Ocular Surface Disease Medical and Surgical Management

288 Pages·2002·7.809 MB·English

by  Edward J. Holland MD, Mark J. Mannis MD, FACS (auth.)

Ocular Surface Disease
Medical and Surgical Management

Ocular Surface Disease
Medical and Surgical Management
Edward J. Holland, MD
Clinical Professor of Ophthalmology
University of Cincinnati
Director of Cornea Services
Cincinnati Eye Institute
Cincinnati, Ohio
◆
Mark J. Mannis, MD, FACS
Professor and Vice-Chair
Director of Cornea, External Disease
and Refractive Surgery
Department of Ophthalmology
University of California, Davis
Sacramento, California
Illustrations by Nelva B. Richardson
With 201 Illustrations
Edward J. Holland, MD Mark J. Mannis, MD, FACS
Director of Cornea Services Professor and Vice Chairman
Cincinnati Eye Institute Director of Cornea, External Disease
and and Refractive Surgery
Clinical Professor Department of Ophthalmology
University of Cincinnati University of California, Davis
10494 Montgomery Road 4860 “Y” Street, Suite 2400
Cincinnati, OH 45242 Sacramento, CA 95817
USA USA
Library of Congress Cataloging-in-Publication Data
Ocular surface disease-medical and Surgical Management / editors, Edward J. Holland,
Mark J. Mannis.
p. ; cm.
Includes bibliographic references and index.
ISBN 0-387-95161-X (h/c : alk. paper)
1. Anterior segment (Eye)—Diseases. 2. Adnexa oculi—Diseases. I. Holland, Edward J.
II. Mannis, Mark J.
[DNLM: 1. Corneal Diseases—therapy. 2. Cornea—anatomy & histology.
3. Cornea—physiology. WW 220 O21 2001]
RE334 .O26 2001
617.7'19—dc21 2001031419
Printed on acid-free paper.
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◆
To our fellows
Whose hard work, long hours, and dedication to patient care
have allowed us the opportunity to help
the most challenging of ophthalmic patients.
◆
Preface
The evolution in our understanding of the anatomy and physiology of the ocular
surface and the accompanying revolution in the management of ocular surface dis-
ease has been a process spanning at least three decades. Despite enormous advances
in corneal transplantation, the advent of immunosuppressive therapy, and advances
in contact lens physiology, ocular surface disease has remained a constant and of-
ten a confounding problem. Diseases of the ocular surface range from mild dry
eye—one of the most common diagnoses in clinical practice—to the less common,
but devastating and blinding, abnormalities that result from chemical and thermal
injuries. Clinical advances notwithstanding, this broad range of diseases has re-
mained a medical and surgical challenge.
Clarification of the role of the cellular components of the ocular surface and of
the relation of these components to tear function, cell adhesion, and surface re-
newal has renewed interest in more effective and successful intervention in this
group of problems. At this writing, even as we appreciate the demonstrated role
of new classes of cells that renew the ocular surface, we are just beginning to learn
about the chemical signals that drive the process of physiologic surface restora-
tion. We stand at the verge of a wealth of new scientific and clinically useful in-
formation that will serve patients who, until now, had limited resources.
In this text, we have endeavored to provide a succinct but thorough overview
of this emerging field. The anatomy and physiology of the ocular surface is de-
tailed. Diseases of the ocular surface are described with special attention given to
the disorders affecting ocular surface stem cells. A significant portion of the book
is devoted to the medical and surgical management of these disorders.
Our goal was to produce a textbook that organizes what we currently know
about the emerging field of ocular surface disease and transplantation, and to
stimulate new ideas for the future. Recent advances have improved outcomes
for patients with blinding corneal surface diseases. Many of these patients have
regained useful vision, which was thought to be impossible as recently as 10
to 20 years ago. Other patients, however, remain refractory to current thera-
pies. It is for these patients that we continue to strive for future breakthroughs,
and it is our sincere hope that this textbook will assist clinicians, and ultimately
our patients, in accomplishing better therapeutic outcomes.
EDWARDJ. HOLLAND, MD
MARK J. MANNIS, MD
2001
vii
Acknowledgments
Many individuals have contributed to this effort. First, we wish to thank our con-
tributing authors, many of whom are the pioneers in the field of ocular surface
disease. We asked the authors for a very rapid turnaround of their work. Despite
busy schedules, all responded with timely and outstanding work.
We would especially like to thank Christy Rains, Executive Secretary in Cincin-
nati, who has overseen the entire project. Christy has masterfully kept track of all
the text, illustrations, and timetables. Without her, the project would not have
been possible. Likewise, we would like to thank Rita Snyder, who coordinated
the effort in Sacramento.
Our appreciation is also extended to Merry Post of Springer-Verlag, as well
as to Nelva Richardson, a talented medical illustrator, who were forced into very
tight work schedules and responded outstandingly. We would also like to thank
Judy Mannis, who designed the book cover and who, more importantly, pro-
vided great support and acted as peacekeeper between the authors.
Finally, a very special thanks to Gary Schwartz, MD, who made significant sci-
entific and editorial contributions to this project.
EDWARDJ. HOLLAND, MD
MARK J. MANNIS, MD
2001
ix
Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Part I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1. Anatomy and Physiology of the Ocular Surface . . . . . . . . . . . 3
KAZUO TSUBOTA, SCHEFFER C.G. TSENG, AND
MICHAEL L. NORDLUND
2. Classification of Ocular Surface Disease . . . . . . . . . . . . . . . . . 16
FREDERICH E. KRUSE
Part II. Diseases of the Ocular Surface . . . . . . . . . . . . . . . . . . . . 37
3. Blepharitis: Lid Margin Disease and the Ocular Surface . . . . . 39
GARY N. FOULKS
4. Dry Eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
STEPHEN C. PFLUGFELDER AND ABRAHAM SOLOMON
5. Epithelial Adhesion Disorders . . . . . . . . . . . . . . . . . . . . . . . . . 58
LARRY F. RICH, FREDERICK W. FRAUNFELDER
6. Pterygium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
DONALD T.H. TAN
Part III. Stem Cell Deficiency Disorders . . . . . . . . . . . . . . . . . . . 91
7. Congenital Stem Cell Deficiency . . . . . . . . . . . . . . . . . . . . . . . 93
JOEL SUGAR
8. Chemical and Thermal Injuries to the Ocular Surface . . . . . . . 100
TERRY KIM, B. ALYSE KHOSLA-GUPTA
9. Autoimmune Diseases Affecting the Ocular Surface . . . . . . . . 113
JOSEPH TAUBER
10. Iatrogenic Limbal Stem Cell Deficiency . . . . . . . . . . . . . . . . . . 128
GARY S. SCHWARTZ, EDWARD J. HOLLAND
Part IV. Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
11. Surface Stabilization Procedures . . . . . . . . . . . . . . . . . . . . . . . 137
MARIAN S. MACSAI, MARK J. MANNIS, JASON K. DARLINGTON
12. The Evolution and Classification of Ocular Surface . . . . . . . . 149
Transplantation
EDWARD J. HOLLAND, GARY S. SCHWARTZ
xi
xii Contents
13. Preoperative Staging of Disease Severity . . . . . . . . . . . . . . . . . 158
GARY S. SCHWARTZ, JOSÉ A.P. GOMES, EDWARD J. HOLLAND
14. Sequential Sectoral Conjunctival Epitheliectomy (SSCE) . . . . . 168
HARMINDER S. DUA
15. Conjunctival Autograft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
DONALD T.H. TAN
16. Conjunctival Limbal Autograft . . . . . . . . . . . . . . . . . . . . . . . . 194
CHRISTOPHER R. CROASDALE, EDWARD J. HOLLAND,
MARK J. MANNIS
17. Living-Related Conjunctival Limbal Allograft . . . . . . . . . . . . . 201
SHERAZ M. DAYA, EDWARD J. HOLLAND, MARK J. MANNIS
18. Keratolimbal Allograft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
GARY S. SCHWARTZ, KAZUO TSUBOTA, SCHEFFER C.G. TSENG,
MARK J. MANNIS, EDWARD J. HOLLAND
19. Keratolimbal Allograft: Recommendations for Tissue . . . . . . 223
Procurement and Preparation by Eye Banks
CHRISTOPHER R. CROASDALE, GARY S. SCHWARTZ,
JACKIE V. MALLING, EDWARD J. HOLLAND
20. Amniotic Membrane Transplantation for Ocular . . . . . . . . . . 226
Surface Reconstruction
SCHEFFER C.G. TSENG, KAZUO TSUBOTA
21. Ex Vivo Stem Cell Expansion . . . . . . . . . . . . . . . . . . . . . . . . . . 232
IVAN R. SCHWAB, R. RIVKAH ISSEROFF
22. Immunosuppressive Therapy in Ocular Surface . . . . . . . . . . . 243
Transplantation
ALI R. DJALILIAN, ROBERT B. NUSSENBLATT, EDWARD J. HOLLAND
23. Penetrating Keratoplasty in Ocular Stem Cell Disease . . . . . . 253
MARK J. MANNIS
24. Etiology of Stem Cell Transplantation Failure . . . . . . . . . . . . . 257
GARY S. SCHWARTZ, EDWARD J. HOLLAND
25. Prosthokeratoplasty in Ocular Surface Disease . . . . . . . . . . . . 263
MARK J. MANNIS
26. Developing a Logical Management Paradigm for the . . . . . . 269
Clinical Management of Severe Ocular Surface Disease
EDWARD J. HOLLAND, MARK J. MANNIS, GARY S. SCHWARTZ
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Contributors
CHRISTOPHER R. CROASDALE, MD FREDERICK W. FRAUNFELDER, MD
Davis Duehr Dean Assistant Professor of Ophthalmology
Assistant Clinical Professor Ophthalmology Oregon Health Sciences University
Department of Ophthalmology and Visual Sciences Casey Eye Institute
University of Wisconsin, Madison 3375 SW Terwilliger Blvd.
Madison, WI, 53792 USA Portland, OR 97201, USA
JOSÉ A.P. GOMES, MD
JASON K. DARLINGTON, MD
Cicatricial Ocular Diseases Study Group
School of Medicine
Coordinator
University of California, Davis
External Diseases and Cornea Service
4860 “Y” Street, Suite 2400
Federal University of São Paulo (UNIFESP/EPM)
Sacramento, CA 95817, USA
São Paulo/SP, Brazil
SHERAZ M. DAYA, MD, FACP, FACS, FRCS (ED) EDWARD J. HOLLAND, MD
Director & Consultant Director of Cornea Services
Corneo-Plastic Unit Cincinnati Eye Institute
Corneoplastic Unit, Queen Victoria Hospital NHS Clinical Professor
Trust University of Cincinnati
Holyte Road 10494 Montgomery Road
East Grinstead, W. Sussex RH193DZ, UK Cincinnati, OH 45242, USA
ALI R. DJALILIAN, MD R. RIVKAH ISSEROFF, MD
Senior Staff Fellow Professor of Dermatology,
National Eye Institute Director of Tissue & Bioengineering Lab
10 Center Drive, Bldg 10 University of California, Davis
Bethesda, MD 20892, USA Dermatology Department
One Shields Avenue, TB192
Davis, CA 95616, USA
HARMINDER S. DUA, MBBS, FRCS, MD, PHD
Chair and Professor of Ophthalmology
B. ALYSE KHOSLA-GUPTA, MD
University of Nottingham
Duke University
B Floor, South Block
Ophthalmology Department
University Hospital, Queens Medical Centre
9008 Lansdale Drive
Nottingham NG7 2UH, UK
Raleigh, NC 27617, USA
GARY N. FOULKS, MD, FACS TERRY KIM, MD
Professor & Chairman of Department of Assistant Professor of Ophthalmology
Ophthalmology Cornea and Refractive Surgery
University of Pittsburgh, School of Medicine, Duke University Eye Center
203 Lothrop Street Box 3802-Erwin Road
Pittsburgh, PA 15213, USA Durham, NC 27710, USA
xiii