Differential precision of corneal Pentacam HR measurements in early and advanced keratoconus.

BACKGROUND/AIMS: Serial Scheimpflug corneal tomography to monitor the progression of keratoconus has become standard practice in most countries where corneal cross-linking is available. The tomographic definitions of progression are, however, poorly defined. The aims of this study were: (a) to estimate the 95% limits of intraobserver and interobserver agreement of corneal shape parameters on Pentacam in patients with keratoconus and (b) to investigate whether these limits of agreement varied according to disease severity. METHODS: 96 adult patients with keratoconus and no corneal scarring or history of previous surgery were recruited from a corneal clinic in a tertiary ophthalmology hospital. One eye of each subject was scanned twice by each of the two observers with the Pentacam HR. 95% limits of intraobserver and interobserver agreement for K1, K2, Kmax and corneal thickness at the thinnest corneal location (TCT) were calculated. RESULTS: Reproducibility of keratometry measures was better for early keratoconus than advanced keratoconus. In patients of Pentacam-derived Krumeich stage 1 or 2, the 95% limits of interobserver agreement for Kmax were from -0.90 to 1.01. In patients of Pentacam-derived Krumeich stage >2, the 95% limits of interobserver agreement for Kmax were from -3.71 to 3.86. CONCLUSIONS: Keratometric measurements on Pentacam HR are less reproducible in advanced keratoconus than in early keratoconus. In patients of Pentacam-derived Krumeich stage 1 or 2, an increase in K1, K2 or Kmax of more than 1 dioptre is likely to represent the real change in the corneal shape.

The dendritic cell in allergic conjunctivitis.

The acquired immune response in health and disease is initiated when foreign antigens are processed and presented to T lymphocytes via antigen-presenting cells as peptides in the context of Class I and II major histocompatibility complex antigens. It is now clear that there are various types of antigen-presenting cells and that the phenotype of these cells (together with the milieu of the tissue or lymphoid organ) dictates the nature of the immune response to the antigen. Very little is known about the phenotype, distribution, and roles of dendritic cell subtypes that contribute to the pathophysiology of type I hypersensitivity reaction in the ocular surface. We review what has been learned from studies of both human ocular allergy and murine models and comment on how this compares to allergic reactions in other mucosal tissues.

Dynamic changes in conjunctival dendritic cell numbers, anatomical position and phenotype during experimental allergic conjunctivitis.

Dendritic cells (DCs) are a subset of antigen-presenting cells (APCs) that are involved in the initiation and control of the immune response to antigens present at the interface with the environment. A limited number of groups have studied DCs in human and animal conjunctiva but no data is available concerning the different DC subsets present in the conjunctival tissue. The aims of this study are to characterize the phenotypes and numbers of DCs present in the murine model of allergic conjunctivitis using the technique of immunohistochemistry so as to aid the understanding of the mechanisms involved in allergic eye disease. A double immunofluorescence method was used to analyze the phenotypic distribution and density of DC subsets in the mouse conjunctival tissues of the allergic model using a panel of antibodies: CD11c, as a general marker of DCs, coupled with another DC subset marker such as Langerin for Langerhans cells (LCs), CD11b for myeloid DCs (mDCs) and mPDCA-1 for plasmacytoid DCs (pDCs). In the naïve conjunctiva, mDCs were consistently detected in the subepithelial layer and substantia propria. In the epithelium and the subepithelial layer, very few LCs and virtually no pDCs were observed. Following allergen challenge, there was a marked influx of mDCs and pDCs, but no LCs, into the subepithelial layer and throughout the substantia propria. These results indicate that conjunctival DC subsets may play an important role in the immune-regulatory processes involved in the inflammatory component of allergic conjunctivitis.

Role of beta-chemokines in mast cell activation and type I hypersensitivity reactions in the conjunctiva: in vivo and in vitro studies.

Chemokines have a clearly defined role in mobilizing the recruitment of leukocytes to both healthy and inflamed tissues. This review details work from our and other laboratories, indicating that beta-chemokines may play important roles (i) in driving the terminal differentiation of mast cell precursors in mucosal tissues and (ii) in providing priming or costimulatory signals required for mast cell activation, leading to an antigen-driven inflammatory response. These data stem from in vivo, ex vivo, and in vitro studies. Data are also presented that suggest that Fc epsilon RI:chemokine receptor cross talk may involve spatiotemporal dynamics that may control the strength and nature of the complex activating signals controlling mast cell effector function.

Allergy and contact lenses.

Allergic conjunctivitis is a response to environmental allergens, as well as a genetic predisposition of the patient. It is classified as either acute (seasonal allergic conjunctivitis) or chronic (perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis and giant papillary conjunctivitis). The immune mechanism of these diseases will be discussed, as well as the allergic response to contact lens wear.

Biological evaluation of a multi-targeted small molecule inhibitor of tumor-induced angiogenesis.

RO4396686 is a small molecule KDR, FGFR, and PDGFR inhibitor with good pharmacokinetic properties in rodents. In a mouse corneal neovascularization assay, this compound inhibited VEGF-induced angiogenesis. Tested in a H460a xenograft tumor model this agent effected significant tumor growth inhibition at doses as low as 50mg/kg.

The influence of social support on depressive symptoms in cancer patients: age and gender differences.

PURPOSE: The relationship between social support and depressive symptomatology in cancer patients is well established, yet the extent to which patient variables impact this relationship is not well known. The purpose of this study was to examine whether the relationship of social support to the severity of depressive symptoms varies by patient age and gender. DESCRIPTION OF THE STUDY: A sample of 342 cancer outpatients were administered self-report measures of depressive symptoms, perceived adequacy of social support, satisfaction with family functioning, and the size of their social support network. RESULTS: There were no significant differences by gender or age in the relationship of the social support variables to depressive symptoms. Although not statistically significant, interesting differences did emerge: a larger social support network was associated with less severe depression for female patients and for younger patients but not for male patients or older patients. For the entire sample, greater perceived adequacy of support and more satisfaction with family functioning were related to less severe depression. CONCLUSIONS: The findings of the study suggest that interventions to alleviate depressive symptoms in cancer patients may be designed with consideration of demographic characteristics such as age and gender to maximize the beneficial impact on quality of life.