Tear Film Immunological Profile in Patients with Ocular Graft versus Host Disease.

PURPOSE: To analyze and compare the tear immunological profile in ocular GVHD (oGVHD) patients with that in non-oGVHD patients and to correlate them with ocular surface parameters based on the International Chronic Ocular GVHD Consensus Group (ICCGVHD) diagnostic criteria. METHODS: Tear samples from 20 individuals who underwent allo-hematopoietic stem cell transplantation and were grouped according the presence or absence of oGVHD were analyzed using Bio-Plex assay. RESULTS: IL-8 and MIP-1α levels were significantly higher in tears from oGVHD patients compared with those in tears from non-oGVHD patients (p<0.001 and p=0.001, respectively). Tear IL-8 levels correlated significantly with OSDI criteria (ρ=0.5159, p=0.001), ocular hyperemia (ρ=0.469, p=0.002), and corneal staining (ρ=0.339, p=0.032), whereas tear Mip-1α levels correlated with OSDI score (ρ=0.358, p=0.023). CONCLUSION: We demonstrated higher tear levels of IL-8 and MIP-1α in oGVHD patients and significant correlations between theses cytokines and ocular surface parameters based on the ICCGVHDCG criteria.

Vernal Keratoconjunctivitis as the Only Clinical Manifestation of HIV Infection.

INTRODUCTION: This case report describes an 8 year old boy unsuccessfully treated for years for Vernal Keratoconjunctivitis. CASE REPORT: We report a VKC resistant to all types of treatment known in the literature, such as topical and oral corticosteroids, topical and oral cyclosporine, immunotherapy, and third generation anti-histamine eye drops, due to unknown HIV co-infection. During further laboratory tests, patient tested positive for HIV even though he did not present any clinical manifestation of HIV disease. Only after antiretroviral treatment was started the allergy symptoms completely regressed. CONCLUSION: This case report suggests considering investigation of HIV infection in patients with refractory allergic conjunctivitis.

Increased lacrimal inflammatory mediators in patients with keratoconus.

Purpose: This study aimed to characterize the tear film immunologic profile in keratoconus (KC) patients compared with healthy individuals (control group) and to investigate the correlation between the tear film immunologic profile and atopy, disease severity, and disease status over time. Methods: The study involved 30 KC patients and 18 healthy individuals. Tear collection was obtained using microcapillary tubes. Tear film levels of fractalkine, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon (IFN)-γ, interleukin (IL)-1ß, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IL-13, IL-17A, IL-21, IL-23, interferon-inducible T-cell alpha chemoattractant (ITAC), macrophage inflammatory protein-1 alpha (MIP-1α), MIP-1ß, MIP-3α, and tumor necrosis factor (TNF)-α were detected. Keratometric measurements and topographic patterns were used to diagnose and define disease progression. Tear immunologic profiles were compared, emphasizing the presence or absence of ocular allergy. Correlations between the cytokine profile, disease severity, and disease status were also analyzed longitudinally in the KC patients. Results: Lacrimal cytokine concentrations were higher in the KC patients than they were in the controls in 14 of 21 cytokines analyzed. IL-6 was the most relevant cytokine found in KC patients, especially when associated with ocular allergy. There was no correlation between KC progression and the level of inflammatory cytokines when analyzed longitudinally. KC severity correlated with IL-6 concentration, where the more severe KC presented a higher IL-6 concentration in tears. Conclusions: Inflammatory activity seems to be involved in the pathogenesis of KC. Out of 21 cytokines, 14 were more concentrated in the tears of KC patients than healthy subjects. IL-6 was significantly higher in KC patients' tears and was related to disease severity. Disease progression did not correlate with cytokine levels when analyzed longitudinally.

Outcomes of a 320-degree intrastromal corneal ring segment implantation for keratoconus: Results of a 6-month follow-up.

IMPORTANCE: This study shows that a newer long-arc length intrastromal corneal ring segment is efficient and safe for keratoconus treatment. BACKGROUND: To evaluate visual, tomographic results and complications of a 320-degree intrastromal corneal ring segment implantation with the femtosecond laser for keratoconus treatment. DESIGN: A prospective, nonrandomized, and interventional study. PARTICIPANTS: A total of 34 eyes of 31 patients diagnosed with keratoconus were enrolled. METHODS: Patients were divided into two groups based on the strategy used for 320-degree intrastromal corneal ring segment thickness selection. In one group, this selection was based on spherical equivalent (SE group) and in the other on the mean asphericity (Q group). The uncorrected and corrected distance visual acuities, spherical equivalent, K1, K2, Km, Kmax, and mean asphericity (Q) on corneal tomography were evaluated preoperatively and at 3 and 6 months postoperatively. For astigmatism improvement, we analyzed the corneal tomographic vectorial astigmatism change preoperatively and at 6 months postoperatively. The mean follow-up period was 6.63 ± 0.96 months. RESULTS: The mean uncorrected distance visual acuity and corrected distance visual acuity improved with a significant spherical equivalent improvement (p < 0.05), with no differences between the 320-degree intrastromal corneal ring segment groups. All corneal tomographic parameters improved significantly (p < 0.05) between the preoperative and postoperative intervals, with a significant better performance when we used spherical equivalent for the 320-degree intrastromal corneal ring segment thickness selection. Finally, the mean vectorial corneal tomographic astigmatism significantly improved after 6 months, again with no differences between groups. CONCLUSION: This study suggests that implanting a 320-degree intrastromal corneal ring segment is a safe and effective procedure for treating patients with keratoconus. It also suggests that for thickness selection spherical equivalent is the better strategy.

Optical microscopy study of human sclera stored in different media.

PURPOSE: To describe microscopic changes in the structure of human sclera immediately after enucleation (negative control group) and to compare them after being stored for three months in four different media: pure glycerin, absolute alcohol, benzalkonium chloride diluted in absolute alcohol (1:5000), and benzalkonium chloride diluted in balanced salt solution (1:5000). The comparison took into consideration their final state of conservation. DESIGN: Experimental study, laboratory investigation. METHODS: Optical microscopy was used to study the specimens after they had been in storage for one, two, and three months. The scleral fragments were prepared in thin plates, dyed, and then submitted to histologic analysis by two masked specialists. Unpreserved scleral fragments obtained right after enucleation were assessed and served as negative controls. RESULTS: The collagen fibers of scleras stored in glycerin presented with a more regular pattern, closer in appearance to the negative control group. Scleras stored in the other three media presented contorted collagen fibers. CONCLUSIONS: Our findings suggest that glycerin is close to being the ideal storage medium for sclera, because it maintains the structural characteristics of the collagen fibers. Research is ongoing to determine how to increase the bactericidal and antiviral properties of glycerin storage.

Contrast sensitivity in deep anterior lamellar keratoplasty versus penetrating keratoplasty.

PURPOSE: To compare the measurements of contrast sensitivity at a distance in patients submitted to penetrating keratoplasty versus patients submitted to deep anterior lamellar keratoplasty for keratoconus treatment. METHODS: Contrast sensitivity of 15 subjects submitted to penetrating keratoplasty and 15 subjects submitted to deep anterior lamellar keratoplasty have been analyzed through the Functional Acuity Contrast Test (F.A.C.T) 301. RESULTS: There was no statistically significant difference between the measurements for penetrating keratoplasty and deep anterior lamellar keratoplasty. CONCLUSION: Contrast sensitivity was similar among the subjects submitted to penetrating keratoplasty and to deep anterior lamellar keratoplasty for keratoconus treatment.