The main treatment available for restoration of the corneal endothelium is keratoplasty. This procedure is faced with several difficulties, including the shortage of donor tissue, postsurgical complications associated with the use of drugs to prevent immune rejection, and a significant increase in the occurrence of glaucoma. Recently, surgical procedures such as Descemet's stripping endothelial keratoplasty have focused on the transplant of corneal endothelium, yielding better visual results but still facing the need for donor tissue. The emergent strategies in the field of cell biology and tissue cultivation of corneal endothelial cells aim at the production of transplantable endothelial cell sheets. Cell therapy focuses on the culture of corneal endothelial cells retrieved from the donor, in the donor's cornea, followed by transplantation into the recipient. Recently, research has focused on overcoming the challenge of harvesting human corneal endothelial cells and the generation of new biomembranes to be used as cell scaffolds in surgical procedures. The use of corneal endothelial precursors from the peripheral cornea has also demonstrated to be effective and represents a valuable tool for reducing the risk of rejection in allogeneic transplants. Several animal model reports also support the use of adult stem cells as therapy for corneal diseases. Current results represent important progresses in the development of new strategies based on alternative sources of tissue for the treatment of corneal endotheliopathies. Different databases were used to search literature: PubMed, Google Books, MD Consult, Google Scholar, Gene Cards, and NCBI Books. The main search terms used were: 'cornea AND embryology AND transcription factors', 'human endothelial keratoplasty AND risk factors', '(cornea OR corneal) AND (endothelium OR endothelial) AND cell culture', 'mesenchymal stem cells AND cell therapy', 'mesenchymal stem cells AND cornea', and 'stem cells AND (cornea OR corneal) AND (endothelial OR endothelium)'.
Pterygium pathogenesis is mainly related to UV light exposure. However, the exact mechanisms by which it is formed have not been elucidated. Clinical advances in surgical treatment use conjunctival autografts and amniotic membranes in combination with adjuvant therapies, including mitomycin C, β-radiation, and 5-fluoroacil, to reduce recurrence. Several studies aim to unveil the molecular mechanisms underlying pterygium growth and proliferation. They demonstrate the role of different factors, such as viruses, oxidative stress, DNA methylation, apoptotic and oncogenic proteins, loss of heterozygosity, microsatellite instability, inflammatory mediators, extracellular matrix modulators, lymphangiogenesis, cell epithelial-mesenchymal transition, and alterations in cholesterol metabolism in pterygium development. Understanding the molecular basis of pterygium provides new potential therapeutic targets for its prevention and elimination. This review focuses on providing a broad overview of what is currently known regarding molecular mechanisms of pterygium pathogenesis.
La pandemia declarada por la Organización Mundial de la Salud impacta en múltiples sectores económicos y sociales incluyendo el de salud y educación superior. Especialmente, las Facultades de Medicina y Ciencias de la Salud se debaten ante la dualidad de formar profesionales de la salud socialmente responsables, protegiendo su integridad física y emocional y contribuyendo en los escenarios de mayor necesidad. Los docentes se enfrentan a una oleada de necesidades de atención a pacientes contagiados según las estimaciones de los expertos y autoridades, y con ello alto riesgo y saturación de labores. Se propone un modelo de directrices como plan de acción ante la expansión del COVID-19. En primer lugar, se debe privilegiar la Protección y Seguridad de la comunidad educativa a través de la disminución o suspensión de actividades no prioritarias con el propósito de capacitarlos adecuadamente para poder enfrentar la contingencia. En segundo lugar, la Continuidad académica con educación a distancia lo cual se logra en diversas etapas que van desde la preparación, diseño, implementación y evaluación con un uso intensivo de tecnología, recursos digitales y simulación con escenarios virtuales. Un tercer componente es el de Comunicación y acompañamiento emocional de la comunidad académica para atenuar la ansiedad, incertidumbre y soledad de quienes conforman la universidad: estudiantes, profesores, padres de familia y personal de apoyo. Por último, se especifica la Respuesta y responsabilidad social que las instituciones para la formación de profesionales de la salud pueden contribuir para la educación, prevención y apoyo a las personas impactadas por la situación de pandemia, permitiendo el desarrollo de competencias en los estudiantes. Se concluye sobre la oportunidad de conciliar de manera inédita la labor clínica y la necesidad de soporte para esta nueva realidad.
Introduction: Keratoconus is an idiopathic and progressive disease, where the cornea develops an irregular and conical shape, being the most common form of dystrophy or corneal ectasia, developing between the age of 12 and 20. In Mexico, the epidemiological information about the pathology is scarce. Purpose: To explore the epidemiology of keratoconus in Mexico among adolescents, and to compare the prevalence with international literature reports. This study identified associated pathologies and examined the management of patients. Methods: A retrospective study was conducted in an ophthalmology clinic; 500 charts were randomly selected from patients between 10 and 20 years of age in order to acquire information about the identification of the patient; the patient's gender, birthday, and age; three principal diagnoses at the first visit; as well as refraction and visual acuity in both eyes. After this, statistical analysis of the information was done. Results: The prevalence rate of keratoconus was 1.8%, affecting 66% of females and 33.3% of males. The mean age of presentation was 16.1 years. The most frequently associated refractive error was compound myopic astigmatism (44.4%); 88.8% presented with bilateralism. The majority of patients were being managed conservatively. Conclusion: Through this study, we found that our statistics matched those of internationally published reports concerning the early age of onset of the disease and its corresponding bilateralism. However, contrary to the international reports, it was evident that this condition was more prevalent among the females in our study sample, and no other associated pathologies were found. Prevalencia de Queratocono en Población AdolescenteResumen Introducción: El queratocono es una enfermedad idiopática y progresiva, donde la cornea adquiere una forma irregular y cónica, siendo la forma más común de distrofia o ectasia corneal desarrollándose entre los 12 y 20 años de edad. En México no se cuenta con suficiente información epidemiológica en cuanto a la patología. Objetivo: Explorar la epidemiología del queratocono en México en adolescentes y comparar la prevalencia con reportes internacionales. Este estudio identifico patologías asociadas y evaluó el manejo de estos pacientes. Métodos: Estudio retrospectivo en una clínica oftalmológica; 500 expedientes fueron aleatoriamente seleccionados de pacientes entre 10 y 20 años de edad, obteniendo: identificación del paciente, sexo, fecha de nacimiento y edad, tres diagnósticos principales en su primer visita, refracción y agudeza visual en ambos ojos. Posterior a la captura de datos, se realizo el análisis estadístico. Resultados: La tasa de prevalencia de queratocono fue de 1.8%, afectando al 66% de las mujeres y el 33% de hombres. La edad media de presentación fue de 16.1 años de edad. El error refractivo asociado a queratocono más común fue astigmatismo miópico compuesto (44.4%); 88.8% se presentó con bilateralidad. La mayoría de los pacientes se trato de manera conservadora. Conclusión: A través de este e...
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