Navegando por Palavras-chave "Limbus corneae"
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- ItemAcesso aberto (Open Access)Assessment of surgical outcomes of limbal transplantation using simple limbal epithelial transplantation technique in patients with total unilateral limbal deficiency(Consel Brasil Oftalmologia, 2016) Queiroz, Ana Gabriela [UNIFESP]; Oiticica Barbosa, Martina Maria [UNIFESP]; Santos, Myrna Serapiao [UNIFESP]; Barreiro, Telma Pereira [UNIFESP]; Pereira Gomes, Jose Alvaro [UNIFESP]This study aimed to evaluate the effectiveness of the novel simple limbal epithelial transplantation (SLET) technique, which reduces the risk of iatrogenic limbal stem cell deficiency in the donor eye. Four patients with total unilateral limbal stem cell deficiency received a limbal graft, measuring 4 mm x 2 mm, from the contralateral healthy eye in a single surgical procedure. The graft was divided into 10-20 pieces and distributed on the corneal surface. At 6-month follow-up, a completely avascular corneal epithelial surface was obtained in two patients, and there was improvement in visual acuity in one patient. The limbal grafts did not adhere to the cornea in one patient. No serious complications related to the surgery were observed in this study.
- ItemAcesso aberto (Open Access)Avaliação da presença de células caliciformes na córnea humana(Conselho Brasileiro de Oftalmologia, 2004-02-01) Barros, Jeison de Nadai [UNIFESP]; Mascaro, Vera Lucia Degaspare [UNIFESP]; Gomes, José Álvaro Pereira [UNIFESP]; Sousa, Luciene Barbosa de [UNIFESP]; Hofling-Lima, Ana Luisa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); FMO I.A.M.S.P.E Hospital do Servidor Público EstadualPURPOSE: To analyze by impression cytology the presence of goblet cells on corneal surfaces with conjunctivalization. METHODS: Corneal-conjunctival impression cytology was performed in 65 eyes of 65 patients who had clinical signs of conjunctivalization with or without previous ocular surgery. Patients were classified into two groups according to previous history of ocular surface reconstructive surgery associated with limbal transplantation and human amniotic membrane. In group I, 49 patients without previous ocular surgery were evaluated and in group II 16 patients were included after ocular surface reconstructive surgery with conjunctivalization recurrence. Samples were obtained in the affected eye between February 2000 and February 2002 at the UNIFESP's External Eye Disease Laboratory. Limbal deficiency was detected when one or more goblets cells were found on the corneal surface. RESULTS: In group I one or more goblet cells were found on the corneal surface of 21 eyes (42.85%). In group II goblet cells were found on the corneal surface of 9 patients (56.25%). CONCLUSION: Presence of goblet cells on the corneal surface detected by impression cytology in patients with conjunctivalization can confirm limbal stem cell deficiency, however, its absence does not exclude the diagnosis.
- ItemAcesso aberto (Open Access)Comparação entre membrana amniótica com e sem epitélio como substrato para cultura de células epiteliais do limbo ex vivo(Conselho Brasileiro de Oftalmologia, 2011-04-01) Covre, Joyce Luciana [UNIFESP]; Loureiro, Renata Ruoco [UNIFESP]; Cristovam, Priscila Cardoso [UNIFESP]; Ricardo, José Reinaldo da Silva [UNIFESP]; Freymüller-Haapalainen, Edna [UNIFESP]; Gomes, José Álvaro Pereira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To evaluate the efficacy and ultrastructural aspects of human limbal epithelial cells cultured on amniotic membrane (AM) with and without epithelium. METHODS: Limbal epithelial cell cultures were established from cadaveric cor neo-scleral rim explants derived from 6 different donors. The explants from each donor were placed under 3 different groups: on human preserved AM with epithelium (Group 1), AM deepithelialized with trypsin (Group 2) and control (Group 3). The epithelial cell migration was evaluated under phase contrast microscopy. After 15 days, the amniotic membrane with cells cultures were removed and submitted to scanning and transmission electron microscopy to check for epithelial migration and adhesion. RESULTS: All epithelial cell cultures from the controls grew over the botton of the culture plate wells until reaching confluence. Epithelial cultures grew over all but one denuded amniotic membrane. In the group amniotic membrane with epithelium, epithelial cell growing was observed only in 1 well. CONCLUSIONS: Using this model, denuded amniotic membrane appeared to be the best substrate for epithelial cell migration and adhesion comparing to amniotic membrane with epithelium. Removal of amniotic membrane epithelial seems to be an important step for establishing limbal epithelial cell culture on amniotic membrane.
- ItemAcesso aberto (Open Access)Cytological features of live limbal tissue donor eyes for autograft or allograft limbal stem cell transplantation(Conselho Brasileiro de Oftalmologia, 2011-08-01) Barros, Jeison de Nadai [UNIFESP]; Santos, Myrna Serapião dos [UNIFESP]; Barreiro, Telma Regina Maria Pereira [UNIFESP]; Belfort, Rubens Junior [UNIFESP]; Gomes, José Álvaro Pereira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To evaluate by impression cytology (IC) the corneal surface of live limbal tissue donor eyes for autograft or allograft limbal stem cell transplantation (LSCT). METHODS: Twenty limbal donors were enrolled (17 for autograft LSCT and 3 for allograft). Impression cytology was performed before transplantation of superior and inferior limbal grafts and after the third postoperative month. RESULTS: Impression cytology analysis showed sheets of corneal epithelial cells and goblet cell absence beyond the edge of the keratectomy sites in all patients, suggesting that conjunctival invasion towards the center did not occur in any eye. Partial conjunctivalization within 2 to 3 clock hours, confirmed by the presence of goblet cells, was limited to the keratectomy site in 10% of the cases. CONCLUSION: A clear central corneal surface was demonstrated in all eyes following surgery leading to the conclusion that limbal donation was a safe procedure in this group of patients. A small percentage of eyes can have donor sites re-epithelized with conjunctival cells at the periphery of the cornea.
- ItemAcesso aberto (Open Access)Importância do co-cultivo com fibroblastos de camundongo 3T3 para estabelecer cultura de suspensão de células epiteliais do limbo humano(Conselho Brasileiro de Oftalmologia, 2008-10-01) Cristovam, Priscila Cardoso [UNIFESP]; Glória, Maria Aparecida da [UNIFESP]; Melo, Gustavo Barreto de [UNIFESP]; Gomes, José Álvaro Pereira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To evaluate the importance of the presence of 3T3 fibroblasts for establishing limbal epithelial cultures from cell suspension obtained from corneo-scleral rims (CSR). METHODS: Corneo-scleral rims from different donors (n=6) had their posterior stroma and endothelium stripped away. Each corneo-scleral rim was divided into three equal segments that were set up in tissue culture in three different conditions: one of the segments was placed with the epithelial side up on the bottom of a 6-well culture plate (Group A). The other two fragments were trypsinized and the obtained cell suspension was cultured with (Group B) or without (Group C) irradiaded 3T3 cells. The cells were cultured in supplemental hormonal epithelial medium (SHEM), the epithelial migration and clone formation in groups A, B and C were evaluated with phase contrast microscopy and rodamine B staining. RESULTS: Epithelial cell growth was observed in 4/6 rims (Group A). All epithelial cell suspensions that were cultured with 3T3 cells (Group B) formed clones. No adhesion or true clone formation (holo- or meroclones) was observed in the cell suspensions that were cultivated without 3T3 (Group C) (p=0.009). CONCLUSIONS: Epithelial cell suspension obtained from corneo-scleral rims in this model needs to be cultivated with 3T3 cells in order to form clones and establish limbal epithelial cell colonies with the potential to be used for ocular surface reconstruction.
- ItemAcesso aberto (Open Access)Impression cytology and in vivo confocal microscopy in corneas with total limbal stem cell deficiency(Conselho Brasileiro de Oftalmologia, 2013-10-01) Araújo, Aline Lütz de [UNIFESP]; Ricardo, José Reinaldo da Silva [UNIFESP]; Sakai, Vivian Naomi [UNIFESP]; Barros, Jeison de Nadai [UNIFESP]; Gomes, José Álvaro Pereira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSES: To describe corneal changes seen on in vivo confocal microscopy in patients with total limbal stem cell deficiency and to correlate them with cytological findings. METHODS: A prospective case series including 13 eyes (8 patients) with total limbal deficiency was carried out. Stem cell deficiency was diagnosed clinically and by corneal impression cytology. Confocal images of the central cornea were taken with the Heidelberg Retina Tomograph II, Rostock Corneal Module (Heidelberg Engineering, Heidelberg, Germany). RESULTS: Impression cytology of the cornea revealed conjunctival epithelial cells and goblet cells in all cases. In vivo confocal microscopy showed disruption of normal layers of the corneal epithelium in all eyes. Confocal images showed cells with characteristics of conjunctival epithelium at the cornea in 76.9% of the total. These findings on confocal microscopy were compatible to limbal stem cell deficiency. Additionally, goblet cells, squamous metaplasia, inflammatory cells and dendritic cells were observed. The sub-basal nerve plexus was not identified in any of the corneas. Corneal neovessels were observed at the epithelium and stroma. All cases showed diffuse hyper-reflective images of the stroma corresponding to opacity of the tissue. CONCLUSIONS: Limbal stem cell deficiency had been confirmed by impression cytology in all cases, and 76.9% of the cases could also be diagnosed by in vivo confocal microscopy through the conjunctival epithelial cell visualization on the corneal surface. Frequent confocal microscopy findings were abnormal cells at the cornea (conjunctival epithelial, goblet and inflammatory cells), corneal neovessels and diffuse hyper-reflection of the stroma.
- ItemAcesso aberto (Open Access)Impression cytology in the evaluation of ocular surface tumors: review article(Consel Brasil Oftalmologia, 2015-03-01) Barros, Jeison de Nadai [UNIFESP]; Araujo de Almeida, Simone Ribeiro [UNIFESP]; Lowen, Marcia Serva [UNIFESP]; Cunha, Marcelo Carvalho da; Gomes, José Álvaro Pereira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Clin Olhos Dr Moacir CunhaImpression cytology (IC) has been widely used as a method for evaluating the ocular surface and superficial cells layers in the diagnosis and follow-up after treatment of several ocular surface tumors of both epithelial and melanocytic origin. Information regarding this can be found in the English-language literature since 1992. Using either cellulose acetate or Biopore membranes for specimen collection, a high correlation has been found between IC and tissue histology. Compared with exfoliative cytology with spatula, IC is less traumatic to the patient's eye, provides a precise location of the area being studied, and allows accurate observation of the cells the way they exist in vivo. the additional advantage of IC is the preservation of limbal stem cells responsible for continuous corneal epithelium renewal; these can be affected after incisional or excisional biopsy at the corneoscleral limbus, which is the most frequent site of appearance of tumors in the stratified epithelium. Treatment for ocular surface squamous neoplasia has historically included surgery, but nonsurgical interventions have also been adopted. Hence, in certain cases, ophthalmologists may prefer interventions less invasive than surgical biopsy such as of impression cytology for both initial diagnosis and therapeutic monitoring of treatment for ocular surface lesions. Nevertheless, it should be considered that IC may be less helpful if the results conflict with the clinical picture or if the clinical diagnosis is uncertain and results are negative. in such cases, surgical biopsy is required for accurate diagnosis. the purpose of this review is to examine the published literature on the utilization of IC for the diagnosis and management of ocular surface tumors and to discuss the requirement for further investigation on the subject.
- ItemAcesso aberto (Open Access)Transplante de células-tronco epiteliais límbicas alógenas expandidas ex vivo sobre membrana amniótica: relato de caso(Conselho Brasileiro de Oftalmologia, 2009-04-01) Gomes, José Álvaro Pereira [UNIFESP]; Pazos, Henrique Santiago Baltar; Silva, André Berger Emiliano; Cristovam, Priscila Cardoso [UNIFESP]; Belfort, Rubens Junior [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Instituto Suel Abujamra Setor de Segmento Anterior; ISA Setor de Segmento AnteriorCase report of a patient who developed failure of an allogenic living related conjunctival limbal transplantation in the right eye after an episode of epidemic keratoconjunctivitis. After a few months, she underwent transplantation of allogenic limbal epithelial stem cells cultivated ex vivo on amniotic membrane (first case in Brazil). The patient evolved with total corneal epithelialization and improvement of the visual acuity. Three months after the surgery, peripheral superficial neovascularization with worsening of the corneal transparency was observed. The vision remained 0.1 after one year of the transplantation.
- ItemAcesso aberto (Open Access)Use of impression cytology for the detection of unsuspected ocular surface squamous neoplasia cells in pterygia(Conselho Brasileiro de Oftalmologia, 2014-10-01) Barros, Jeison de Nadai [UNIFESP]; Lowen, Marcia Serva [UNIFESP]; Moraes-Filho, Milton Nunes de [UNIFESP]; Martins, Maria Cristina [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: To evaluate the agreement between the methodologies of impression cytology (IC) and histopathology regarding epithelial lesions clinically diagnosed as pterygium and also regarding the detection of unsuspected and associated ocular surface squamous neoplasia (OSSN). Methods: Thirty-two Brazilian patients were included and IC was performed on all pterygia before excision. Histopathogical examination was considered the gold standard and was performed by two experienced ocular pathologists in which consensus existed regarding pterygia diagnosis. IC accuracy was assessed by sensitivity and specificity with a 95% confidence interval. Results: From the 32 primary lesions studied, histopathological examination confirmed the diagnosis of pterygium without atypical cells in 19 cases (60%) and showed unsuspected and associated OSSN cells in 13 cases (40%). IC demonstrated one false-negative and one false-positive result for atypia. Statistical analysis showed an estimated sensitivity of 92%, specificity of 94%, positive predictive value of 92%, and negative predictive value of 94%. Conclusion: IC demonstrated high agreement with histopathological analysis in the detection of atypical epithelial cells in unsuspected OSSN in Brazilian pterygia patients.