Reconstruction of posterior lamellar eyelids remains challenging due to their delicate structure, highly specialized function, and cosmetic concerns. Current clinically available techniques for posterior lamellar reconstruction mainly focus on reconstructing the contour of the eyelids. However, the posterior lamella not only provides structural support for the eyelid but also offers a smooth mucosal surface to facilitate globe movement and secrete lipids to maintain ocular surface homeostasis. Bioengineered posterior lamellar substitutes developed via acellular or cellular approaches have shown promise as alternatives to current therapies and encouraging outcomes in animal studies and clinical conditions. Here, we provide a brief reference on the current application of autografts, biomaterials, and tissue-engineered substitutes for posterior lamellar eyelid reconstruction. We also shed light on future challenges and directions for eyelid regeneration strategies and offer perspectives on transitioning replacement strategies to regeneration strategies for eyelid reconstruction in the future.

The tarsal plate is an eyelid tissue that maintains lid structure from inside the upper/lower eyelids, and it surrounds the meibomian glands and supports their unique secretion mechanism. Sebaceous carcinoma, a malignant eyelid tumour, can sometimes develop from the meibomian glands and is usually excised together with the tarsal plate during surgery, so the tarsal plate serves as a control research tissue. However, since the plate is thick, hard and heterogeneous with few cells, obtaining enough genomic DNA and/or total RNA is often difficult. Therefore, we attempted to establish an efficient protocol to obtain DNA and RNA simultaneously by comparing the combinations of homogenization (mortar/pestle, pellet pestle or SK mill) and purification (organic solvent or spin column) methods using rabbit tarsal plates. Based on the yield, quality and hands-on time, the SK mill and spin column was found to be the most efficient combination. We then applied the established protocol to extract DNA/RNA from six human tarsal-plate samples and succeeded in generating high-quality exome and transcriptome datasets via a next-generation sequencer with sufficient coverage and meibomian gland-specific expression of representative genes, respectively. Our new findings will provide ideal reference data for future genetic and gene-expression studies of sebaceous carcinoma.

This report describes the clinical features and management in a case of vernal keratoconjunctivitis (VKC) with bilateral tarsal conjunctival keratinization. A 32-year-old male presented with VKC since childhood that had exacerbated in the eight years prior to presentation. Examination revealed partial limbal stem cell deficiency in both eyes, with keratinization of the superior tarsal conjunctiva. The corresponding areas of the cornea exhibited punctate keratopathy in both eyes. To address this, the patient underwent excision of the conjunctival keratinization in both eyes. The resultant bare areas were covered with conjunctival autografts (CAGs). Postoperatively, the grafts were well apposed, and there was no recurrence of keratinization observed during the period of follow-up of four years. Resolution of corneal epitheliopathy was also noted. Although keratinization can occur in eyes with VKC, it is usually limited to the bulbar conjunctival areas. This is the first report of tarsal conjunctival keratinization in such cases. Milder cases may be observed or managed with scleral contact lenses. In more severe forms, there is associated corneal epitheliopathy, which may progress to corneal vascularization and scarring. Surgical excision of the lesion is recommended in these eyes. Following excision, several options exist to cover the bare area, which include a CAG, an amniotic membrane, or an oral mucous membrane. Of these, a CAG is an autologous tissue that can be harvested with a simple surgical technique and yields stable long-term results. Thus, tarsal conjunctival keratinization is a rare complication of chronic VKC. Excision of the lesion followed by a CAG is a viable approach for treatment, which reestablishes and maintains a stable ocular surface.

UNASSIGNED: : To evaluate the cost, safety, surgical outcome, and efficacy of modified Cutler-Beard eyelid reconstruction utilizing a novel silicone plate as a tarsal plate replacement in the repair of 60% to 100% eyelid defects following the excision of large malignant tumors.
UNASSIGNED: : A prospective, noncomparative, interventional study of 30 eyes was done over 3 years. Fourteen patients were female, and 16 patients were male. In all the cases, a silicone plate, the synthetic, artificial tarsal plate, was utilized for a total or subtotal replacement of the tarsal plate. The created defect was measured in mm (length and width) and later expressed in percentage. Pre- and postoperative action of levator palpebrae superioris (LPS) was measured. Pre- and postoperative measurements of the margin-to-margin reflex distance (MRD1) were noted.
UNASSIGNED: : Preoperative LPS action was 1.23 ± 1.35 mm, whereas postoperative LPS actions at the end of 1 week and 18 months were 11. 8 ± 0.88 mm and 13.53 ± 0. 73 mm, respectively. Preoperative MRD1 was - 3.0 ± 1.144 mm, whereas postoperative MRD1 values at the end of 1 week and 18 months were 2.18 ± 0.27 mm and 4.16 mm ± 0.35, respectively. The mean created defect after the removal of the tumor was 87.3% ±11.10. The mean length of the silicone plate implanted in this study was 27.53 ± 2.48 mm. The follow-up period for the study participants was 18 months.
UNASSIGNED: : The synthetic novel silicone plate was successful as a tarsal plate replacement. A second surgical site for ear cartilage harvesting is avoided. Cadaver transfer of Achilles tendon carries the risk of transmission of communicable diseases, for example, hepatitis B and HIV. Silicone is an inert, nonreacting, and tissue-tested material, thus eliminating the possibility of graft rejection. This material is readily available and cost-effective. The novel silicone plate is considered to be the most promising alternative material as a tarsal replacement in the future generation.

[This corrects the article DOI: 10.3389/fbioe.2020.00219.].

Tarsal plate regeneration has always been a challenge in the treatment of eyelid defects. The commonly used clinical treatments such as hard palate mucosa grafts cannot achieve satisfactory repair effects. Tissue engineering has been considered as a promising technology. However, tarsal plate tissue engineering is difficult to achieve due to its complex structure and lipid secretion function. Three-dimensional (3D) printing technology has played a revolutionary role in tissue engineering because it can fabricate complex scaffolds through computer aided design (CAD). In this study, it was novel in applying 3D printing technology to the fabrication of tarsal plate scaffolds using poly-caprolactone (PCL). The decellularized matrix of adipose-derived mesenchymal stromal cells (DMA) was coated on the surface of the scaffold, and its biofunction was further studied. Immortalized human SZ95 sebocytes were seeded on the scaffolds so that neutral lipids were secreted for replacing meibocytes. In vitro experiments revealed excellent biocompatibility of DMA-PCL scaffolds with sebocytes. In vivo experiments revealed excellent sebocytes proliferation on the DMA-PCL scaffolds. Meanwhile, sebocytes seeded on the scaffolds secreted abundant neutral lipid in vitro and in vivo. In conclusion, a 3D-printed PCL scaffold modified with DMA was found to be a promising substitute for tarsal plate tissue engineering.

BACKGROUND: Congenital and acquired diseases, as well as traumatic injuries of the sclera and tarsal plate can lead to serious complications up to the complete loss of visual functions and loss of the eye as an organ if not treated timely. Due to that, it becomes necessary to use biological and synthetic materials during reconstructive and regenerative surgeries to replace the defects and reinforce the carcass properties of the sclera and tarsal plate.
OBJECTIVE: To compare experimental and morphological features of the response of the eye and surrounding tissues to implantation of the synthetic polymeric implant for reconstructive and regenerative surgery (PERRS) \'Reperen-6\' and biological xenopericardium implant taken from cattle on the sclera in animal experiment.
METHODS: The studies were conducted on 12 chinchilla rabbits. PERRS \'Reperen-6\' was implanted on the surface of the sclera (into the subtenon space) of left eyes of 6 rabbits from the main group. Similar surgeries with biological xenopericardium implant taken from cattle were performed on the left eyes of 6 rabbits from the comparison group. The right eyes of each animal from both groups remained intact. After the surgery, we performed examination of the animals and acquisition of the material (the eyes and surrounding tissue) in 16, 34 and 68 days. Enucleated eyes were fixed in 10% buffered formalin solution with subsequent preparation of histologic specimen according to standard procedure.
CONCLUSIONS: The experimental and morphological studies showed that the postoperative period went smoother in the main group of animals. Thanks to its structure, PERRS \'Reperen-6\' fixed tightly to the sclera and surrounding structures forming a firm \'own tissue-implant\' complex. The polymeric implant \'Reperen-6\' can be recommended for reconstructive and regenerative surgeries to reinforce the connective tissue structures in pathological conditions of sclera and appendages of the eyes.
Введение. Врожденные и приобретенные заболевания, а также травматические повреждения склеры и тарзальной пластинки при несвоевременном лечении могут приводить к грозным осложнениям вплоть до полной потери зрительных функций и утраты глаза как органа. В связи с этим возникает необходимость в проведении реконструктивно-восстановительных операций с использованием биологических и синтетических материалов для замещения дефектов и укрепления каркасных свойств склеры и тарзальной пластинки. Цель - изучить экспериментально-морфологические особенности реакции глаза и окружающих структур в эксперименте на животных после имплантации на поверхность склеры синтетического эндопротеза полимерного для восстановительной и реконструктивной хирургии (ЭПВРХ) \'Реперен-6\' в сравнении с биологическим ксенотрансплантатом из перикарда крупного рогатого скота (ПКРС). Материал и методы. Исследования проводились на 12 кроликах породы шиншилла. В основной группе 6 кроликам на одном глазу были проведены операции по имплантации ЭПВРХ \'Реперен-6\' в субтеноново пространство на поверхность склеры с подшиванием имплантата. В группе сравнения 6 кроликам выполнены аналогичные операции по имплантации биологического ксенотрансплантата из ПКРС. Второй глаз каждого животного оставался интактным. После операции проводились осмотр животных и изъятие материала (глаза и окружающих тканей) через 16, 34 и 68 дней. Энуклеированные глаза фиксировались в 10% забуференном растворе формалина с последующим приготовлением гистологических препаратов стандартным методом. Заключение. Экспериментально-морфологические исследования показали, что послеоперационный период у животных основной группы протекал более спокойно в отличие от такового в группе сравнения. Благодаря своей конструкции ЭПВРХ \'Реперен-6\' плотно фиксировался к фиброзной оболочке глаза и окружающим структурам, создавая прочный комплекс \'собственные ткани-имплантат\'. Поэтому ЭПВРХ \'Реперен-6\' можно рекомендовать с целью армирования, в частности склеры, а также других соединительнотканных структур глаза и его вспомогательного аппарата при нарушении их целостности или ослаблении каркасных свойств.

Lid eversion is an essential component of contact lens aftercare. Hence, this study determined the best method of lid eversion based on three criteria: comfort, speed of administration and the area of the palpebral conjunctiva exposed.
Twenty-five participants (aged 20-34) had 6 different techniques applied in random order by the same clinician on two separate occasions: three involving a cotton bud placed on the extended upper eyelid either centrally, at the top of the tarsal plate or off-centre; one using the wooden end of the bud placed at the top of the tarsal plate; one using the clinician\'s index finger to evert the lid; and one using a silicone rubber, finger-shaped substitute. The participants judged the degree of discomfort of each technique on a visual analogue scale. The time to complete the task was timed with a stop-watch and the area of exposed palpebral conjunctiva was captured with a digital slit lamp and assessed using image analysis.
There was no difference between the initial lid eversion or subsequent repeat in terms of comfort (F = 0.304, p = 0.586), time to complete (F = 3.075, p = 0.092) or area exposed (F = 2.311, p = 0.142). Lid eversion using fingers alone or the silicone substitute everter were similar in comfort (p = 0.312), being the most comfortable methods, with off-centre cotton bud eversion or the wooden end of the cotton bud the least comfortable techniques (F = 17.480, p < 0.001). The quickest method to perform was the wooden end of the cotton bud, followed by the silicone everter (F = 17.522, p < 0.001). The area of exposed palpebral conjunctiva was greatest using the silicone everter (F = 28.199, p < 0.001).
Lid eversion had repeatable results, with the silicone everter placed at the top of the tarsal plate the most comfortable for the patient, quick to perform and exposed a greater area of tarsal plate than other techniques and therefore is recommended to clinicians.

The possible role of sex in the biosynthesis of lipids in the Meibomian glands (termed meibogenesis) remains unclear. To determine if there were any major sex-specific differences in the lipid composition of meibomian gland secretions (meibum) and gene expression patterns (GEP) related to meibogenesis, we conducted a study using healthy, age and diet-matched young adult wild-type C57BL/6J mice (2-2.5 month old). Tarsal plates (TP) were surgically excised from the eyelids of mice and subjected to transcriptomic and lipidomic analyses. The GEP were studied using mRNA microarrays. Lipids were extracted with organic solvents and analyzed using liquid chromatography and mass spectrometry. GEP in the TP of female and male mice demonstrated no statistically significant differences in the expression levels of the main protein-coding genes related to lipid metabolism and storage in general, and meibogenesis specifically (such as Elovl, Scd, Fads, Soat, Far, Awat, Acat, Lss, Dhcr, Hmgcr, Hmgcs, Dgat, Bckdh, Dbt, Fasn, and Plin, among others). The meibomian lipid profiles of female and male mice were virtually indistinguishable: all major lipids such as waxes, cholesteryl esters, cholesterol, (O)-acylated omega-hydroxy fatty acids (OAHFA), cholesteryl esters of OAHFA etc., were present in similar ratios. It seems that the major biosynthetic pathways in the Meibomian glands of male and female mice function in a similar fashion and produce secretions of the same overall chemical composition.

BACKGROUND: Reconstruction of the upper eyelids following traumatic, congenital and tumor surgeries is often difficult owing to a variety of reasons including the influence of the lacrimal system, visual system and aesthetic appearance. In most cases of the reconstruction in the upper eyelid tarsal plate is the main anatomical area that should be protected against the damage. The aim of this study is to investigate the types and the measurements of the tarsal plate of the upper eyelids in Anatolian population.
METHODS: Fifty cadaver upper eyelids, tarsal plates were exposed to investigate the location, shape, position and their relationships to the upper eyelid. Their morphometric details such as linear analyses (vertical and horizontal) and ratio analyses were studied. As for the shape of the upper tarsal plate, it was categorized into three distinct types: sickle, trapezoid, and triangular type.
RESULTS: The vertical height of the upper tarsal plate was the greatest at the central point 10.6 ± 1.1 mm, followed by the lateral point (7.81 ± 1.0 mm), and medial point (6.2 ± 0.8 mm) medially. The mean medial width of the upper tarsal plate was measured as 37.6 ± 4.1 mm and the lower width as 38.5 ± 4.6 mm. The base-central height ratio of the upper tarsal plate was approximately 0.28. For the upper eyelids, the shapes of tarsal plates were observed as sickle (48%), trapezoid (28%) and triangular (24%). Sickle type was the most frequent upper eyelid type.
CONCLUSIONS: Considering the shielding function of the upper eyelid, tarsal plate, serves as fibrocartilaginous skeleton of the upper tarsal plate. In successful lid oculoplastic reconstructive surgery, tarsal plate may be restored by evaluating each patient individually to have symmetrical and youthful eyes. Although sickle tarsal plate is the most frequent type, personalized treatment requires measurement and classification. The findings manifest the necessity of oculoplastic surgical treatment peculiar to each individual.
METHODS: I, Randomized controlled trial.