, it would be 7.8% / year in the first five years and 4.2% / year after 10 years. Some studies suggest a greater endothelial cell loss in DSAEK (34% after six months) than in penetrating keratoplasty (11%) while others show that endothelial cell loss after one year is higher in penetrating keratoplasty. Graft survival in both techniques were similar and higher optical result in DSAEK technique. For nearly a century the penetrating keratoplasty has been surgical technique of choice in the management of corneal changes. Despite the advantages of lamellar procedures such as intraocular lower risk of complications and graft rejection further shows penetrating keratoplasty is the preferred technique of most of the world transplant. However, in recent years, several lamellar keratoplasty techniques have been developed, modified or improved, especially techniques for replacement of the posterior portion for correction of bullous keratopathy. Objective: To evaluate the efficacy and safety in endothelial keratoplasty when compared to penetrating keratoplasty for the improvement of visual acuity in aphakic and pseudophakic bullous keratopathy. Methods: Systematic review of randomized controlled trials (RCTs) and / or quasirandomized studies that assessed endothelial keratoplasty versus penetrating keratoplasty in adults diagnosed with aphakic or ...
Henkel, Tassilo. "Synthese und Charakterisierung von Limbusepithel-Amnion-Transplantaten aus langzeitorgankonservierten Hornhäuten und kryokonservierten Amnionmembranen." Doctoral thesis, Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2011. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-63630.
Full textSantos, Marcio Alexandre Araujo Florencio dos. "Perfil dos familiares responsaveis pela autorização ou recusa a doação de corneas em Hospital de Referencia." [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311487.
Full textTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Os objetivos deste estudo foram identificar o perfil epidemiológico dos familiares responsáveis pela autorização ou recusa à doação de córneas de seus parentes falecidos no Hospital de Clínicas da Universidade Estadual de Campinas; suas razões para autorizar ou não a doação; e razões para ser ou não doador de córneas. O estudo foi desenvolvido na Faculdade de Ciências Médicas, no Hospital de Clínicas da Universidade Estadual de Campinas - Unicamp, Campinas, São Paulo, Brasil, entre dezembro de 2005 e dezembro de 2006. O desenho adotado nesta pesquisa foi um estudo transversal do tipo analítico e descritivo, realizado através de questionário testado em estudo piloto. A amostra populacional desse estudo foi calculada baseado em teste estatístico para estudo descritivo e variável qualitativa. Foram realizadas 184 entrevistas e os resultados sugeriram que os familiares que eram solteiros, divorciados ou separados; católicos ou sem religião; que possuíam conhecimento que sua religião era a favor da doação; que possuíam atitudes altruísticas; que possuíam algum grau de conhecimento sobre doação e que obtinham informação sobre doação pela TV ou rádio, autorizaram mais a doação das córneas de seu parente falecido. As razões citadas para autorizar a doação de córneas foram: solidariedade às famílias que esperam por uma córnea; respeito ao desejo em doar do falecido; atitude altruística de ajudar ao próximo; conforto ao momento de dor que a família vivia. E as razões citadas contra a doação foram: respeito ao desejo em não doar do parente falecido; desconfiança na utilização da córnea; demora para captar a córnea e razões religiosas. O conhecimento desse perfil e dessas razões poderá levar a um melhor entendimento da recusa familiar e assim, planejar medidas mais efetivas para aumentar a doação de córneas.
Abstract: The objectives of this study was to identify the epidemiological profile of the family responsible for granting or refusing the donation of corneas of their deceased relatives in the Clinical Hospital of State University of Campinas and identify their reasons for granting or not giving, and reasons to be or not donor corneas. The study was conducted at the College of medical Sciences of Clinical Hospital of state University of Campinas, São Paulo, Brazil, between December 2005 and December 2006. The design adopted in this research study was a cross-sectional analytical and descriptive study through a questionnaire tested in a pilot study. The sample population of this study was calculated based on statistical test for a descriptive and qualitative variable. One hundred eighty four interviews were conducted and the results suggested that family members who were single, divorced or separated, Catholic or no religion, who had knowledge that their religion was in a favor donation, which had altruistic attitudes, which had some degree of knowledge about cornea donation and they obtained information about donation by TV or radio were more significant to authorize the donation of corneas of their deceased relative. Reasons cited to authorize the donation of corneas were: solidarity, the deceased wanted to donate, altruistic attitude to the next, comfort the moment of pain that the family lived. And the reasons cited against the donation were the deceased relative did not want to be a donor, do not have confidence in the use of the cornea, the delay to capture the cornea and religion reasons. Knowledge of this profile and theses reasons may lead to a better understanding of family refusal and so, plan the most effective measures to increase the donation of corneas.
Doutorado
Oftalmologia
Doutor em Ciências Médicas
Harfuch, Bruno. "Eficácia e segurança da ceratoplastia endotelial no tratamento da ceratopatia bolhosa pseudofácia e afácia : revisão sistemática e metanálise /." Botucatu, 2015. http://hdl.handle.net/11449/128072.
Full textCoorientador: Amélia Kamegasawa
Banca: Eliane Jorge
Banca: Tais W.
Resumo: Introdução: A córnea é uma túnica transparente responsável por 60% do poder refrativo do olho. Segundo a Organização Mundial da Saúde (OMS), doenças que afetam a transparência da córnea são responsáveis por 5,1% do total de cerca de 45 milhões de cegos. O Brasil é o país que mais realiza transplantes de córnea na América Latina. A taxa de perda endotelial gira em torno de 0,6/ano em pessoas normais. Essa taxa é acelerada após cirurgias oculares ou glaucoma. Essa perda, após o transplante penetrante devido trauma inicial, reação imune, glaucoma secundário, interação celular entre o doador e receptor, seria de 7,8%/ano nos primeiros cinco anos e 4,2%/ano após 10 anos. Alguns estudos sugerem perda endotelial maior no Descemet's stripping automated endothelial keratoplasty/Ceratoplastia endothelial automatizada "stripping" de Descemet (DSAEK) (34% após seis meses) do que no transplante penetrante (11%) enquanto outros mostram que a perda endotelial após um ano é maior no transplante penetrante. A sobrevida do enxerto em ambas as técnicas foram semelhantes e o resultado óptico superior na técnica DSAEK. Há quase um século o transplante penetrante tem sido a técnica cirúrgica de escolha no manejo de alterações corneais. Apesar das vantagens de procedimentos lamelares, como menor risco de complicações intra-oculares e rejeição do enxerto, o transplante penetrante ainda mostra ser a técnica de preferência da maioria dos transplantadores mundiais. Entretanto, nos últimos anos, várias técnicas de ceratoplastia lamelar têm sido desenvolvidas, modificadas ou melhoradas, principalmente técnicas para substituição da porção posterior para correção da ceratopatia bolhosa. A escolha de ceratopatia bolhosa pós facectomia foi por esta ser a principal causa de transplantes relacionados a disfunções endoteliais. Objetivo: Avaliar a eficá cia e a seguranç a d a ceratoplastia endotelial quando...
Abstract: Introduction: The cornea is a transparent organ responsible for 60% of the refractive power of the eye. According to the World Health Organization (WHO), diseases affecting the transparency of the cornea are responsible for 5.1% of total of about 45 million blind. Brazil is the country that performs corneal transplants in Latin America. Endothelial loss rate is around 0.6 / year in normal people. This rate is accelerated after eye surgery or glaucoma. This loss after penetrating keratoplasty because initial trauma, immune reaction, secondary glaucoma, cell interaction between donor and recipient, it would be 7.8% / year in the first five years and 4.2% / year after 10 years. Some studies suggest a greater endothelial cell loss in DSAEK (34% after six months) than in penetrating keratoplasty (11%) while others show that endothelial cell loss after one year is higher in penetrating keratoplasty. Graft survival in both techniques were similar and higher optical result in DSAEK technique. For nearly a century the penetrating keratoplasty has been surgical technique of choice in the management of corneal changes. Despite the advantages of lamellar procedures such as intraocular lower risk of complications and graft rejection further shows penetrating keratoplasty is the preferred technique of most of the world transplant. However, in recent years, several lamellar keratoplasty techniques have been developed, modified or improved, especially techniques for replacement of the posterior portion for correction of bullous keratopathy. Objective: To evaluate the efficacy and safety in endothelial keratoplasty when compared to penetrating keratoplasty for the improvement of visual acuity in aphakic and pseudophakic bullous keratopathy. Methods: Systematic review of randomized controlled trials (RCTs) and / or quasirandomized studies that assessed endothelial keratoplasty versus penetrating keratoplasty in adults diagnosed with aphakic or ...
Mestre
Salauze, Marianne. "Bilan d'activité de prélevement et de greffe à l'île de La Réunion du 01-07-94 au 01-07-95." Montpellier 1, 1996. http://www.theses.fr/1996MON11060.
Full textCosta, Dacio Carvalho. "Uso de triancinologia subconjuntival no tratamento da rejeição endotelial do transplante de cornea." [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311490.
Full textTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Objetivo: Comparar a eficácia da injeção subconjuntival de 20 mg de triancinolona associada a prednisolona 1% tópica com a injeção intravenosa de 500 mg de metilprednisolona associada a prednisolona 1% tópica no tratamento da rejeição endotelial de transplante de córnea. Métodos: Estudo caso-controle realizado no Hospital das Clínicas da UNICAMP. Os pacientes submetidos a transplante penetrante de córnea que apresentaram primeiro episódio de rejeição endotelial com até 15 dias do início dos sintomas durante o período de novembro de 2005 a outubro de 2006 foram tratados com injeção subconjuntival de 20 mg de acetonido de triancinolona associado a acetato de prednisolona 1% tópico. Estes pacientes foram pareados por idade e diagnóstico com pacientes submetidos a tratamento com injeção intravenosa de 500 mg de succinato sódico de metilprednisolona associado a acetato de prednisolona 1% tópico e analisados quanto à capacidade de reversão do episódio de rejeição, pressão intraocular aos 30 dias e acuidade visual ao final de 1 ano. Resultados: 16 pacientes foram tratados com 20 mg de triancinolona subconjuntival e prednisolona 1% tópica durante o período de recrutamento e foram pareados com 16 pacientes tratados com 500 mg de metilprednisolona intravenosa e prednisolona 1% tópica. Ao final de 1 ano, o grupo tratado com triancinolona obteve melhores resultados do que o grupo tratado com metilprednisolona (p=0,025), obtendo 15 pacientes com córnea transparente enquanto o grupo tratado com metilprednisolona obteve 10 pacientes. 3 pacientes do grupo tratado com triancinolona apresentaram segundo episódio de rejeição durante o seguimento e foram retratados com sucesso enquanto no grupo da metilprednisolona, 4 pacientes apresentaram segunda rejeição, com 2 pacientes apresentando falência com o retratamento e 2 obtendo sucesso. A pressão intraocular subiu nos dois grupos (p=0,002) após 30 dias, porém não houve diferença entre os grupos (p=0,433). A acuidade visual melhorou após 1 ano em ambos os grupos (p=0,049) e o grupo tratado com triancinolona obteve melhor acuidade visual (p=0,002). Conclusão: A injeção subconjuntival de 20 mg de triancinolona combinada com prednisolona 1% tópica mostrou-se mais eficaz em reverter episódios de rejeição de transplante de córnea neste estudo caso-controle do que a aplicação intravenosa de 500 mg de metilprednisolona. Estudos adicionais necessitam ser realizados para verificar a segurança e eficácia deste tratamento em grandes populações
Abstract: Purpose: To compare the efficacy of 20 mg subconjunctival triamcinolone in association with topical prednisolone 1% to 500 mg intravenous methylprednisolone in association with topical prednisolone 1% in the treatment of cornea endothelial graft rejection. Methods: Case-control study carried out at State University of Campinas Hospital. Patients submitted to penetrating keratoplasty that presented first episode of corneal endothelial rejection within 15 days of symptoms onset between November 2005 and October 2006 were treated with 20 mg subconjunctival injection of triamcinolone acetate in association with topical prednisolone acetate 1%. These patients were matched for age and diagnosis to patients that were submitted to a single 500 mg intravenous injection of methylprednisolone sodium succinate in association with topical prednisolone acetate 1% and analyzed regarding the reversion of the rejection episode, intraocular pressure at day 30 and visual acuity at the end of 1 year. Results: 16 patients were treated with 20 mg subconjunctival triamcinolone and topical prednisolone 1% during the period of recruitment and were matched to 16 patients treated with 500 mg intravenous methylprednisolone and topical prednisolone 1%. At the end of 1 year, the group treated with triamcinolone had a better outcome than the group treated with methylprednisolone (p=0.025), having 15 patients with clear grafts as the group treated with methylprednisolone had 10 patients. 3 patients from the group treated with triamcinolone had new rejection episodes during follow-up and were retreated successfully as in the group treated with methylprednisolone 4 patients had a new rejection episode, with 2 progressing to failure and 2 to success with retreatment. Intraocular pressure rose in both groups (p=0.002) at day 30 but there were no statistically significant differences between the groups (p=0.433). Visual acuity improved after 1 year in both groups (p=0.049) and the group treated with triamcinolone had better visual acuities (p=0.002). Conclusions: 20 mg subconjunctival injection of triamcinolone acetonide associated with topical prednisolone acetate 1% showed to be more effective than 500 mg intravenous methylprednisolone associated with prednisolone acetate 1% in this case-control study. Further studies need to be accomplished to verify its safety and effectiveness in larger populations
Doutorado
Oftalmologia
Doutor em Ciências Médicas
Bray, Laura Jane. "Evaluation of fibroin-based scaffolds for ocular tissue reconstruction." Thesis, Queensland University of Technology, 2012. https://eprints.qut.edu.au/52665/1/Laura_Bray_Thesis.pdf.
Full textLima, Juvina Leonor de Souza. "Transplantes de córnea em Sergipe : caracterização dos doadores e dos receptores, de 2000 a 2009." Universidade Federal de Sergipe, 2010. https://ri.ufs.br/handle/riufs/3738.
Full textA situação dos transplantes de córnea no Brasil se assemelha a de outros países, onde se observa uma oferta de córnea insuficiente para suprir a necessidade de realização dos transplantes. O presente estudo tem como Objetivo: a caracterização dos doadores de córnea e dos pacientes que se submeteram ao transplantes, avaliando dados epidemiológicos, indicações da cirurgia, presença de rejeição, tempo de lista de espera. Método: Trata-se de um estudo observacional, transversal, descritivo, onde foram coletados dados dos prontuários de todos os doadores e receptores de córneas, arquivados na Central de Notificação, Captação e Distribuição de Órgãos de Sergipe, no período de janeiro de 2000 a abril de 2009, sendo esses dados sumarizados como média e desvio padrão ou medianas e percentis para as variáveis quantitativas, enquanto para as categóricas utilizaram-se freqüência simples, percentagens e intervalo de confiança para 95%, quando necessário. Resultados: Foi observado um total de 272 doadores (544 córneas), com um número total de 415 córneas aproveitadas para transplante, e esse foi o número total de receptores pesquisados. A média de idade dos doadores foi de 39,4 ± 15,9 anos, com predomínio do sexo masculino com 68% (185/272) e a causa morte mais freqüente foi o trauma com 56% (152/272). Houve um aproveitamento de 79% (429/544) das córneas doadas, e apenas 415 transplantes foram elegíveis para a análise no presente estudo, de acordo com os critérios de inclusão e exclusão. Verificou-se uma positividade para doenças infecciosas entre o total das doações de 7,7% (44/544), que motivou o descarte das mesmas, além de 13% (70/544), descartadas por baixa qualidade do tecido. A solução mais utilizada para preservação foi o Optsol® (56%). Entre os receptores de córneas houve um predomínio da indicação de transplantes pela ceratopatia bolhosa (37,3%), seguida do leucoma (23,%) e posteriormente o ceratocone (18,3%). A idade média dos receptores foi de 51,4 ± 25,0 anos, sendo o percentual de 51% para o sexo masculino e 49% para o sexo feminino. O percentual de rejeição foi de 8,7%. Quanto ao tempo de espera pelo transplante, a mediana foi 9,9, meses, o percentil 25 foi 2,2 meses e o percentil 75 foi 38,6 meses., além de observa-se um aumento do número de pacientes na fila de espera, que passou de 89 em 2000, a 325, ao final de 2009. Conclusão: Os doadores de córnea foram predominantemente homens, jovens, vítimas de trauma, em sua maioria, implicando em boa qualidade da córnea, com um alto aproveitamento destas doações. O nível de rejeição foi considerado baixo o tempo de espera pelo transplante foi considerado alto, além de se verificar um grande aumento da fila de espera, que triplicou ao longo de quase 10 anos. A principal indicação para a cirurgia de transplante foi a ceratopatia bolhosa do pseudofácico,.
Patel, Hussain Y. "Analysis of eye banking and corneal transplantation in New Zealand." 2007. http://hdl.handle.net/2292/5553.
Full textHaydari, M. Nour. "Regenerative potential of corneal endothelium from patients with fuchs endothelial corneal dystrophy." Thèse, 2012. http://hdl.handle.net/1866/10115.
Full textFuchs endothelial corneal dystrophy (FECD) is a primary disease of the corneal endothelium. Its pathogenesis is poorly understood. No medical treatment is effective. Surgical treatment (the only available treatment) carries 10% of immunogenic rejection. Experimental models are needed in order to better understand the disease and to investigate potential autologous treatments (to prevent immunogenic rejection). The overall goal of this thesis is to develop an experimental model for FECD using tissue engineering. This was achieved in three steps. 1) An in vitro tissue-engineered FECD model was created and characterized. Briefly, Descemet’s membranes from patients with late-stage FECD undergoing Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) were used to isolate and culture FECD endothelial cells. Second or third-passaged FECD endothelial cells were seeded on a previously decellularized human cornea. After 2 weeks in culture, TE-FECD corneas (n=6) were assessed using histology, transmission electron microscopy (TEM) and immunofluorescence labeling of various proteins. TE-FECD endothelium yielded a monolayer of polygonal cells well adhered to Descemet’s membrane. The TE-FECD corneal endothelium expressed the function-related proteins Na+-K+/ATPase α1 and Na+/HCO3-. Clusterin expression was faint and uniform. 2) In order to determine the best surgical procedure to transplant the TE-FECD corneas in the feline model, a DSAEK procedure was evaluated and compared to penetrating keratoplasty technique. DSAEK assessments included surgical challenges and clinical outcomes. DSAEK technique was challenging to perform in the feline model. Rapid fibrin formation was observed in all DSAEK cases (n=5). 3) The in vivo functionality of the TE-FECD corneas was assessed. TE-FECD corneas were grafted in the feline model (n=7) using penetrating keratoplasty procedure and observed for seven days. In vivo assessments included transparency, pachymetry, optical coherence tomography, endothelial cell morphometry, TEM and immunostaining of function-related proteins. After transplantation, pachymetry gradually decreased and transparency gradually increased. Seven days after transplantation, 6 out of 7 grafts were clear. Post-mortem TEM showed subendothelial loose fibrillar material deposition in all TE-FECD grafts. The TE grafted endothelium expressed Na+-K+/ATPase and Na+/HCO3-. This thesis demonstrates that endothelial cells from late-stage FECD corneas can be used to engineer a corneal endothelium. Compared to DSEAK, penetrating keratoplasty is a more appropriate procedure for corneal transplantation in the feline model, since the DSAEK procedure in the feline model presently yields inconsistent clinical results. Restoration of corneal thickness and transparency demonstrates that the TE-FECD grafts are functional in vivo. This novel FECD living model suggests a potential role of tissue engineering for FECD cell rehabilitation. Potential applications are numerous, including pathophysiological and pharmacological studies.
Bernardes, Luís Araújo Matos Caldeira. "Trends in corneal transplant indications and techniques in Coimbra, Portugal: 2011 -2016." Master's thesis, 2017. http://hdl.handle.net/10316/81896.
Full textIntrodução: O objectivo deste estudo é determinar as recentes mudanças nas indicações para transplantes de córnea e no uso de tecido corneano em Coimbra.Métodos: os dados relativos a todos os transplantes realizados no Centro Hospitalar e Universitário de Coimbra (CHUC) entre 2011 e 2016 foram colhidos e compilados no Banco de Olhos dos CHUC. Analisámos retrospectivamente a idade, género, diagnóstico primário e técnica de transplante utilizada. Resultados: Ao longo dos 6 anos considerados, foram realizados 711 transplantes de córnea. A indicação para transplante mais frequente foi o re-transplante, responsável por 207 (29.2%) procedimentos, seguido da queratopatia bolhosa com 125 (17.6%) casos e queratocone, com 118 (16.6%) casos. Não foram encontradas alterações estatisticamente significativas nas indicações entre os 6 anos do estudo. No total, foram realizadas 506 (71.3%) queratoplastias penetrantes (PK), 129 (18.2%) Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) e 64 (9.0%) Deep Anterior Lamellar Keratoplasty (DALK). Ao longo dos anos, observámos uma diminuição estatisticamente significativa dos números de PK, acompanhada de um aumento da realização de DALK e DSAEK.Conclusões: os registos do banco de olhos dão-nos a capacidade de avaliar a evolução dos transplantes de córnea. As indicações permaneceram estáveis ao longo da janela temporal considerada. Comparando com outros estudos, apresentamos mais re-transplantes, menos queratocones (particularmente comparando com estudos mais antigos), e percentagens semelhantes de queratopatia bolhosa e distrofias da córnea. Em termos de técnica cirúrgica, este estudo contribui para evidenciar a popularidade crescente de queratoplastias lamelares em oposição a PK. Em conclusão, as indicações e técnicas para transplante de córnea continuam em evolução rápida, e merecem investigação continuada de modo a optimizar as actividades de bancos de olhos e centros de transplantação.
Introduction: The aim of this study is to determine the recent trends in corneal transplant indications and corneal tissue use in Coimbra. Methods: data concerning all corneal transplantation procedures performed at Centro Hospitalar e Universitário de Coimbra (CHUC) between 2011 and 2016 were collected and stored at the CHUC Eye Bank. We retrospectively analysed recipient age, gender, primary diagnosis and transplantation technique.Results: Across the 6 years considered, 711 corneal transplants were reviewed for analysis. The most frequent indication for corneal transplantation was regraft, which accounted for 207 (29.2%) of all procedures, followed by bullous keratopathy, with 125 cases (17.6%) and keratoconus, with 118 cases (16.6%). No statistically significant shift in indications for grafting was identified over the 6-year period (p = 0.70). All years accounted, penetrating keratoplasty (PK) accounted for 506 procedures (71.3%), Descemet’s stripping automated endothelial keratoplasty (DSAEK) for 129 (18.2%), and deep anterior lamellar keratoplasty (DALK) for 64 (9.0%). Over the 6 years, we observed a statistically significant decline in the numbers of PK, accompanied by an increase in DSAEK and DALK. Conclusions: Eye bank registries provide an effective means to evaluate corneal transplantation evolution. Transplant indications have remained stable across the time frame considered. Compared with other series, we report more repeat grafts, less keratoconus (particularly when comparing with older studies) and similar percentages of bullous keratopathy and corneal dystrophies. In terms of surgical technique, this study provides further evidence of the increasing popularity of lamellar keratoplasties, in opposition to PK. In conclusion, the indications and techniques for corneal transplantation continue to evolve rapidly, and merit continued investigation to optimize the activities of eye banks and transplant centres.
Bostan, Cristina. "Fonctionnalité in vivo d’un endothélium cornéen reconstitué par injection de cellules endothéliales cornéennes dans la chambre antérieure d’un modèle félin." Thèse, 2015. http://hdl.handle.net/1866/16255.
Full textIntroduction : Despite their growth arrest in vivo, corneal endothelial cells (CEC) can be amplified in vitro. Their subsequent transplantation by cell-injection therapy could overcome the tissue scarcity associated with traditional allo-transplantation, which is the only currently available treatment for irreversible corneal endothelial failure. Objective : To evaluate the functionality of a corneal endothelium reconstituted by cell- injection therapy in the feline. Methods: The right eyes of 16 animals underwent surgery. Eight underwent central endothelial scraping and injection with 2x10e5 (n=4) or 1x10e6 (n=4) feline CEC supplemented with Y-27632 and labeled with SP-DiOC18(3). After total scraping, two eyes were injected with 1x10e6 labeled CEC and Y-27632. The central (n=3) or entire (n=3) endothelium was scraped in six controls followed by Y-27632 injection without CEC. Outcomes included clinical performance, anatomical integrity, functional phenotype and SP-DiOC18(3) expression of the new endothelium. Results: Corneas grafted with 2x10e5 CEC and centrally scraped controls performed the best clinically. Entirely scraped controls remained hazy and thick. Histopathology revealed a confluent, functional endothelial monolayer in corneas grafted with 2x10e5 CEC and centrally scraped controls, a non-uniform, non-functional endothelial multilayer in centrally scraped corneas grafted with 1x10e6 CEC, and a non-functional fibrotic endothelium in entirely scraped grafts and controls. SP-DiOC18(3) was scarce in grafts and absent in controls. Conclusion : Cell-injection therapy reconstituted an incompletely functional endothelium, to which injected CEC contributed little. Y-27632 injection without CEC reconstituted the healthiest endothelium. Further studies investigating the therapeutic effect of Y-27632 alone are warranted.
Correia, Ana Filipa Soares. "Transplantes de Córnea de Alto Risco - Prevenção de Rejeições." Master's thesis, 2020. http://hdl.handle.net/10316/97719.
Full textIntrodução: Os transplantes de córnea de alto risco apresentam taxas de rejeição mais elevadas e precoces devido à perda do “privilégio imunológico” habitualmente presente em doentes submetidos a transplante de córnea. Não havendo atualmente consenso sobre qual o melhor esquema imunossupressor a utilizar nestes casos, avaliámos o impacto do tacrolimus tópico na sobrevida do transplante, quando adicionado ao esquema terapêutico previamente utilizado no Serviço de Oftalmologia do Centro Hospitalar e Universitário de Coimbra.Métodos: Analisámos de forma observacional e retrospetiva o pós-operatório do transplante de córnea em doentes considerados de alto risco submetidos a esquema imunossupressor com recurso ao tacrolimus pomada oftálmica 0.2mg/g 2id. Os doentes foram classificados como alto risco caso tivessem sido submetidos a transplante de córnea prévio e apresentassem dois ou mais quadrantes do estroma da córnea com neovascularização. A informação foi obtida através dos registos clínicos relativos às consultas de pré e pós-operatório. O grupo de controlo foi constituído pelo mesmo grupo de doentes, considerando os dados relativos ao transplante de córnea realizado previamente ao transplante em estudo, no qual não foi adicionado tacrolimus ao esquema de imunossupressão. Desta forma, a comparação foi feita entre o transplante anterior, sem adição de tacrolimus, e o transplante atual (com tacrolimus) no mesmo grupo de doentes.Resultados: A amostra foi constituída por 16 doentes, 8 do género masculino e 8 do género feminino, sendo a idade média de 62,94 ± 18,50 anos (média ± desvio-padrão). Durante um follow up de 20,00 ± 9,83 meses (mediana ± desvio-padrão), cerca de 18,8% dos doentes em estudo apresentaram rejeição do transplante, comparativamente a 100% dos doentes no grupo controlo, durante o follow up de 14,00 ± 50,33 meses (mediana ± desvio-padrão). Discussão: Estudos anteriores revelam taxas de sobrevida dos transplantes de córnea de alto risco inferiores a 35% aos 10 anos e sem melhoria destes valores ao longo das últimas décadas. A nossa análise revelou uma melhoria da sobrevida dos transplantes de córnea de alto risco caso com a adição do tacrolimus tópico pomada oftálmica ao esquema terapêutico convencional, baseado em corticosteroides tópicos.Conclusão: O tacrolimus tópico revelou-se seguro e eficaz no prolongamento da sobrevida do transplante em doentes de alto risco.
Purpose: High-risk corneal grafts have high levels of rejection because they lose their “immunological privilege”. Nowadays there is no consensus of which immunosuppression should be used, so we studied how topical tacrolimus ointment could help prevent rejection in these cases, when added to the previous immunosuppression regimen on the Ophthalmological Department of Centro Hospitalar e Universitário de Coimbra.Methods: We retrospectively analyzed the post-operative time in high-risk patients who used an immunosuppression regimen with topical tacrolimus ointment 0.2mg/g twice a day. The information was gathered from the clinical files. Patients were considered high risk if they had history of previous graft rejection and at least two quadrants of stromal neovascularitization. The controls were previous grafts in the same group of patients.Results: We studied 16 patients, 8 males and 8 females, with a media age of 62,94 ± 18,50 years (media ± standard deviation). During a follow-up of 20.00 ± 9.83 months (median ± standard deviation), about 18,8% of patients in the study group experienced transplant rejection, compared to 100% of patients in the control group. The median follow-up of the control group (previous transplant without tacrolimus) was 14,00 ± 50.33 months (median ± standard deviation).Discussion: Previous studies showed survival rates less than 35% at 10 years, with no improvement of these values during the last decades. Our study showed that topical tacrolimus ointment increases the survival rate of the graft if added to the previous topical steroid regimen.Conclusion: Topical tacrolimus ointment is safe and effective in prolonging graft survival in high-risk patients.
"Human umbilical cord lining epithelial cells with stem cell-like properties: an adjunct to skin regeneration." 2013. http://library.cuhk.edu.hk/record=b5549751.
Full text本論文的第二章對CLECs的體外分離和增殖進行了詳細地描述。這一類細胞具有較長的染色體端粒,較高的增殖潛能和傳代能力。同時,它們表達上皮幹細胞和多能性幹細胞的標誌性表面抗原。它們還具有多種分化潛能,包括成脂、成骨和成軟骨。然而當皮下異種移植後,它們並不會形成畸胎瘤。
本論文的第三章對CLECs的免疫特性進行了評估。結果顯示CLECs不但具有低免疫原性,還具有免疫調節功能。它們表達典型性的一型主要組織相容性複合體(MHC class I),即人白細胞ABC抗原(HLA-ABC),但不表達典型性的二型主要組織相容性複合體(MHC class II),即人白細胞DR抗原(HLA-DR)。它們同時還表達非典型性的MHC class I, 包括人白細胞G抗原和人白細胞E 抗原(HLA-G和HLA-E), 但不表達共激分子(CD40, CD80和CD86)。此外,體外檢測還發現它們表達適度的促炎/抗炎細胞因子和大量的生長因子.
本論文的第四章對CLECs在表皮重建應用中的潛能進行了考察。結果顯示無論在體外器官培養還是異種移植動物模型中,CLECs都能形成分層的上皮結構,與用表皮細胞構建的分層上皮結構相類似。而且在CLECs構建的皮膚替代物中證實了有表皮分化標誌性抗原的表達。
結論:本論文證明了CLECs具有幹細胞樣特性但無致瘤性,具有低免疫原性和表皮分化的可塑性。研究結果支持CLECs在創傷癒合和皮膚再生領域的臨床應用可行性.
The skin is the largest organ in the body and has multiple functions. One of the most important functions is to serve as a protective barrier between the internal and external environments of the body. Restoration of the integrity of this protective barrier is an essential aspect of wound healing and tissue regeneration. In this thesis, the potential of human umbilical cord lining epithelial cells (CLECs) as a source of stem cells with appropriate differentiation capacity for epidermal reconstitution has been explored.
The isolation and propagation of CLECs from human umbilical cord lining epithelium were described in Chapter II. The cells presented a long telomere length and had high proliferative potential and passaging capability. They were also shown to display both epithelial and pluripotent stem cell markers. They were capable of multipotent differentiation, including adipogenesis, osteogenesis and chondrogenesis. However, they didn’t form teratoma after subcutaneous xenotransplantation until 12 weeks.
The immune properties of CLECs in vitro were assessed in Chapter III. The cells were shown to have low immunogenicity but high immunosuppressive function. They expressed classical major histocompatibility complex (MHC) class I antigens (HLA-ABC), but not MHC class II antigen (HLA-DR). They also expressed non-classical MHC class I antigens (HLA-G and HLA-E), but lacked the expression of the co-stimulatory molecules (CD40, CD80 and CD86). Moreover, they expressed moderate pro/anti-inflammatory cytokines and multiple growth factors both in cell supernatants and cell lysates.
The potential of CLECs for epidermal reconstitution was investigated in Chapter IV. In both organotypic culture and xenotransplantation model, CLECs were capable of generating a stratified epithelial structure, which is similar to that constructed by using keratinocytes. Furthermore, the expression of epidermal differentiation markers was verified in CLEC-constructed skin substitutes.
In conclusion, the stem cell-like properties of CLECs have been demonstrated in the present study. In addition to the lack of tumorigenicity, CLECs also have low immunogenicity and significant plasticity in epidermal differentiation. The findings support the potential clinical application of CLECs in wound healing and skin regeneration.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Cai, Yijun.
"October 2012."
Thesis (Ph.D.)--Chinese University of Hong Kong, 2013.
Includes bibliographical references (leaves 114-129).
Abstract also in Chinese.
Abstrac --- p.i
Table of Contents --- p.v
Abbreviations --- p.vii
List of Figures --- p.viii
List of Tables --- p.x
Chapter Chapter I --- Introduction --- p.1
Skin --- p.3
Wound healing --- p.6
Wound regeneration and repair --- p.6
Recent history of wound treatment --- p.9
Skin substitutes --- p.11
Stem cells for wound treatment --- p.14
Stem cells overview --- p.15
Adult stem cells --- p.16
Fetal stem cells --- p.18
Amniotic membrane derived stem cells --- p.19
Umbilical cord stem cells --- p.22
Hypothesis and Specific aims --- p.24
Chapter Chapter II --- The Isolation and Characterization of the Stem Cell-like Properties of Human Umbilical Cord Lining Epithelial Cells --- p.28
Introduction --- p.28
Materials and methods --- p.30
Results --- p.47
Discussion --- p.62
Conclusion --- p.67
Chapter Chapter III --- The assessment of the Immune Properties of Human Umbilical Cord Lining Epithelial Cells --- p.69
Introduction --- p.69
Materials and methods --- p.72
Results --- p.75
Discussion --- p.83
Conclusion --- p.88
Chapter Chapter IV --- The Investigation of the Potential of Human Umbilical Cord Lining Epithelial Cells for the Epidermal Reconstitution --- p.89
Introduction --- p.89
Materials and methods --- p.91
Results --- p.94
Discussion --- p.101
Conclusion --- p.104
Chapter Chapter V --- Summary and Future Plan --- p.105
Summary --- p.105
Future plan --- p.108
Acknowledgements --- p.113
References --- p.114
Appendix --- p.130
Chen, Hung Chi, and 陳宏吉. "Phenotypic Characterization of Human Corneas after Cultivated Oral Mucosal Epithelial Transplantation." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/66229451124838775763.
Full text長庚大學
臨床醫學研究所
101
Recent advances in stem cell (SC) biology have led to novel application of stem cell-based therapies. Second to hematopoietic SCs, epithelial SCs are among the most studied populations. The primary source of corneal epithelium is considered to be a population of SCs, residing in the limbal region and giving rise to transient amplifying cells. Not only do SCs ensure that the corneal epithelium undergoes continual self-renewal, they are also responsible for repair and regeneration of the corneal epithelial tissue. Unfortunately, there are still limitations for use of adult SCs. First, there are no definitive markers for the identification of adult SCs in general and corneal SCs in particular. Second, ex vivo systems for manipulating SCs are still ill-defined. Finally, it remains unclear about the safety, efficacy, and phenotype of the ex vivo cultivated epithelial cell sheets after transplantation into the human body. Limbal SC deficiency of any cause may result in poor corneal epithelialization, persistent epithelial defects, corneal vascularization, corneal scarring, i.e. conjunctivalization of the cornea, leading to decreased vision, ocular discomfort and pain, and an unstable ocular surface. The past two decades have witnessed considerable progress in the treatment of such ocular surface diseases. Ex vivo cultivated corneal epithelial SC transplantation, an advanced form of conventional limbal transplantation, is now considered one surgical modality of choice. Autologous in nature for the proto-type surgical method though, for bilateral total limbal deficiency, it is important to realize that without the use of immunosuppressives, allogeneic cultivated corneal epithelial cells are easily rejected. On the other hand, definitive evidence for the long-term persistence of transplanted SCs is not yet provided. Recently, autologous cultivated oral mucosal epithelial transplantation (COMET) was developed in Japan and is now recognized as an innovation in cell therapy. However, compared with corneal epithelial cells, the inferior anti-angiogenic effect and epithelial barrier function of oral mucosal epithelial cells (OMECs) may result in less satisfactory epithelial transparency and regularity, thus limiting the visual outcome after COMET, which is the main disadvantage of this technique. In the first part of this study, we executed phase I clinical trial of COMET. Since April 2006, COMET was performed in the acute (n = 6) and chronic stage (n = 7) of corneal burns. The results show the clinical potential of COMET to promote epithelialization and reduce inflammation in acute burns, to reconstruct the conjucntival and corneal surface in chronic burns, and to improve visual acuity after subsequent ocular surface reconstruction procedures. Free from rejection and repeatable, COMET may be considered an alternative treatment or bridge therapy for the management of severe corneal burns. In the second part of this study, adopting conventional histopathology and immunofluorescent confocal microscopy, we investigated differentiation-related and putative SC markers in corneas after COMET as well as oral mucosa and cultivated OMECs for COMET. Between 10 and 22 months after COMET, corneal tissues were obtained after penetrating keratoplasty (PKP, n = 1) in and after conjunctivolimbal autografting (CLAU, n = 3). The results confirm the notion that keratin 8, normally expressed by simple epithelia, is expressed by both normal corneal and conjunctival epithelia, but not by normal OMECs unless in malignancy. Importantly, small and compact p75-positive cells in the basal epithelium are likely to contain SCs and are suggestive of long-term existence of OMECs in corneas after transplantation. In the third part of this study, following the similar protocol, we investigated angiogenesis-related factors in corneas after COMET in another six patients. Between 9 and 26 months after COMET, corneal tissues were obtained after PKP (n = 3) and CLAU (n = 3). The results support clinical speculation that low levels or lack of anti-angiogenic activity of cultivated OMECs result in corneal neovascularization after COMET. Specifically, soluble fms-like tyrosine-1 (sFlt-1), tissue inhibitor of metalloprotease-3 (TIMP-3), and thrombospondin-1 (TSP-1) probably play a pivotal role in determining heterogeneous angiogenic activity of transplanted OMECs in corneas after COMET. Through the phenotypic analysis of the aforementioned clinical trial, we have justified the rationale for clinical use of cultivated epithelial transplantation. We have also paved a way to further improve the clinical practicability of this innovative procedure.
Henkel, Tassilo. "Synthese und Charakterisierung von Limbusepithel-Amnion-Transplantaten aus langzeitorgankonservierten Hornhäuten und kryokonservierten Amnionmembranen." Doctoral thesis, 2010. https://tud.qucosa.de/id/qucosa%3A25456.
Full textLin, Hsiu-Fen, and 林秀芬. "Effect of Transplantation with Cultured Human Adipose Tissue Derived Stem Cells on Rabbits Cornea RepairAfter Alkaline Chemical Burn ---- An Animal Study." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/16432366598597946283.
Full text高雄醫學大學
職業安全衛生研究所
97
Chemical burn is the absolute ocular emergency. It is the most severe injuries to the organ of vision with a very high percentage of unfavorable outcomes. It often causes extensive damage and results in permanent visual impairment. Recurrent epithelial erosions, symblepharon, corneal scar, corneal ulceration, severe stromal inflammation, and corneal neovascularization are common clinical complications of alkali burn .We studied the effect of cultured human adipose tissue-derived stem cells on regeneration of rabbit cornea after alkaline chemical burn. Human adipose tissue–derived stem cells are served as the source of donor material. The frozen stem cells were defreezing and sub-cultured up to 80% with Keratinocyte -SFM (Invitrogen ) and supplements of EGF , BFE( Bovine pituitary extraction), 10 %FBS ( FBS 50 cc / SFM 500 cc),GM solution 100 ul / 500 cc SFM. The cell suspension was cultured in 25 cm2 culture flasks at 37oC and 5% CO2. Culture medium was replaced by 80-90 % every 2 days. The study was performed on 8 rabbits (2-2.5 kg) with alkaline burns of the cornea. NaOH-impregnated disks (impregnated for 5 minutes, size as 7 mm in diameter) were placed into strictly central cornea area for 40 sec. After removal of the disks, the eyes were washed with 20 ml saline for 30 sec. All the procedures were taken under general anesthesia (5% ketamine plus rompune 1 to 2 mg/kg IM) and local analgesia of the cornea (1% Proparacaine Hydrochloride). Immediately after the chemical burn, experimental animals received a single subconjunctival injection of stem cell suspension (1.3×105 cells/ 0.2 ml ml). Controls were injected with 0.2 ml saline. Topical treatment with gentamycin oint (twice per day) was applied for preventing secondary infections. The eyes were eviscerated after sacrifice on days 30. Histological studies were performed on paraffin sections stained with hematoxylin and eosin. Real-time PCR are performed to detect the surface markers of P 63, E-Catherin, Beta-catenin, and Connexin 43. We evaluate the corneal functions via the following criteria, corneal opacity assessments, Real-time PCR and Histology, to prove the corneal regeneration effects of human adipose tissue - derived stem cells. The average grading of experimental group is graded as 1-2 while the controlled group is graded as 4.This means the stem cells offer more cell renewal processes than the controlled group. Real-time for beta- catena, connexin43 (Cx43), E-Catherin, and P63 are checked, which represent as cell membrane, cell membrane, non-neural epithelium and corneal stratified epithelium individually. Positive correlation of beta- catenin, connexin43 (Cx43), E-Catherin means good cell renewal for damage repair of corneal epithelium related to chemical burn. P63 shows non-significant change. Histologically, there are 5-6 cell layers at epithelium for the experimental group and 2-3 cell layers for the controlled group. Except the 8th rabbits with poor section of histology, 6 experimental groups show 5-6 cell layers and 7 control group show 2-3 cell layers over the epithelia . Transplantation of cultured human adipose tissue derived stem cells on rabbits corneal chemical burn promotes cell renewal and damage repair. Corneal transparency, Real-time PCR, epithelium cell layers are evaluated and proved as positive for wound healing.
Faltýsková, Helena. "Experimentální modely přenosu kmenových buněk pro léčebné účely." Master's thesis, 2010. http://www.nusl.cz/ntk/nusl-297762.
Full textŠmeringaiová, Ingrida. "Použití endotelu rohovky a amniové membrány k transplantačním účelům." Doctoral thesis, 2020. http://www.nusl.cz/ntk/nusl-436277.
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