ABSTRACT
PURPOSE: To report 3 cases of punctal plug surface defects as a cause of irritation complicating punctal plug therapy. METHODS: Interventional case series and scanning electron microscopy (SEM) of punctal plugs. RESULTS: Three patients were found to have punctal plug surface defects and local irritation of conjunctiva and inferonasal cornea 9, 40, and 69 months after placement of AquaFlo silicone punctal plugs for the treatment of dry eyes. SEM of the explanted plugs confirmed a defective collarette surface. In addition, unused AquaFlo plugs from different lots examined by SEM showed a rough irregular collarette surface that was not seen in unused plugs of Parasol silicone punctal plugs. DISCUSSION: AquaFlo punctal plugs inherently have surface irregularities when compared with similar plug brands, which we suggest may predispose to plug breakdown over time, leading to mechanical irritation of the adjacent conjunctiva and cornea. This report highlights the local complications by AquaFlo punctal plugs associated with plug surface defects as a complication of punctal plug therapy.
Subject(s)
Conjunctival Diseases/etiology , Corneal Diseases/etiology , Dry Eye Syndromes/surgery , Eyelids/surgery , Lacrimal Apparatus/surgery , Prostheses and Implants/adverse effects , Prosthesis Failure , Silicone Elastomers/adverse effects , Adult , Female , Fluorophotometry , Humans , Microscopy, Electron, Scanning , Middle Aged , Ophthalmic Solutions/administration & dosage , Prostheses and Implants/ultrastructure , Prosthesis Implantation , Retrospective StudiesABSTRACT
PURPOSE: To evaluate iris involvement in Blau syndrome using histology and immunohistochemistry. METHODS: Iridectomy specimen of a patient with treated Blau syndrome and a normal control were evaluated by light microscopy and immunohistochemistry using antibodies against CD4(+), CD8(+), HLA-DR, CD68(+), NF-κB and IL-17. RESULTS: Blau iris tissue demonstrated increased numbers of CD4(+) lymphocytes and CD68 negative, HLA-DR positive spindle shaped cells compared to normal iris tissue. Blau iris tissue also demonstrated elevated CD4(+)/CD8(+) ratio and IL-17 and NF-κB immunolabeling. No macrophages, epithelioid cells, or granulomas were noted in the Blau specimen. CONCLUSIONS: The persistent immunolocalization of inflammatory markers in an iris specimen from an aggresively treated patient with proven Blau syndrome suggests that further pathologic and immunohistochemical investigation of Blau ocular tissue is necessary to better understand the complexities of NOD2 activating mutations in the eye.
