Challenges in the treatment of ocular surface pathologies

Abstract

Introduction. Tissue transplantation at the ocular surface for therapeutic, tectonic, reconstructive, or optical purposes is a routine practice among ophthalmic surgeons worldwide. The main ocular surface pathologies requiring such interventions include corneal ulcers, keratitis of various etiologies, congenital corneal anomalies, Fuchs dystrophy, conjunctival defects, transplant rejection, xerophthalmia, various corneal dystrophies, etc. Objective. To report data regarding ocular surface tissue transplantation performed in 2024 and the challenges encountered in treating ocular surface pathologies. Materials and Methods. This retrospective study was conducted in the Ophthalmology and Ocular Microsurgery Department of Sfanta Treime Municipal Clinical Hospital. The study included 111 patients with various ocular surface pathologies who underwent surgical intervention in 2024. Before and after treatment, all patients underwent a comprehensive ophthalmological examination, including visual acuity measurement with and without optical correction, tonometry in both eyes (when possible), biomicroscopy, aesthesiometry, Schirmer’s test, and lacrimal duct irrigation. Results. In 2024, within the Ophthalmology and Ocular Microsurgery Department of Sfanta Treime Municipal Clinical Hospital, 94 amniotic membrane transplants were performed using the “inlay” and “overlay” techniques, along with 16 tectonic corneal transplants and one optical corneal transplant. Among the transplanted patients, 90% had a clinical diagnosis of corneal ulcer. Following treatment, ocular status improved in all cases. The main challenges encountered during the treatment of ocular surface pathologies included transplant rejection, systemic diseases, corneal anesthesia, progressive glaucoma, limbal dystrophy, corneo-conjunctival pathologies, and patient compliance. Conclusions. Amniotic membrane and corneal transplantation contribute to stabilizing pathological processes at the ocular surface, preserving or improving visual function and ocular status. Undoubtedly, one of the key factors contributing to successful outcomes in this field is the close collaboration between the transplant team, the Transplant Agency, and the Human Tissue Bank.