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. © 2002 Springer-Verlag New York, Inc. All rights reserved. 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Printed in the United States of America. 9 8 7 6 5 4 3 2 1 ISBN 0-387-95161-X SPIN 10785181 Springer-Verlag New York Berlin Heidelberg A member of BertelsmannSpringer Science(cid:1)Business Media GmbH ◆ 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