Rupture and chemical accumulation in contact lenses with dexamethasone eye drop administration after congenital cataract surgery.

PURPOSE: To investigate whether contact lenses used after surgery for congenital cataracts act as a depot for dexamethasone, which would allow the prescribed amount of drops to be reduced, and to examine whether the preservative benzalkonium chloride accumulates in the contact lens matrix, which would suggest a need for more frequent replacements. METHODS: Contact lenses (n = 10) worn by infants treated with dexamethasone eye drops after congenital cataract surgery were analysed with scanning electron microscopy, UV-vis, 1 H-NMR and LDI-MS for chemical deposits and for changes on the contact lens surface. Unused lenses (n = 5) and lenses (n = 4) from patients with no eye drop treatment were analysed as reference. RESULTS: The treated contact lenses displayed ruptured surfaces in comparison with unused and reference lenses. Dexamethasone and BAK were not detected in any of the lenses. A polyethylene oxide component was found in the treated lenses, likely originating from the dexamethasone eye drops or the contact lens solution. CONCLUSION: Dexamethasone and BAK do not accumulate in the contact lenses, and a depot effect of any clinical significance is unlikely. Therefore, the number of drops given after surgery should remain the same regardless of whether the child has contact lenses. The ruptured surface may both decrease the child's comfort and increase the risk of microbial adhesion, and so it is recommended that contact lenses should be replaced once a month throughout the course of anti-inflammatory eye drop treatment after surgery for congenital cataract.

Swedish Parents' Experiences and Their Need for Support When Having a Child with Congenital Cataract: A Qualitative Study.

PURPOSE: To explore parents' experiences of living with a child with congenital cataract, with the intention of identifying how to improve the parental support. DESIGN AND METHOD: A qualitative descriptive design using semi-structured interviews. The parents were interviewed when the children were aged 12-24 months. All children were operated on for congenital cataract before three months of age. The interviews were transcribed and analysed using qualitative content analysis with an inductive approach. Findings were reported following the Standard for Reporting Qualitative Research (SRQR) checklist. RESULTS: Three categories emerged from the data: trying to survive during a chaotic time; adapting to a different normal; being in need of support. When receiving the preliminary diagnosis, most of the parents were upset but managed well once the initial shock had subsided. However, some described feelings of despair, difficulties in accepting the situation and in connecting with the child. All parents stated that, to be valuable, a counsellor needed to have insights in how the eye works and the function of visual development. CONCLUSION: The parents' need for psychosocial support in the early post-diagnostic stage varied greatly. Early identification of those in need of specialized counselling is therefore of importance, preferably at the maternity ward or by the regional ophthalmologist when the referral is made. CLINICAL IMPLICATIONS: The study provides understanding of the importance to take the parents' well-being beyond the medical issues into consideration. This knowledge can be used to provide support at an earlier stage in the treatment programme than is currently the case.

Evaluation of PD-L1, PD-L2, PD-1 and cytotoxic immune response in oral lichen planus.

OBJECTIVE: To investigate the expression of programmed death-ligands 1 and 2 (PD-L1, PD-L2), programmed death-1 (PD-1), CD8 and granzyme B (GrB), as well as its correlation with the severity of oral lichen planus (OLP). MATERIALS AND METHODS: In a collaborative study, 33 cases of OLP were evaluated according to the latest criteria proposed by the American Academy of Oral and Maxillofacial Pathology (AAOMP/2016) and were submitted to immunohistochemistry. Positivity was measured semiquantitatively (PD-L1, PD-L2) and quantitatively (PD-1, CD8, GrB). The severity of OLP was assessed according to clinical subtype, symptomatology and response to corticosteroid therapy. RESULTS: Most OLPs were considered to be negative for PD-L1 (66.6%), but high expression of PD-L2 (96.9%) by keratinocytes and immunoinflammatory cells was observed. PD-1+ cell density/mm2 was reduced compared to CD8+ cells. A low cytotoxic immune response (CD8:GrB ratio) was also demonstrated. Interestingly, there were fewer GrB+ cells in the intraepithelial region in reticular OLP compared to erosive/bullous OLP. CONCLUSIONS: PD-L1/PD-1 pathways appear to be compromised in OLP due to low PD-L1 expression in most samples. In contrast, PD-L2 overexpression associated with a possible regulation of the cytotoxic immune response suggests an immune tolerance that may contribute to the chronic profile of OLP.

Congenital cataract in newborns: A qualitative study on parents' experiences of the surgery and subsequent care.

PURPOSE: Having a child with congenital cataract that requires surgery, contact lens treatment, and frequent medication is a life-altering experience. The aim of this study was to provide more in-depth knowledge of parents' experiences of diagnosis, surgery, and subsequent care, in order to find the areas for improvement. METHODS: Data were collected via semi-structured interviews with parents recruited from St. Erik Eye Hospital, Sweden. The children were operated for congenital cataract before 3 months of age and were aged 12-24 months at the time of the interviews. The interviews were analysed using qualitative content analysis with an inductive approach. RESULTS: Three themes emerged from the data: living in a turbulent time before the diagnosis, coping during the time of initial treatment, and managing the responsibility of their child's visual development. All parents expressed confidence in the operating unit. However, there was a clear need for reliable information on the condition, the surgery, and likely the long-term outcome in the time between receiving the preliminary diagnosis at the maternity ward and getting it confirmed by a paediatric ophthalmologist. CONCLUSION: Much of the parents' concern in this turbulent time is linked to poor information before the visit to the eye hospital. We, therefore, recommend earlier contact with the eye hospital, preferably at the time of writing the referral. Moreover, the possibility of providing up-to-date information via alternative information channels such as smartphone apps should be investigated.

Clinicopathologic data of individuals with oral lichen planus: A Brazilian case series.

BACKGROUND: The aim of the present series was to analyze the sociodemographic characteristics, clinicopathologic features, and oral health-related quality of life of 41 individuals with oral lichen planus (OLP). MATERIAL AND METHODS: In a retrospective analysis (1998-2018), individuals with a clinical diagnosis of OLP from a referral service of Oral Medicine of Brazil were invited for follow-up. The individuals were assessed using the Oral Health Impact Profile-14 (OHIP-14) form. Histopathological data were reviewed according to the latest criteria proposed by the American Academy of Oral and Maxillofacial Pathology (AAOMP/2016). RESULTS: This series mainly consisted of females (70.7%) in their forties (31.7%). The buccal mucosa (68.2%) was the most commonly affected site. Reticular (56.1%) and erosive (34.3%) appearances were the most frequent. According to OHIP-14, individuals with OLP at multiple sites in the oral cavity showed worse values in the handicap domain and those who did not respond to corticosteroids showed a higher score on the psychological discomfort domain. CONCLUSIONS: The findings of the present study, using the AAOMP/2016 criteria, agree with case series and retrospective studies reported in the literature. Besides, OLP in its more severe clinical forms had an influence on patient quality of life. Key words:Diagnosis, epidemiology, oral lichen planus, oral mucosa, quality of life.

In vitro and in vivo effects of ophthalmic solutions on silicone hydrogel bandage lens material Senofilcon A.

BACKGROUND: Acuvue Oasys silicone hydrogel contact lenses (Senofilcon A) are used as bandage lenses and often combined with ophthalmic solutions in the treatment of ocular diseases. Concerns have been raised regarding the compatibility and effect of eye-drop solutions on the bandage lenses, which have led to frequent replacement of lenses causing clinical problems. Some patients experience pain or discomfort during treatments and the accumulation of drugs and preservatives in lenses has been suggested as a possible reason. The aim with this study was to investigate the effect of ophthalmic solutions on silicone hydrogel bandage lens material Senofilcon A in vitro and in vivo. METHODS: The effect of three common ophthalmic solutions Isopto-Maxidex, Timosan and Oftaquix on Acuvue Oasys (Senofilcon A) bandage lenses was evaluated. An in vitro model method was developed where drug and preservative uptake by Acuvue Oasys was monitored with ultraviolet-visible spectroscopy and laser desorption ionisation mass spectrometry. Surface morphology changes of the lenses were evaluated using scanning electron microscopy. The method was then implemented for the in vivo pilot study evaluating lenses worn by patients. RESULTS: In vitro model study monitoring the drug and preservatives uptake showed that the active ingredients from all the eye drops together with preservatives were taken up by the lenses in significant amounts. For the in vivo study no traces of active ingredients or preservatives could be found on the worn and treated lenses regardless of time being worn or dosage profiles. The surface morphology changes in the in vivo study were also minor in contrast to the changes observed in the in vitro scanning electron microscopy images. CONCLUSION: The in vivo results demonstrate minor effects of the ophthalmic solutions on the worn lenses. These results do not support the building up of preservatives and drugs on the contact lenses as the cause of pain or discomfort experienced by some patients, which is encouraging for the use of bandage lenses in combination with ophthalmic solutions.