Difficulties in Performing Daily Activities in Patients with Dry Eye before and after Treatment.

Dry eye disease (DED) represents an important public health problem causing visual discomfort which affects the quality of life. This paper investigates the current comprehension of DED on life quality and vision. METHODS: This research consists of a cross-sectional study of 121 patients, with a mean age of 70 ± 9 years, diagnosed with DED. All patients were treated in the University Clinic for Ophthalmology in "St. Spiridon" Emergency Hospital, Iasi. For all patients, we evaluated visual acuity on the Snellen chart, tear breakup time (TBUT), Schirmer I test scores, and contrast sensitivity. For this study, we used the Visual Functioning Questionnaire-25 (VFQ-25) version 2000, modified and adapted for this research (19 items). RESULTS: Prior to treatment, patients had very high difficulty reading a text in a newspaper or on TV, reading prices on products in shops, or recognizing people they already met. Performing manual work or favorite activities was also very difficult. Post-treatment visual challenges improved in the majority of cases, regardless of the treatment method used. CONCLUSIONS: We found that symptomatic dry eye disease was associated with reduced ability in performing several important vision-related daily tasks and has a significant impact on life quality and visual performance.

The Complement System, T Cell Response, and Cytokine Shift in Normotensive versus Pre-Eclamptic and Lupus Pregnancy.

Successful pregnancy requires an immunological shift with T helper CD4+ bias based on disbalance Th1/Th17 versus Th2/T regulatory (Tregs) required to induce tolerance against the semi-allogeneic fetus and placenta and to support fetal growth. Considered a pregnancy-specific hypertensive disorder, pre-eclampsia is characterized by multifaceted organ involvement related to impaired maternal immune tolerance to paternal antigens triggered by hypoxic placental injury as well as excessive local and systemic anti-angiogenic and inflammatory factor synthesis. Both systemic and local Th1/Th2 shift further expands to Th17 cells and their cytokines (IL-17) complemented by suppressive Treg and Th2 cytokines (IL-10, IL-4); alterations in Th17 and Tregs cause hypertension during pregnancy throughout vasoactive factors and endothelial dysfunction, providing an explanatory link between immunological and vascular events in the pathobiology of pre-eclamptic pregnancy. Apart from immunological changes representative of normotensive pregnancy, lupus pregnancy is generally defined by higher serum pro-inflammatory cytokines, lower Th2 polarization, defective and lower number of Tregs, potential blockade of complement inhibitors by anti-phospholipid antibodies, and similar immune alterations to those seen in pre-eclampsia. The current review underpins the immune mechanisms of pre-eclampsia focusing on local (placental) and systemic (maternal) aberrant adaptive and innate immune response versus normotensive pregnancy and pregnancy in systemic autoimmune conditions, particularly lupus.

Conjunctival melanocytic tumors in children - a challenge in diagnosis and treatment.

Conjunctival melanocytic lesions are very diverse pigmented tumors that include benign, premalignant and malignant tumors. The aim of this article is to highlight the clinical and histopathological aspects of conjunctival melanocytic tumors at children. This study is a retrospective case series study of three patients selected from fifteen cases with melanocytic conjunctival tumors who were operated in the Department of Ophthalmology, "St. Spiridon" Emergency Hospital, Iasi, Romania. A systematic review of the literature was undertaken, using an electronic search of PubMed/MEDLINE, Google Scholar and ISI Web of Knowledge, to identify original English or French articles and reviews on this subject. Patients were diagnosed by the same doctor between 2004 and 2016, in ambulatory of Department of Ophthalmology of the same Hospital. The age of patients was between 7 and 17 years old. Three cases (boys) were treated by surgery - one patient with conjunctival malignant melanoma (histologically confirmed) derived from a pre-existing benign conjunctival nevus (diagnosed 1.5 years before), a patient was operated for aesthetic reasons (with histological diagnosis of compound conjunctival melanocytic nevus) and one boy was diagnosed of melanocytic conjunctival nevus. All cases operated had normal visual acuity and fundoscopy. There was no regional lymph node present in any case studied. The traditional method for clinical diagnosis of suspected pigmented conjunctival lesions was to remove these lesions surgically and to examine architectural and cytological features with light microscopy. We recommend an immunohistochemical staining for the detection of specific cellular antigens in conjunctival melanocytic tumors in children. The diagnosis, treatment and the follow-up of the patient were challenges for the ophthalmologist.