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Carlà MM, Giannuzzi F, Boselli F, Mateo C, Caporossi T, Rizzo S. The applications of viscoelastic agents in vitreoretinal surgery. Surv Ophthalmol 2025; 70:713-724. [PMID: 39952440 DOI: 10.1016/j.survophthal.2025.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Revised: 02/08/2025] [Accepted: 02/10/2025] [Indexed: 02/17/2025]
Abstract
The introduction of viscoelastics in human ocular surgery dates back to 1972.Subsequntly, several substances were proposed as adjuvants, particularly for cataract surgery; however, the rheologic properties of ophthalmic viscosurgical devices (OVDs), such as viscosity, pseudoplasticity, and coatability led to their employment also in vitreoretinal surgery. OVDs can be used to separate tissues and create space, to break adhesions, to allow space for surgical manipulation, and to contain hemorrhage by dampening capillary oozing. We focus on the principles and clinical results of several viscosurgery techniques, such as viscodissection and viscodelamination for the management of proliferative vitreoretinopathy and diabetic retinopathy and suprachoroidal buckling for primary retinal detachment. Furthermore, we analyze the techniques in which OVDs served as adjuvants in macular hole surgery, particularly in the handling of the internal limiting membrane, and as volumetric substances against hypotony. Finally, we analyze recent perspectives on vitreous humor biochemical features. Preclinical research led to the belief that hyaluronic acid-based hydrogels could become ideal vitreous substitutes, thanks to their viscoelasticity, porosity, optical properties, and biocompatibility; however, although promising, long-term toxicity issues have limited studies on human subjects.
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Affiliation(s)
- Matteo Mario Carlà
- Ophthalmology Department, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome 00168, Italy; Ophthalmology Department, Catholic University "Sacro Cuore", Rome 00168, Italy.
| | - Federico Giannuzzi
- Ophthalmology Department, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome 00168, Italy; Ophthalmology Department, Catholic University "Sacro Cuore", Rome 00168, Italy
| | - Francesco Boselli
- Ophthalmology Department, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome 00168, Italy; Ophthalmology Department, Catholic University "Sacro Cuore", Rome 00168, Italy
| | - Carlos Mateo
- Instituto de Microcirugia Ocular, Barcelona, Spain
| | - Tomaso Caporossi
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome 00168, Italy; Vitreoretinal Surgery Unit, Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Rome, Italy
| | - Stanislao Rizzo
- Ophthalmology Department, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome 00168, Italy; Ophthalmology Department, Catholic University "Sacro Cuore", Rome 00168, Italy; Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Pisa, Italy
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Zhong Z, Deng X, Wang P, Yu C, Kiratitanaporn W, Wu X, Schimelman J, Tang M, Balayan A, Yao E, Tian J, Chen L, Zhang K, Chen S. Rapid bioprinting of conjunctival stem cell micro-constructs for subconjunctival ocular injection. Biomaterials 2021; 267:120462. [PMID: 33129190 PMCID: PMC7719077 DOI: 10.1016/j.biomaterials.2020.120462] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/28/2020] [Accepted: 10/18/2020] [Indexed: 12/19/2022]
Abstract
Ocular surface diseases including conjunctival disorders are multifactorial progressive conditions that can severely affect vision and quality of life. In recent years, stem cell therapies based on conjunctival stem cells (CjSCs) have become a potential solution for treating ocular surface diseases. However, neither an efficient culture of CjSCs nor the development of a minimally invasive ocular surface CjSC transplantation therapy has been reported. Here, we developed a robust in vitro expansion method for primary rabbit-derived CjSCs and applied digital light processing (DLP)-based bioprinting to produce CjSC-loaded hydrogel micro-constructs for injectable delivery. Expansion medium containing small molecule cocktail generated fast dividing and highly homogenous CjSCs for more than 10 passages in feeder-free culture. Bioprinted hydrogel micro-constructs with tunable mechanical properties enabled the 3D culture of CjSCs while supporting viability, stem cell phenotype, and differentiation potency into conjunctival goblet cells. These hydrogel micro-constructs were well-suited for scalable dynamic suspension culture of CjSCs and were successfully delivered to the bulbar conjunctival epithelium via minimally invasive subconjunctival injection. This work integrates novel cell culture strategies with bioprinting to develop a clinically relevant injectable-delivery approach for CjSCs towards the stem cell therapies for the treatment of ocular surface diseases.
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Affiliation(s)
- Zheng Zhong
- Department of NanoEngineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Xiaoqian Deng
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Pengrui Wang
- Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, 92093, USA
| | - Claire Yu
- Department of NanoEngineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Wisarut Kiratitanaporn
- Department of Bioengineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Xiaokang Wu
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Jacob Schimelman
- Department of NanoEngineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Min Tang
- Department of NanoEngineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Alis Balayan
- School of Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Emmie Yao
- Department of NanoEngineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Jing Tian
- Department of Bioengineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Luwen Chen
- Department of NanoEngineering, University of California San Diego, La Jolla, CA, 92093, USA
| | - Kang Zhang
- Department of Ophthalmology, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Shaochen Chen
- Department of NanoEngineering, University of California San Diego, La Jolla, CA, 92093, USA; Materials Science and Engineering Program, University of California San Diego, La Jolla, CA, 92093, USA; Department of Bioengineering, University of California San Diego, La Jolla, CA, 92093, USA.
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