Control of Scar Tissue Formation in the Cornea: Strategies in Clinical and Corneal Tissue Engineering
Abstract
:1. The Importance and Correlation of Transparency and Scar Tissue
2. Diseases Linking to Scar Tissue Formation in the Cornea
Disease | Epidemiology | Causes | Treatment | Further information |
---|---|---|---|---|
Fuchs dystrophy | Deterioration of endothelial cells. | |||
Loss in efficiency of pumping water from stroma. | ||||
Swelling and distortion of cornea. | Thought to be inherited, autosomal dominant trait [32]. | Salt solutions such as sodium chloride drops or ointment are often prescribed to draw fluid from the cornea and reduce swelling. | Short-term success with transplantation, but long-term survival is a problem. | |
Changes in the cornea’s curvature. | Gene mutation strongly suspected. | Contact lenses. | Cannot be cured. | |
Hazing. | Hair dryer to dry out corneal blisters. | |||
Tiny blisters on corneal surface. | ||||
Glare and light sensitivity. | ||||
Usually affects both eyes. | ||||
Ocular trauma and ulceration | Unilateral vision loss. | |||
Ulceration. | Mechanical trauma, debris entering the eye, chemical and thermal burns. | |||
Corneal perforation Endophthalmitis. | Workplace activities, such as mining injuries, agriculture and warfare. | Corneal transplant. | Ocular traumas are becoming more prevalent causes of scarring and blindness. | |
Phthisis. | Road accidents [33]. | Antibiotic and antifungal treatments although visual outcome usually poor [30]. | Worldwide, half a million people are blind as the result of trauma [30,33]. | |
Blindness. | Domestic accidents [33]. | |||
Hyphaemas [33]. | ||||
Ruptured globes. | ||||
Opthalmia Neonatorum (conjunctivitis of the newborn) | Bilateral scarring. | Infection caused by Neisseria gonorrhoeae. | Saline washes. | Blindness risk is reduced when opthalmia neonatorum is caused by less virulent pathogens such as Chlamydia trachomatis [30]. |
Blindness. | Herpes simplex virus (HSV) can also cause childhood corneal blindness by causing opthalmia and xerophthalmia, although such infections are infrequent in infants. | Antibacterial eye ointments. | ||
Affects both eyes. | Treatments with tetracyanite/erythromycin/silver nitrate ointments. | |||
Stevens-Johnson Syndrome (SJS) also known as Erytheme multiform | Subepithelial bullae. | Withdrawal of all potential causative drugs [35]. | ||
Scarring. | Drugs including sulphonamides, anticonvulsants, salicytes, NSAIDs, penicillin [34]. | Intravenous fluid replacement. | <100 drugs associated with SJS [34]. | |
Keratinocyte apoptosis of the surrounding skin and epidermal necrolysis. | Infection, such as HSV. | Immunosupressive therapy. | Most severe cases referred to as toxic epidermal necrolysis (TEN) | |
Erosion of mucous membranes [34]. | Streptociocci, adenovirus and microplasma [35]. | Corneal stem cell transplant. | Transplanted tissue often rejected. | |
Scarring. | Corneal transplant. | |||
Bilateral blindness [35]. | ||||
Xerophthalmia (dry eye syndrome) | Night blindness. | 70% of cases are due to a vitamin A deficiency [30,36]. | Artificial tears. | |
Xerosis. | Increase humidity of surroundings. | Xerophthalmia patients are predominantly infants or young children, with a peak age of approximately 2.5 years [36]. | ||
Corneal perforation. Scarring. | Vitamin A supplementation. | All but disappeared in Western Europe [36]. | ||
Irreversible blindness [36]. | ||||
Trachoma | Vascularization. | Bacterial infection trachoma caused by Chlamydia trachomatis [30]. | Corneal transplant. | World’s leading cause of ocular morbidity and blindness [30]. |
Ocular surface problems Entropion. | Infection can be transmitted from eye to eye via contaminated fingers, clothes, make-up and flies. | The disease is preventable via antibiotic treatment with azithromycin [37]; however more antibiotic treatment is still required to prevent further progression of the infection to corneal blindness in previously infected individuals [30]. | ||
Trichiasis. | ||||
Onchocerciasis (river blindness) | Destructive chorioretinitis. Blinding keatitis | Caused by a parasite Onchocerca volvulus [30]. | Invermectin kills the microfilaria (larval form) and sterilizes the adult worm to prevent spread in infected individuals. | Incidences of onchoceriasis have decreased since the introduction of invermectin in the 1980s. |
Acute corneal scarring. | Collagenase secretion, caused by the influx of inflammatory cells is believed to be responsible for the rapid destruction of the xerophthalmic cornea [36]. | |||
Vascularization. | ||||
Leprosy | Blindness. | Mycobacterium laprae usually affects the anterior segment of the eye. | Multi drug therapy using dapsone, rifampicin and clofazamine. | Corneal complications caused by leprosy are a significant cause of corneal blindness globally affecting 250,000 people, predominantly in Africa and Southern India. |
Chronic uveitis. | ||||
Cataract formation. Exposure keratitis. Reoccurring corneal ulcers. Corneal scarring. | ||||
Vascularization. |
3. Mechanisms of Wound Healing in the Cornea
3.1. Regeneration
3.2. Scar Formation
4. Effectors to Control the Outcome of Corneal Wound Healing
4.1. Phenotype Differentiation in the Corneal Stroma
4.2. Growth Factors
4.3. Matrix Components
4.4. Mechanical Stress
5. Refractive Surgery and Scar Tissue
5.1. Refractive Surgery Techniques
5.2. Associated Scar Tissue Formation
5.3. Summary
6. Corneal Grafts and Corneal Tissue Engineering
6.1. Corneal Allografting
6.2. Xenografts
6.3. Keratoprostheses
6.4. Tissue Engineered Corneas
6.4.1. Manipulation of Chemical Cues
6.4.2. Utilizing Topographic Cues
6.4.3. Micro- and Nano-Patterning
6.4.4. Magnetically Aligned Collagen
6.4.5. Electrospinning of Nanofibers
6.4.6. Co-Culture Approaches
6.4.7. Growth Factors
6.5. Summary
7. Conclusions
8. Perspectives
Acknowledgements
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Wilson, S.L.; El Haj, A.J.; Yang, Y. Control of Scar Tissue Formation in the Cornea: Strategies in Clinical and Corneal Tissue Engineering. J. Funct. Biomater. 2012, 3, 642-687. https://doi.org/10.3390/jfb3030642
Wilson SL, El Haj AJ, Yang Y. Control of Scar Tissue Formation in the Cornea: Strategies in Clinical and Corneal Tissue Engineering. Journal of Functional Biomaterials. 2012; 3(3):642-687. https://doi.org/10.3390/jfb3030642
Chicago/Turabian StyleWilson, Samantha L., Alicia J. El Haj, and Ying Yang. 2012. "Control of Scar Tissue Formation in the Cornea: Strategies in Clinical and Corneal Tissue Engineering" Journal of Functional Biomaterials 3, no. 3: 642-687. https://doi.org/10.3390/jfb3030642