Comparing the efficacy of sodium hyaluronate eye drops and carboxymethylcellulose eye drops in treating mild to moderate dry eye disease

Purpose: Aim of this study was to compare the efficacy of sodium hyaluronate (SH) and carboxymethyl cellulose (CMC) eye drops in treating mild to moderate dry eye disease in terms of relief of symptoms, mean change in tear film breakup time, Schirmer’s test, and impression cytology of conjunctiva from baseline. Methods: An observational study was carried out during a 2?year period in our tertiary referral hospital. The study consisted of 60 patients randomly allotted to two groups to receive SH and CMC eye drops for an 8?week period. Ocular surface disease index, tear film breakup time, and Schirmer’s test were performed at baseline visit and 4 and 8 weeks of treatment, and impression cytology of conjunctiva was performed at baseline and 8 weeks. Results: Significant improvement in patient symptoms, tear film breakup time, and Schirmer’s test from baseline was seen in both SH and CMC groups at 8 weeks posttreatment, whereas impression cytology of conjunctiva in both groups did not show significant improvement at 8 weeks of treatment. Data analysis using unpaired t?test showed comparable results. Conclusion: Both CMC and SH demonstrated equal efficacy in treating mild to moderate dry eye disease.

Prevalence of dry eye, its categorization (Dry Eye Workshop II), and pathological correlation: A tertiary care study

Purpose: To study the prevalence of dry eye disease (DED), further categorize using DEWS II protocol, grade squamous metaplasia in each group, and determine associated risk factors in a tertiary care hospital. Methods: This cross?sectional hospital?based study screened 897 patients ?30 years via systematic random sampling. Patients with both symptoms and signs as defined by the Dry Eye Workshop II protocol were considered as DED, further categorized, and subjected to impression cytology. Categorical data were assessed using the Chi?square test. P value < 0.05 was considered statistically significant. Results: In total, 265 (of 897) patients were defined as DED based on the presence of symptoms (DEQ?5 ?6) and at least one positive sign (fluorescein breakup time [FBUT] <10 s or OSS ?4). DED prevalence was thus 29.5% with aqueous deficient dry eye (ADDE), evaporative dry eye (EDE), and mixed type seen in 92 (34.71%), 105 (39.62%), and 68 (25.7%) patients, respectively. The risk of developing dry eye was higher in the age above 60 years (33.74%) and in the third decade. Females, urban dwellers, diabetics, smokers, history of previous cataract surgery, and usage of visual display terminal devices were found to be significantly associated with risk factors of DED. Squamous metaplasia and goblet cell loss were more severe in mixed compared to EDE and ADDE. Conclusion: Hospital?based prevalence of DED is 29.5% with a preponderance of EDE (EDE 39.62%, ADDE 34.71%, and mixed 25.71%). A higher grade of squamous metaplasia was seen in the mixed type compared to other sub?types.

Analytical Study of Ocular Surface Changes in Patients of Chronic Kidney Disease undergoing Hemodialysis and Peritoneal Dialysis

Objectives?The idiopathic group is a significant cause of chronic kidney disease (CKD) in developing countries. Literature available on ocular surface changes has predominantly been reported in patients undergoing hemodialysis. Little is known about the changes in patients undergoing peritoneal dialysis. The present study aimed to identify ocular surface changes in an idiopathic group of CKD undergoing dialysis. Aim?To compare tear film disorders and the severity of ocular surface changes (goblet cell density, squamous metaplasia, and corneoconjunctival calcification) in patients of idiopathic etiology with CKD undergoing hemodialysis and peritoneal dialysis. This is an analytical study. Materials and Methods?Asymptomatic adult patients of idiopathic CKD, on treatment with dialysis underwent comprehensive ophthalmic examination, including best-corrected visual acuity, slit-lamp examination, and a dilated fundus examination. Dry eye assessment was done by ocular surface staining score, Schirmer test, and tear breakup time (TBUT). Conjunctival impression cytology was studied to assess changes on ocular surface. Chest X-rays for aortic calcification were reviewed and data analyzed. Results?Both eyes of 76 patients of hemodialysis and 32 patients of peritoneal dialysis were studied. Ocular surface staining (OSS) scores were low. Impression cytology showed a drop in goblet cell density, presence of squamous metaplasia, and conjunctival keratinization significantly more in the hemodialysis group. No correlation was seen between the presence of conjunctival calcification and aortic calcification. Conclusion?The hemodialysis group had mild subclinical dry eye but keratinization of conjunctiva was seen. Similarly, advanced squamous metaplasia was seen in the peritoneal dialysis group. These changes were positively correlated to decrease in goblet cell density.

Analyze on the value of conjunctival impression cytology in the diagnosis of allergic conjunctivitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the value of conjunctival impression cytology(CIC)in the diagnosis of allergic conjunctivitis(AC). <p>METHODS: A case-control study. Forty patients(80 eyes)who were clinically diagnosed with AC in our department from January to February 2021 were included in the study,and 40 normal controls(80 eyes)were enrolled too. All subjects underwent double upper palpebral CIC examinations. Observed the morphology and number of conjunctival eosinophils and carried out Tseng classification in each group. To Compare the differences between the results of the two groups and analyze the effects of gender, age and course of disease on the results of CIC eosinophil examination in AC group.<p>RESULTS: The positive rate of eosinophils in the upper palpebral CIC examination of AC patients was significantly higher than that of the normal control group(χ²=57.744, <i>P</i><0.001); The Tseng grade of AC patients was also higher than that of the normal control group(<i>Z</i>=-2.453, <i>P</i><0.05). Gender, age and course of disease had no significant effect on the results of CIC eosinophils in AC group(all <i>P</i> >0.05).<p>CONCLUSION: CIC examination is simple, and the result is objective and accurate. It has good application value in the diagnosis of AC.

New progress in classification and diagnosis of Sjögren's syndrome / 国际眼科杂志(Guoji Yanke Zazhi)

@#Sjögren's syndrome(SS)is a complex connective tissue disease, with an incidence only secondary to rheumatoid arthritis. The initial record was case reports in the late 19th century. In 1930, Henrik Sjögren proposed the conception of “Keratoconjunctivitis Sicca”for the first time, and preliminarily realized that SS was a systemic disease. Subsequently, the discovery of specific autoantibodies and the application of labial biopsy technique significantly improved the accuracy for SS diagnosis. As the understanding the disease improving, different classification criteria were proposed to improve the diagnostic accuracy. However, there still no classification criteria that can be applied as diagnostic criteria so far due to uncovered pathological mechanism of the disease. Currently, comprehensive managements are required with the cooperation of rheumatology, ophthalmology, and stomatology department. Further exploration of the pathogenesis and development of new diagnostic tools are expected to improve the diagnosis of SS. The paper aims to review the development of the classification criteria and to propose new ophthalmic examinations in order to improve the diagnosis of SS.

Changes of ocular surface before and after phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate ocular parameters changes after age-related cataract phacoemulsification surgery using Keratograph 5M combined with conjunctival impression cytology.<p>METHODS: This prospective study included 39 eyes(39 patients)from December 2016 to December 2017, who underwent cataract phacoemulsification and intraocular lens implantation in Fujian Provincial Hospital. OSDI questionnaire, tear meniscus height, tear break-up time, conjunctival hyperemia and impression cytology were performed preoperatively at 1d, 1wk, 1mo and 2mo after surgery.<p>RESULTS: GCD and OSDI were worsen at 1d, 1wk, 1mo, 2mo, postoperatively(<i>P</i><0.05). The first-time tear break-up time was significantly shorter at 1wk(6.91±4.52, 6.12±3.55, 5.18±3.37, 6.28±4.70, 5.96±3.17s, <i>P</i><0.05). The average tear break-up time was significantly shorter at 1wk(10.21±5.20, 8.89±4.47, 6.87±3.68, 7.35±3.52, 9.00±4.23s, <i>P</i><0.05).<p>CONCLUSION: phacoemulsification will influence ocular surface parameters. The tear instability and conjunctival cell damage began at 1d postoperatively, and aggravated at 1wk postoperatively. It still couldn't return to preoperative level even at 2mo postoperatively.

Comparison of conjunctival impression cytology in primary open angle glaucoma, ocular hypertension and normal subjects / 国际眼科杂志(Guoji Yanke Zazhi)

?AlM:To compare the tear functions and the impression cytology scores of the patients with primary open angle glaucoma ( POAG ) , ocular hypertension ( OHT ) and normal subjects with healthy ocular surface both functionally and clinically. ?METHODS: Eleven eyes of 11 patients with POAG (mean age: 62. 7±6. 1y), 12 eyes of 12 patients ( mean age:62. 8±6. 4y ) with OHT and 12 eyes of 12 normal subjects ( mean age: 62. 9±6. 03y) were included to this prospective study. The patients with POAG and OHT had been recently diagnosed with these diseases and none of them had taken anti - glaucoma treatment before. ln addition to conjunctival impression cytology, tear break-up time ( TBUT ) and basal Schirmer’s tests ( BST ) were performed. lmpression cytology specimens of each group were graded and scored in the range of 0-3 according to Nelson’s method. Kruskal- Wallis analysis and Dunn’s multiple comparison tests were used for statistical analysis. ?RESULTS:The mean BST values were 10. 4±1. 3, 10. 9±1. 2 and 11. 1±1. 1 mm/5min of POAG, OHT and control groups respectively. The differences among the BST values of the POAG, OHT and control group were not statistically significant (P=0. 33). The mean TBUT values were 11. 2±1. 1, 11. 3±1. 1 and 11. 8±1. 2s in POAG, OHT and normal subjects respectively. The differences among the BUT values of the POAG, OHT and control group were not statistically significant (P=0. 35). Six eyes (54. 5%) revealed grade 0 and 5 eyes ( 45. 5%) revealed grade 1 impression cytology scores in POAG group. Six eyes (50%) revealed grade 0 and 6 eyes (50%) revealed grade 1 impression cytology scores in OHT group and 6 eyes (50%) revealed grade 0 and 6 eyes (50%) revealed grade 1 impression cytology scores in normal subjects ( P =0. 97). ?CONCLUSlON: Oxidative stress may cause glaucoma, ocular surface diseases, lacrimal gland malfunction and a decrease in mucus secretion ofgoblet cells in all of the body. There were no significant differences between the impression cytology scores of patients with POAG, OHT and normal subjects.

Research of association between the primary progressive type of pterygium and the tear film / 国际眼科杂志(Guoji Yanke Zazhi)

To research the association between primary progressive pterygium and tear film. ●METHODS: Totally 60 cases of primary progressive pterygium from September 2012 to June 2013 in our hospital were enrolled. The pterygium eye was for observation group and the contralateral eye as the control group. The differences of eye symptoms, tear film break-up time ( BUT ), Schirmer Ⅰ test ( S Ⅰ t ), corneal fluorescein staining (FL), tear ferning test (TFT) and the conjunctival impression cytology ( ClC) were compared between two groups. ●RESULTS: The eyes in observation group had higher symptoms score, FL score, grades of conjunctival squamous metaplasia, percentage of abnormal tear ferning, but had lower BUT and density of goblet cell, the differences had statistically significance (P0. 05). ● CONCLUSlON: Primary progressive pterygium can cause a decrease in tear film stability, which in turn lead to some dry eye symptoms such as dry feeling and burning sensation, and its mechanism may be caused by multi-factors, such as density change of goblet cell and the tear fluid dynamics.

Validez de la citología de impresión para neoplasias de la superficie ocular: resultados preliminares / Validation of impression cytology for ocular surface neoplasia: preliminary results

Objetivo: determinar la validez de la citología de impresión en lesiones conjuntivales clínicamente sospechosas de neoplasia comparada con la histopatología. Diseño: estudio de prueba diagnóstica. Métodos: pacientes que ingresaron a la Fundación Oftalmológica Nacional de Colombia con diagnóstico clínico de neoplasia de superficie ocular o lesión sospechosa de neoplasia quienes fueron sometidos a citología de impresión y posterior resección quirúrgica completa más estudio patológico de la lesión. Resultados: se examinaron 54 pacientes de los cuales 27 fueron mujeres y 27 hombres correspondiendo a 50% en cada grupo. La media de edad fue 52.3 años. La lesión más frecuente fue la neoplasia conjuntival escamosa intraepitelial (NIC) en los diagnósticos clínico, citológico y patológico. Se encontró que la sensibilidad de la citología de impresión fue de 92.86% y la especifi cidad de 50%. Con respecto al diagnóstico clínico relacionado con la patología se obtuvo una sensibilidad de 92.86% y una especificidad de 80.77%. Conclusiones: Se encontró que la citología de impresión es una prueba sensible mas no específica para el tamizaje de neoplasias de superficie ocular, sin embargo no muestra una superioridad frente a un buen diagnóstico clínico. Se debe aclarar que son observaciones preliminares de un estudio que se encuentra en curso.

Objective: to determine impression cytology validity for conjunctival malignant lesions compared to pathology. Design: diagnostic test study. Methods: patients admitted to Fundación Oftalmológica Nacional of Colombia with clinical diagnosis of ocular surface neoplasia or suspicious ocular surface neoplasia who underwent impression cytology before excisional surgery of the lesion and pathologic study. Results: fifty four patients were obtained for this initial analysis, 27 were of female sex and 27 males, each group corresponded to 50%. Mean age obtained was 52.3 years. The most frequent lesion found was ocular surface squamous cell neoplasia in the clinical diagnosis, impression cytology and pathology. Impression cytology sensitivity found is 92.86% and 50% of specificity. Clinical diagnosis was found to have 92.68% sensitivity and 80.77% Conclusions: impression cytology was found to be a sensitive test but not specific, which is adequate for a screening test, however it does not demonstrate to be superior to a clinical diagnosis made by a trained specialist. It must be clear that these are preliminary observations and calculations of a study that is still in course and the sample is incomplete.

Histopathologic Characteristics of Conjunctivochalasis

PURPOSE: In this study we investigated the histopathologic characteristics of conjunctivochalasis and its association with lymphangiectasis using impression cytology and conjunctival excisional biopsy in patients with conjunctivochalasis. METHODS: This prospective study included 14 outpatients diagnosed with conjunctivochalasis, and who had excisional biopsies performed between March 1, 2012 and November 30, 2012. Preoperative slit-lamp examination, dry eye diagnostic test and impression cytology were also performed. For histological analysis, conjunctival sections were stained with hematoxylin and eosin (H&E), Verhoeff-van Gieson (VVG) elastic staining, and monoclonal antibody D2-40, a lymphatic endothelial marker. RESULTS: Tear break-up time and Schirmer's value were decreased in patients with conjunctivochalasis. Impression cytology showed a decrease in goblet cell density and an increase in nucleoplasmic/cytoplasmic ratio. The patients' conjunctival tissues exhibited an infiltration increase of chronic inflammatory cells on H&E stain, and a decrease in collagen density with degeneration of elastic fibers on VVG stain compared to tissues from the control subjects. D2-40 immunohistochemistry revealed the dilated subconjunctival lymphatics in patients with conjunctivochalasis. CONCLUSIONS: This study suggests that the characteristic histopathological features of conjunctivochalasis include dilated lymphatic vessels as well as decreased goblet cell and collagen densities with degeneration of elastic fibers.

Changes in Corneal Sensation, Tear Film Stability and Ocular Surface after Advanced Surface Ablation

PURPOSE: To evaluate the changes in tearfilm, corneal sensation and ocular surface after advanced surface ablation. METHODS: Tearfilm break-up time (BUT), Schirmer test without local anesthesia, fluorescein staining, corneal sensitivity test, ocular surface disease index (OSDI), and conjunctival impression cytology were evaluated in 50 eyes of 25 patients who underwent advanced surface ablation preoperatively and postoperatively at 2 weeks and at 1, 2, 3, and 6 months. Each value was compared to the preoperative value. RESULTS: OSDI diminished by 2 weeks postoperatively, and corneal sensation diminished by 1 month postoperatively (p < 0.05). There were significant decreases in BUT by 2 weeks to 1 month postoperatively as well as decreases in the Schirmer test by 2 to 3 months postoperatively (p < 0.05). Fluorescein staining increased at 2 weeks postoperatively (p < 0.05). Goblet cells decreased substantially by 1 month postoperatively and conjunctival squamous metaplasia increased significantly by 2 months postoperatively (p < 0.05). CONCLUSIONS: Advanced surface ablation may affect tearfilm, corneal sensation and ocular surface up to 3 months postoperatively. Early treatment of dry eye syndrome following advanced surface ablation should strongly be considered.

Tear and ocular surface profile in adult anophthalmic sockets

Objective@#To determine the tear and ocular surface profile of the anophthalmic socket in relation to the contralateral normal eye.@*Methods@#Twenty-five adult patients with unilateral anophthalmic sockets were included into the study. They were at least 2 months post-enucleation or post-evisceration and without any topical medications on the anophthalmic socket and control eye for at least 2 weeks. Assessment was performed using the following parameters: (1) meibomian gland evaluation, (2) ocular surface staining, (3) degree of conjunctival inflammation, (4) Schirmer I and II, and (5) conjunctival impression cytology. @*Results@#Mucoid discharge (52%) was the most common complaint in anophthalmic sockets, followed by itchiness (40%), tearing (36%), and dryness (4%). Compared to control eyes, the anophthalmic sockets had more pronounced and statistically significant lid wiper epitheliopathy, conjunctival staining, and bulbar inflammation. Meibomian gland dysfunction, Schirmer I and II, and conjunctival impression cytology showed no difference between the 2 groups. There was a correlation between the symptoms complained and the ocular staining patterns of the anophthalmic sockets.@*Conclusion@#Anophthalmia predisposes to various ocular surface problems, such as a change in the composition of tears, specifically an increase in the mucin component and a decrease in the aqueous and lipid components, resulting to increased tear viscosity.

Deficiencia de vitamina A en adolescentes no gestantes y gestantes de Maracaibo, Venezuela / Vitamin A deficiency in non pregnant and pregnant adolescents from Maracaibo, Venezuela

Antecedentes: La deficiencia de vitamina A (DVA) es un problema nutricional de salud pública en el mundo. Durante el embarazo se ha asociado con incremento en la morbilidad y mortalidad materno-infantil. Objetivo: Determinar en adolescentes no gestantes y gestantes venezolanas, el estado nutricional de la vitamina A (ENVA). Método: Se realizó un estudio transversal, descriptivo y controlado, en 235 adolescentes mujeres (edad: 16,76 +/- 1,48 años); 75 no gestantes y 160 gestantes. El ENVA fue evaluado según valores de retinol sérico (RS) por cromatografía líquida de alta eficacia (HPLC) y citología de impresión conjuntival (CIC). Resultados: En gestantes y no gestantes la prevalencia de CIC anormal (37,5 por ciento vs 48 por ciento; p>0,05) y afectación del ENVA (41,24 por ciento vs 13,34 por ciento; p=0,0001) fue alta; significativamente mayor durante el segundo y tercer trimestre de gestación (p<0,0002). Las gestantes mostraron una disminución significativa de los valores promedio RS (p<0,0001), una correlación inversa no significativa con la edad gestacional y 4,56 veces mayor probabilidad de presentar afectación del ENVA (OR=4,56; IC95 por ciento: 2,0-10,23) que las no gestantes. Conclusión: La alta prevalencia de DVA observada en este trabajo, representa un problema de salud pública en adolescentes venezolanas, por lo que este grupo vulnerable requiere intervención inmediata.

Background: Vitamin A deficiency (VAD) is a public health nutrition problem in the developing world. VAD had been associated with increased risk of maternal and childhood mortality and morbidity. Objective: To determine vitamin A status (VAS) between non pregnant and pregnant adolescents from Maracaibo-Vene-zuela. Methods: A cross-sectional and descriptive study was conducted in 235 female adolescents (16.76 +/- 1.48y old); non pregnant (n=75) and pregnant (n=160). Vitamin A status was assessed by using serum retinol concentrations (SRC) and conjuctival impression cytology (CIC). SRC were measured by high-performance liquid chromatography and CIC. Results: In pregnant and non pregnant adolescents the prevalence of CIC abnormal (37.50 percent vs 48 percent) and non normal VAS (41.24 percent vs 13.34 percent; p=0.0001) were high, predominantly in the second and third trimester of pregnancy (p<0.0002). Pregnant adolescents showed significative reduction of the mean SRC values (p<0.0001), while gestational age had a negative and no significant relationship with SRC. The odds ratio for pregnant adolescents with non normal VAS was 4.56 (95 percentIC: 2.0-10.23), resulting significantly more frecuent non normal VAS in pregnant adolescents than non pregnant adolescents. Conclusions: The high prevalence of VAD found in this work, is a public health problem in venezuelan female adolescents and this vulnerable group require immediate interventions.

Ocular surface disorder in pterygium: Role of conjunctival impression cytology.

Objective: To study ocular surface abnormalities in patients with pterygium, conjunctival impression cytology was explored as a tool for the assessment of the cytological changes. Materials and Methods: A comparative case control study was undertaken to evaluate the ocular surface disorders in pterygium. Fifty cases of pterygium and 50 age and sex-matched controls were analyzed for the presence of local tear film abnormalities as assessed by the tear film break up time and Schirmer test. The spectrum of changes in cytomorphology was studied in detail using conjunctival imprint cytology. Results: Tear film break-up time and Schirmer's strip wetting were found to be significantly different in study and control groups. Studying the cytomorphology of the conjunctival imprint smears, reduced cellularity and squamous metaplasia of different grades was observed more frequently in patients compared to controls. On overall grading of cytological changes, statistically significant difference was noted between the study and control groups (P value 0.00172). Conclusion: From the present study we can suggest that aqueous tear film deficiency leading to ocular surface disorder brings about a change at the cytological level, and ocular surface disorders found in pterygium can be interpreted by conjunctival impression cytology.

Alteration of tear film after sutureless large incision manual cataract extraction / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the alterations of tear film after sutureless large incision manual cataract extraction (SLIMCE). METHODS: Sixty-eight SLIMCE operation eyes were studied with slit-limp microscope, break- up time (BUT), SchirmmerⅠtest (SⅠt),and fluorescence(FL) to observe the alterations of tear film at different time points in postoperation. Impression cytology and microphoto-analyses technique were also applied to observe the goblet cells at different time points postoperation(7,14,30,60,90 days). RESULTS: Subjective complaint of dry eye within 90 days after the operations were significantly increased compare with preoperations(5-27,23,19,16,13; 2-16,14,8,6,3). The schirmmer Ⅰ test were greatly increased in 14 days postoperation(10.1±4.5;15.0±4.7,13.8±5.7),the mean scores of fluorescence increased (0-17,9,5;0-8,3,1) and the mean break-up time decreased in 30 days post-operation(10.3±2.2;5.5±2.3,7.0±2.4,7.9±2.2) (P<0.05). CONCLUSION: SLIMCE operation have effect on the stability of tear film.

Clinical Usefulness of Conjunctival Brush Cytology in the Diagnosis of Dry Eye Syndrome

PURPOSE: To investigate the clinical usefulness of conjunctival brush cytology (CBC) in the diagnosis of dry eye syndrome. METHODS: Conjunctival impression cytology (CIC) was performed on the right eye and CBC was performed on the left eye in 24 patients with dry eye syndrome (9 patients with Sjogren's syndrome (SS) and 15 patients with non-Sjogren syndrome (Non-SS)) and 7 control subjects. The grade of squamous metaplasia was analyzed and the correlation between the grade and tear surface parameters was evaluated. RESULTS: The squamous metaplasia grade score in CIC and CBC were 2.44+/-0.73 and 1.56+/-1.01 in SS patients (p=0.047), 1.53+/-0.74 and 0.80+/-0.78 in Non-SS patients (p=0.017), and 0.43+/-0.54 and 0.14+/-0.38 (p=0.250) in control subjects, respectively. In SS patients, the score correlated significantly with the symptom score, basal tear secretion, break-up time (BUT) and keratoepitheliopathy score in CBC (p<0.05), but did not correlate with the tear surface parameters in CIC. In Non-SS patients, the score correlated significantly with the symptom score, basal tear secretion, BUT and keratoepitheliopathy score in CBC, and with the keratoepitheliopathy score in CIC (p<0.05). CONCLUSIONS: CBC is a more useful method than CIC in the diagnosis of dry eye syndrome.

Asociación entre los síntomas y signos en pacientes con ojo seco / Association between the symptoms and signs in patients with dry eye

De acuerdo con la definición de ojo seco dada por el Workshop Dry Eye en 2007, la sintomatología en el ojo seco es consecuencia de los cambios en la películalagrimal y daño de la superficie ocular. Sin embargo,los estudios que buscan establecer la asociación y la correlación entre los signos y síntomas son bastantecontradictorios.Objetivo: determinar la asociación entre los síntomas reportados en el cuestionario de Donate et ál. (2002), y los tests de Schirmer, BUT, citología de impresión conjuntival y expresión HLA-DR en pacientes con ojo seco.Metodología: se estudiaron 63 ojos de pacientes con ojo seco que acudieron al Instituto de Investigaciones Optométricas de la Universidad de La Salle, y 19 ojos de sujetos que no presentaron ningún tipo de patologíaocular, y que se analizaron como controles. A todos los pacientes y controles se les aplicó el cuestionariode Donate, test de Schirmer, BUT, citología de impresión conjuntival y expresión de HLA-DR en citología de impresión por inmunohistoquímica. Se aplicó X2 para establecer la asociación entre los síntomasreportados en el cuestionario y cada unos de los test clínicos y de laboratorio.Resultados: se presentó asociación estadísticamente significativa entre los síntomas y el test de Schirmer (X2= 16.9 p<0.0001), el BUT (X2= 9.10 p=0.0026), y expresión de HLA-DR (X2= 9.9 p= 0.017). No hubo asociación entre la sintomatología reportada en el cuestionario y la citología de impresión conjuntival (X2= 3.25 p= 0.07).Conclusiones: la sintomatología en los pacientes con ojo seco analizados presentó una fuerte asociación con la disminución en la cantidad y calidad de la película lagrimal. También se estableció asociación entre los síntomas y la respuesta inflamatoria evidenciadapor la expresión de HLA-DR en las células epiteliales conjuntivales.

According to the definition of dry eye given by the Workshop dry eye in 2007, the symptoms of the dry eye is the result of changes in the tear film and ocular surface damage. But the studies that seek to establish partnership and/or correlation between the signs and symptoms are quite contradictory.Objective: to determine the association between the symptoms reported in the questionnaire Donate et al (2002) and the Schirmer test, BUT, conjunctival impression cytology and HLA-DR expression in patientswith dry eye.Methods: we studied 63 eyes of patients with dry eye that Instituto de Investigaciones Optometricas of University of La Salle, with clinic suspected dry eye and 19 eyes of subjects who showed eye disease,which was analyzed as controls. All patients and controls were applied the questionnaire Donate, Schirmer test, BUT, conjunctival impression cytologyand expression of HLA-DR in impression cytology by immunohistochemistry. X2 is applied to establish the association between the symptoms reported in the questionnaire and each of the clinical and laboratorytests.Results: we present statistically significant associationbetween symptoms and Schirmer test (X2 = 16,9 p < 0,0001), BUT (X2 = 9,10 p = 0,0026), expression of HLA-DR (X2 = 9,9 p = 0,017). There was no associationbetween the symptoms reported in the questionnairewith conjunctival impression cytology (X2 = 3,25 p = 0,07).Conclusions: a strong association was found between symptoms of patients with dry eye with the decrease in the quantity and quality of the tear film. It was also established association between the symptoms and the inflammatory response evidenced by the expression of HLA-DR in the conjunctival epithelial cells.

Efficacy of Vitamin A-containing Lubricant in Dry Eye Syndrome Evaluated by Impression Cytology

PURPOSE: To evaluate the therapeutic effect of topical vitamin A-containing lubricant in dry eye patients. METHODS: Three hundred eyes of 150 patients with dry eye (Schirmer I test< or =10 mm, BUT< or =10 seconds) were divided into three groups. Preservative-containing artificial tears, preservative-free artificial tears, and vitamin A-containing lubricant were administrated to Groups 1, 2, and 3, respectively (N=50). We evaluated and checked symptom scores, tear film breakup time (tBUT), Schirmer I test results, corneal fluorescein stain scores, and impression cytology immediately and at 1, 2, and 3 months after treatment. RESULTS: Mean tBUT and goblet cell density significantly increased from 5.06+/-1.25 to 6.76+/-1.21 sec and from 125.62+/-61.52 to 192.86+/-69.38 cell/mm2, respectively, after 2 months in group 3 (P<0.05). Impression cytology grade significantly decreased from 2.14+/-0.38 to 1.67+/-0.41 after 2 months in group 3 (P<0.05). The Schirmer I test score significantly increased from 9.12+/-4.15 to 12.83+/-0.96 mm, and the corneal stain score decreased from 2.13+/-0.95 to 1.18+/-0.68 after 3 months in group 3 (P<0.05). CONCLUSIONS: The improvement of symptoms and the stabilization of tear films and ocular surfaces suggested that treatment with vitamin A-containing lubricant for dry eye was effective.

Long-term Outcome of Limbal Epithelial Cells Cultivated in Vivo on Amniotic Membrane Transplantation

PURPOSE: To investigate the characteristics and the results of long-term follow-up of limbal epithelial cells cultivated in vivo on amniotic membranes (LIVAM) in corneal limbal deficiency. METHODS: Twenty-two eyes of twenty-two patients diagnosed with corneal limbal deficiency underwent transplantation of in vivo cultivated corneal limbal epithelial cells on the amniotic membrane. Biopsy and immunohistochemical staining (AE5, MUC5AC) of the amniotic membrane cultivated for one week were performed to verify that the cultivated epithelial cells on the amniotic membrane were corneal epithelial cells. Impression cytology was performed to evaluate the characteristics of the transplanted corneal limbal epithelial cells at postoperative 1 week, 3 months, 6 months, and 1 year. RESULTS: Successful epithelial growth was observed on the amniotic membrane at one week. The epithelial cells were confirmed to be corneal epithelial cells by immunohistochemical staining. Transplanted in vivo cultivated corneal epithelial cells were confirmed to have corneal specificity by impression cytology and immunohistochemical staining at postoperative 1 week, 3 months, 6 months, and 1 year. CONCLUSIONS: In vivo cultured corneal epithelial cells showed morphological and immunohistochemical findings similar to those of normal corneal epithelial cells. Transplanted in vivo cultivated corneal epithelial cells were maintained and showed the characteristics of corneal epithelial cells. Transplantation of in vivo cultivated corneal limbal epithelial cells can be performed to reconstruct the corneal limbus in treating corneal limbal deficiency.

Adjacent limbal transplantation for pterygium treatment / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate a technique of limbal reconstruction for pterygium through surgery using flaps of adjacent limbal conjunctiva.METHODS: As for a prospective non-comparative case series of 100 pterygium surgeries, pterygium resection was performed with topical anesthesia. Once resected, two adjacent flaps of conjunctiva with the adjoining limbus were dissected and then sutured, reassembling the corneo-conjunctival limbus. Limbal reconstruction was evaluated with impression cytology.RESULTS: Complete reconstruction of the limbus was documented with impression cytology. A recurrence rate of 4% was observed with this technique, during follow-up of 6 to 24 months (with a mean of 14 months). There was a minimal difference between surgeons (3% vs 4%). Loss of limbal anatomy with mucous hyperplasia and squamous metaplasia was documented during recurrences.CONCLUSION: Adjacent limbal transplantation is a safe and simple technique for pterygium surgery and complete reconstruction of limbus is documented, with a minimal rate of recurrence.