EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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EW MEETING REPORTER 76 May 2015 The best and final solution for LSCD, however, is culturing the patient's own pluripotent bone mar- row stem cells and differentiating them into cornea limbal and epithelial cells, Dr. Holland said. Using the patient's own cells will eliminate the need for finding a suitable donor and the problem of rejection, and Dr. Holland hopes to see this become a reality in the near future. Editors' note: Dr. Holland has financial interests with Alcon, Bausch + Lomb, Kala Pharmaceuticals, Mati Therapeu- tics, Rapid Pathogen Screening, Senju Pharmaceutical, TearLab, and TearScience. Ophthalmologists urged to 'strongly recommend' zoster vaccine There are 1,000,000 new cases a year in the United States alone—that's 1 in 3 people in the U.S.—and the incidence is increasing for unknown reasons. In her keynote lecture at the "Infections and Inflammations" session at the WCC, Elisabeth J. Cohen, MD, New York, discussed the management and prevention of this condition, herpes zoster, with particular emphasis on herpes zoster ophthalmicus (HZO). Herpes zoster, commonly known as shingles, is the reactiva- tion of a latent varicella zoster virus (VZV) infection (chicken pox). The rate of disease increases with age, peaking in people in their 50s—the age at which Dr. Cohen herself, she said, acquired HZO. Significantl , the increasing incidence, while of unknown provenance, began before the VZV vaccine was introduced, and is not correlated with vaccination. Clinically, zoster involves unilateral vesicular rashes follow- ing a dermatomal distribution that respects the midline. If these appear early, the diagnosis can be made quickly and treatment administered as soon as possible. Unfortunately, when typical lesions don't appear early, treatment may be unable to prevent compli- cations that include chronic eye diseases—such as dendriform and stromal keratitis—and postherpetic neuralgia. There are other less obvious but even more serious complications that not only threaten vision but also quality of life—even, Dr. Cohen said, the patient's very life. For instance, zoster is associated with depression. The pain from pos- therpetic neuralgia in particular is a significant cause of suicide in the elderly population. Zoster, particularly HZO, is also a risk factor for potentially fatal stroke. Stroke in these cases is due to chronic VZV infection of cerebral arteries. Meanwhile, cardiovascular disease—due to chronic VZV infec- Reporting from World Cornea Congress VII, April 15–17, 2015 San Diego starting with autografts from the fellow eye in unilateral disease—a technique that is still in use today. Patients with bilateral disease represent the biggest challenge in managing LSCD, Dr. Holland said. For these patients, physicians moved on to keratolimbal allograft (KLAL) procedures using cadaveric donor tissues, and in 1995, doctors per- formed the first living-related co - junctival limbal allograft (LR-CLAL) procedures, using donor tissue from a living relative. The success of these proce- dures was largely dependent upon a change in thinking that occurred among eye banks in the mid-1990s, Dr. Holland said. "Eye banks were totally focused on the endothelium and were not harvesting tissue and saving the limbus," he said. "In fact, they were taught to take all the conjunctival cells off. So it was a whole change in thinking to harvest tissue for both epithelial disease and endothelial disease, and today, that is what is done." Advances in cell culture tech- niques have led to the use of cul- tured limbal epithelial cell trans- plantation (CLET) as an alternative procedure. This method involves harvesting epithelial stem cells from a fellow eye, relative, or cadaver, cul- turing the cells in vitro, and trans- planting them to a diseased cornea. Graft rejection is the leading cause of ocular surface transplant failure for both LR-CLAL and KLAL procedures, Dr. Holland said. Sur- prisingly, the biggest obstacle to suc- cess in these procedures is not the technique, he said, but the mindset of the physicians. Dr. Holland advocates for strict adherence to organ transplantation immunosuppression protocols, including using individualized im- munosuppression regimens based on recipient risk factors. What Dr. Holland would like to see in the next decade of ocular surface transplantation is safer, more efficacious immunosuppression protocols, reduced or non-antigenic donor tissues, and improvements in CLET protocols. Culturing limbal stem cells needs to be more afford- able, he said, and conjunctival stem cells need to be included in the culture. View all the daily news and photos at daily.eyeworld.org Supported by