Características epidemiológicas, clínicas y oftalmológicas de pacientes con queratoconjuntivitis seca / Epidemiological, clinical and ophthalmologic characteristics of patients with keratoconjunctivitis Sicca

Introducción: La queratoconjuntivitis seca es una enfermedad de causa multifactorial, que afecta la producción de lágrimas y la superficie ocular, a la vez que ocasiona malestar, visión borrosa e inestabilidad de la película lagrimal. Métodos: Se realizó un estudio descriptivo y transversal de 50 pacientes con diagnóstico de queratoconjuntivitis seca, atendidos en el Centro Oftalmológico del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde enero hasta julio de 2020. Objetivo: Caracterizar a los pacientes con queratoconjuntivitis seca según variables epidemiológicas clínicas y oftalmológicas. Resultados: En la serie predominaron las féminas (66,0 %), los pacientes mayores de 60 años (40,0 %), la lectura excesiva como factor de riesgo (42,0 %), la irritación, la fatiga ocular y la visión borrosa como criterios diagnósticos, además de la disminución del tiempo de rotura de la película lagrimal en 68,0 % de la muestra, entre otros resultados. Conclusión: La queratoconjuntivitis seca, desde el punto de vista clínico y epidemiológico fue similar a lo descrito en la bibliografía especializada en cuanto a los grupos de edades, sexo y principales síntomas descritos.

Introduction: The keratoconjunctivitis sicca is a disease of multifactorial cause that affects the production of tears and the ocular surface, at the same time that causes discomfort, blurred vision and instability of the lacrimal thin layer. Methods: A descriptive and cross-sectional study of 50 patients with diagnosis of keratoconjunctivitis sicca, assisted in the Ophthalmolgic Center of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, was carried out from January to July, 2020. Objective: To characterize patients with keratoconjunctivitis sicca according to clinical, epidemiologic and ophthalmologic variables. Results: In the series there was a prevalence of the females (66.0 %), patients over 60 years (40.0 %), excessive reading as risk factor (42.0 %), irritation, ocular fatigue and blurred vision as diagnostic criteria, besides the decrease of the lacrimal thin layer break up time in 68.0 % of the sample, among other results. Conclusion: The keratoconjunctivitis sicca was similar to that described in the specialized literature review as for the age groups, sex and main described symptoms from the clinical and epidemiologic points of view.

Revisiting Keratoconjunctivitis sicca associated with Human T-Cell Lymphotropic Virus Type 1: prevalence, clinical aspects and proviral load

ABSTRACT Background: The prevalence of keratoconjunctivitis sicca (KCS) associated with Human T-Cell Lymphotropic Virus Type 1 (HTLV-1) (HTLV-1/KCS) has been estimated at around 37%, but its clinical manifestations are poorly described. Purpose: To determine the prevalence and associated factors of HTLV-1/KCS in a large cohort of HTLV-1-infected individuals living in Salvador, Brazil. Methods: A cross-sectional study was conducted between June 2004 and September 2017 at the Integrative and Multidisciplinary Center for HTLV in Salvador, Bahia-Brazil. Data from 758 HTLV-1-infected patients was collected. A complete ophthalmologic examination was performed in both eyes. Lacrimal function was evaluated by breakup time, Rose Bengal and Schirmer I Tests. KCS diagnosis was considered in the presence of at least two out of three positive tests. HTLV-1 proviral load Crude and Adjusted Prevalence Rates (PR) with 95% Confidence Intervals (95% CI) were estimated using multivariate Poisson Regression with robust error variance. Results: The overall prevalence of KCS was 31.7%, with higher rates observed in HTLV-1-associated myelopathy/tropical spastic paraparesis patients (crude PR: 1.84; CI95%: 1.50-2.26) even after adjusting for age, sex, time of HTLV-1 diagnosis and schooling (adjusted PR: 1.63; CI95%: 1.31-2.02). Proviral load, low corrected visual acuity, burning and/or pain and itching were all significantly higher in patients with KCS. Conclusion: Burning and/or pain and itching and low corrected visual acuity were the most common alterations of HTLV-1/KCS. High Proviral load was found to be associated with the presence of KCS. It is strongly recommended that HTLV-1 patients undergo periodic ophthalmologic examination to promote the early diagnosis of KCS and prevent the consequences associated with dry eye disease.

Comportamiento clínico-oftalmológico del síndrome de ojo seco / Clinical-ophthalmologic behavior of the dry eye syndrome

Introducción: el síndrome de ojo seco o queratoconjuntivitis seca, constituye uno de los trastornos oculares de mayor frecuencia en la actualidad. Objetivo: evaluar el comportamiento clínico del síndrome de ojo seco en la consulta de córnea. Material y Métodos: se realizó un estudio observacional, descriptivo, prospectivo en 103 pacientes con diagnóstico de síndrome de ojo seco que acudieron al Servicio de Córnea del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez, de Matanzas, en el período comprendido entre noviembre de 2013 a noviembre de 2016. Se analizaron las variables clínico-epidemiológicas, examen oftalmológico, test de Schirmer y BUT. Resultados: el grupo etáreo que predominó fue el de 60 a 69 años y el género femenino. La medicación sistémica fue el factor de riesgo que en mayor porciento se presentó. El síntoma predominante fue la sequedad ocular, mientras que la disminución del menisco lagrimal estuvo presente en gran parte de los pacientes. Tanto el BUT, como el test de Schirmer se presentaron alterados en el 81,5 y 65% de los investigados respectivamente. Conclusiones: el síndrome de ojo seco es una enfermedad frecuente en la práctica oftalmológica, el reconocimiento de sus elementos clínicos contribuye al diagnóstico preciso de la misma (AU).

Introduction: the dry eye syndrome or dry keratoconjunctivitis is, nowadays, one of the most frequent ocular disorders. Objective: to assess the clinical behavior of the dry eye syndrome in the cornea consultation. Materials and methods: a prospective, descriptive, observational study was carried out in 103 patients with diagnosis of dry eye syndrome who came to the Service of Cornea of the Clinical Surgical University Hospital "Comandante Faustino Pérez", of Matanzas, between November 2013 and November 2016. The clinical epidemiological variables, the ophthalmologic examination, the Schirmer´s test and BUT were analyzed. Results: the age group that predominated was the 60-69 years group, and female gender. Systematic medication was the risk factor showing higher percent. The predominant symptom was eye dryness, while the reduction of the lachrymal meniscus was present in most of the patients. The BUT as much as the Schirmer´s test were altered in 81.5 % and 65 % of the studied persons respectively. Conclusions: the dry eye syndrome is a disease frequently found in the ophthalmological practice; the recognition of its clinical elements contributes to its precise diagnosis (AU).

Avaliação de células T regulatórias e pefil de ativação de linfócitos T na ceratoconjuntivite seca associada ao HTLV-1 / Regulatory T cells evaluation and T lymphocyte activation profile in keratoconjunctivitis sicca associated with HTLV-1

O HTLV-1 é o agente etiológico da leucemia /linfoma de células T do adulto (ATLL), da paraparesia espástica tropical/ mielopatia associada ao HTLV-1 (HAM/TSP) e da uveíte. Além destas, a ceratoconjutivite seca (CCS), doença multifatorial da lágrima e da superfície ocular, tem sido descrita com maior frequência em indivíduos infectados pelo HTLV-1. Assim como em outras doenças associadas, a CCS tem sido relacionada a uma elevada carga proviral. As células T regulatórias (Treg) são importantes na manutenção da homeostase do sistema imunológico e um comprometimento da imunorregulação exercido por elas pode contribuir para o ambiente inflamatório observado na CCS. Este estudo objetivou avaliar os linfócitos Treg de pacientes com CCS associada à infecção pelo HTLV-1. Foram realizados ensaios de imunofenotipagem por citometria de fluxo para avaliar a frequência de linfócitos T ativados (HLA-DR+) e de células T CD4+ e CD8+ regulatórios (FOXP3+), bem como a produção de IL-10 e TGF-β por estas células. Foram avaliados 37 pacientes infectados pelo HTLV-1 e assintomáticos para HAM/TSP, sendo 27 com diagnóstico positivo para a manifestação ocular (CCS), 10 com diagnóstico negativo (ASS), além de 17 voluntários não infectados pelo vírus (NI). As frequências de linfócitos T CD4+FOXP3+, CD8+FOXP3+, CD4+HLA-DR+ e CD8+HLA-DR+ foram significativamente maiores nos grupos CCS e ASS, quando comparados aos indivíduos não infectados. Quanto à produção das citocinas imunossupressoras, foi observada uma maior frequência de linfócitos T CD4+FOXP3+ duplo produtores de IL-10 e TGF-β no grupo CCS quando comparado ao grupo ASS. Com relação aos linfócitos CD8+FOXP3+, o grupo CCS apresentou uma maior frequência de células mono produtoras de IL-10 quando comparado ao ASS. Nossos resultados sugerem que a menor frequência de células Treg CD8+ produtoras de TGF-β em indivíduos infectados pelo HTLV-1 com CCS, pode contribuir para a intensificação da ativação celular e fisiopatologia da doença.

HTLV-1 is the causative agent of leukemia/lymphoma adult T-cell (ATLL), tropical spastic paraparesis / myelopathy associated with HTLV-1 (HAM / TSP) and uveitis. In addition, keratoconjunctivitis sicca (KCS), a multifactorial disease of the tear and of the ocular surface, has been more frequently reported in patients infected with HTLV-1. As for other HTLV-1-associated diseases, KCS has been related to a high proviral load. Regulatory T (Treg) cells are important in maintaining the homeostasis of the immune system. An impairment in the immunoregulation function of Treg may contribute to the inflammatory environment observed in the KCS. This study aimed to evaluate the Treg cells of patients with KCS associated with HTLV-1. Frequency of activated T cells (HLA-DR+) and CD4+ and CD8+ Treg cells (FOXP3+), as well as IL-10 and TGF-β production by Treg were quantified using flow cytometry. Thirty-seven HTLV-1 individuals were included (27 asymptomatic for HAM/TSP with positive diagnosis of ocular manifestation (KCS), 10 with negative diagnosis (ASS - asymptomatic). Seventeen non-infected individuals were included as controls (NI). The frequencies of CD4+ FOXP3+ T cells, CD8+FOXP3+, CD4+HLA-DR+ and CD8+HLA-DR+ were significantly higher in KCS and ASS groups when compared to non-infected individuals. As the production of immunosuppressive cytokines, a higher frequency of CD4+ FOXP3+ double producers of IL-10 and TGF-β in the KCS group was observed when compared to group ASS. Regarding the CD8+FOXP3+ lymphocytes, the KCS group had a higher frequency of mono cells producing IL-10 when compared to the ASS. Our results suggest that the lower frequency of Treg cells CD8+ TGF-β-producing in individuals infected with HTLV-1 with KCS, may contribute to the intensification of cellular activation and pathophysiology of the disease.

Prevalence of eye disease in Brazilian patients with psoriatic arthritis

OBJECTIVES: The aim of this study was to report the type and frequency of ocular manifestations in Brazilian psoriatic arthritis patients. METHODS: We conducted a cross-sectional study in a Brazilian tertiary hospital. The test group included 40 patients who had psoriatic arthritis according to the Classification Criteria for Psoriatic Arthritis. A control group of 40 individuals was matched for age and gender. All of the patients underwent ophthalmic evaluation, which included best-corrected visual acuity, slit lamp and fundus examinations, and dry eye diagnostic tests (Schirmer I, tear breakup time and rose bengal). Demographic parameters were also evaluated. RESULTS: The mean age of the patients was 53.9±13.1 years; the mean disease duration was 8±10.5 years. Most of the patients were women (60%), and the majority had polyarticular disease (57.5%). Several ocular abnormalities were found, including punctate keratitis, pinguecula, blepharitis, pterygium, cataract, glaucoma, uveitis, and retinal microvascular abnormalities. There were no significant differences in the rates of these abnormalities compared with the control group, however. The Keratoconjunctivitis sicca and dry eye diagnostic tests were more often positive in the patients with psoriatic arthritis than in the control group. CONCLUSIONS: In this study, keratoconjunctivitis sicca was the most common ocular finding related to psoriatic arthritis. Therefore, we recommend early ophthalmologic evaluations for all psoriatic arthritis patients who complain of eye symptoms.

Ocular lesions in HTLV-1 infected patients from Salvador, State of Bahia: the city with the highest prevalence of this infection in Brazil / Lesões oculares em pacientes infectados pelo HTLV-1 em Salvador, Estado da Bahia: a cidade com maior prevalência desta infecção no Brasil

In order to determine the prevalence of ocular lesions in HTLV-1 infected patients in Salvador Bahia, a transversal study was conducted on 140 HTLV-1 infected patients (90 asymptomatic and 50 tropical spastic paraparesis/HTLV-1-associated myelopathy) between June 2004 and November 2005. The ophthalmological examination included visual acuity measurement, ocular motility, biomicroscopy of the anterior and posterior chambers, intraocular pressure and evaluation of lachrymal secretion. Observation verified 4 (2.8 percent) out of 140 patients with uveitis (two patients had intermediate uveitis and two had pan-uveitis) and 39 (36.4 percent) out of 107 patients with keratoconjunctivitis sicca. The prevalence of Keratoconjunctivitis sicca was significantly higher among the TSP/HAM patients (OR age adjusted=3.64; 95 percentCI 1.59-8.32). Uveitis and corneal opacities were also important findings, indicating the strong need for periodic ophthalmological follow-up in all HTLV-1 subjects.

Com o objetivo de determinar a prevalência de lesões oculares, em portadores de HTLV-1 em Salvador, Bahia, foi realizado um estudo transversal em 140 pacientes (90 assintomático e 50 com paraparesia espática tropical/mielopatia associada ao vírus linfotrópico de células T humanas) entre junho de 2004 e novembro de 2005. O exame oftalmológico incluiu medida da acuidade visual, exame da motilidade ocular, biomicroscopia anterior e posterior, pressão intraocular e avaliação do filme lacrimal. Observamos 4.0 (2.8 por cento) pacientes com uveites (dois com uveíte intermediária e dois com panuveíte) e 39 (36,4 por cento) pacientes com ceratoconjuntivite seca. A prevalência de Ceratoconjuntivite seca foi significantemente mais elevada entre os pacientes com TSP/HAM (RC ajustada para idade = 3,64; IC 95 por cento 1,59-8,32). As uveítes e opacidades corneanas foram também, patologias importantes, indicando a necessidade de acompanhamento oftalmológico periódico nos portadores de HTLV-1.

Olho seco em pessoas com idade superior a 40 anos selecionadas em 3 cidades brasileiras / Frequency of dry eyes in 3 different Brazilian cities

Foram estudados 300 pacientes (100 em Brasília, 100 em Säo Paulo e 100 em Teresina), de 40 a 89 anos, 50 por cento das mulheres, nos meses de junho a agosto de 1993, com o objetivo de determinar a frequência de olho seco e avaliar a influência de fatores ambientais: temperatura e umidade relativa do ar. Foram coletados dados de identificaçäo, fatores ambientais, sintomatologia e realizada avaliaçäo biomicroscópica, testes de Schrimer I, Rosa Bengala e break up time (BUT). Dos 200 olhos examinados em cada cidade, foram encontrados 38 olhos em Brasília, 37 em Säo Paulo e 2 em Teresina com teste de Schirmer I positivo; 2 olhos em Brasília, 37 em Säo Paulo e 10 em Teresina com BUT positivo. A temperatura média em Brasília foi de 21oC, variando de 14oC a 29oC; em Säo Paulo foi de 17,5 por cento, variando de 28oC a 32oC. A umidade relativa do ar média em Brasília foi de 49,5, variando de 12 por cento a 87 por cento; a média em Säo Paulo foi de 70,5 por cento, variando de 43 por cento a 98 por cento; a média em Teresina foi de 58 por cento, variando de 46 a 70 por cento. Foram determinados como olhos secos em Brasília, 42 em Säo Paulo e 5 em Teresina. Os resultados näo mostram a influência da temperatura e umidade relativa do ar na síndrome do olho seco. Os casos positivos foram mais frequentes em mulheres, em média de 60 por cento. Pacientes mais jovens em Säo Paulo apresentaram uma incidência maior de olhos secos, fato atribuído talvez a fatores do meio ambiente näo avaliados, possivelmente a poluiçäo do ar. O número de pacientes com sintomas visuais foi maior em Brasília, fato atribuído à baixa umidade relativa do ar