Impact of gender mismatch on corneal graft rejection and rejection-related graft failure in repeat penetrating keratoplasty.

PURPOSE: To explore the impact of gender mismatch on corneal allograft rejection and rejection-related graft failure in patients with repeat penetrating keratoplasty (PK). METHODS: A retrospective cohort was conducted at Ramathibodi Hospital, Bangkok, Thailand. Patients with repeat PK and follow-up period of at least 6 months were recruited. Demographic data, pre-operative ocular findings and donor information were collected. Patients were divided into 2 groups according to gender mismatch between donor and recipient (male to female vs others). Survival analysis was performed using the Kaplan-Meier method. The association between risk factors and the outcomes of graft rejection and rejection-related graft failure were analyzed using Cox proportional hazards regression. RESULTS: Of 68 patients with repeat PK, 26 patients (38.2%) were gender mismatched. There was no difference in 3-year rejection-free survival and graft survival between patients with gender mismatch and others (p = 0.698 and p = 0.402, respectively). Younger recipients (< 40 years) showed a significantly higher rejection rate compared to older recipients (hazard ratio; HR = 3.14, 95% confidence interval; CI 1.15 to 8.58), while patients with multiple PK (> 2 times) were found to be significantly associated with higher rejection-related graft failure compared to patients with 2 times or less PK (HR = 2.72, 95% CI 1.03 to 7.21). After multivariate analysis, only younger recipients demonstrated a statistical significance on graft rejection (adjusted HR = 2.86, 95% CI 1.04 to 7.84). CONCLUSIONS: Gender mismatch might not impact corneal graft rejection or rejection-related graft failure in patients with repeat PK. Younger age was found to be a strong factor associated with graft rejection. Gender matching might not be compulsory for repeat PK.

Evaluating Dry Eye and Meibomian Gland Dysfunction With Meibography in Patients With Stevens-Johnson Syndrome.

PURPOSE: To investigate ocular surface and meibomian gland characteristics using infrared meibography in patients with Stevens-Johnson syndrome (SJS). METHODS: This is a single-center, prospective, noncontrolled, observational study. Thirty-two Thai patients (64 eyes) with SJS for 1 year or longer (1-44 years) were enrolled in the study. All participants underwent a comprehensive ophthalmic examination including slit-lamp biomicroscopy, tear meniscus height, fluorescein tear breakup time, ocular surface fluorescein staining, eyelid morphology, Schirmer 1 test, meibomian gland expressibility, and upper and lower eyelid meibography using a noncontact infrared meibograph mounted on a slit-lamp biomicroscope. RESULTS: The mean age was 42.2 ± 17.7 years (range, 4-68 years). Twenty-nine patients (90.6%) had a history of severe ocular complications in the acute stage of the disease. Medications were the most common cause of SJS (93.8%). Meibum quality could not be assessed in 23 patients (71.9%) due to no glands expressible. Partial or complete loss of the meibomian glands in either the upper or lower eyelid was found in all patients. The degree of meibomian gland dropout significantly correlated with tear breakup time (P < 0.001), meibum quality (P < 0.001), meibum expressibility (P < 0.001), ocular surface staining (P < 0.001), and presence of long-term ocular sequelae including symblepharon (P = 0.027) and limbal stem cell deficiency (P = 0.003). CONCLUSIONS: SJS is associated with obstructive meibomian gland dysfunction. The severity of meibomian gland dropout has a relationship with abnormal dry eye tests, subjective meibomian gland evaluation, and other ocular sequelae of SJS.

Hair follicle counts in Thai population: a study on the vertex scalp area.

OBJECTIVE: To assess the normal value of the hair follicle counts in a 4-mm punch biopsy on the vertex scalp area from the Thai population. To compare the hair follicle count in the present study with those in previous described reports. MATERIAL AND METHOD: Twenty autopsy patients of clinically normal scalp were obtained for study from the Department of Forensic Medicine, Siriraj Hospital, Mahidol University. A 4-mm punch biopsy was performed on each patient on the vertex area of the scalp and, subsequently, horizontally bisected at the level of 1 mm below the skin surface and studied by hematoxylin-eosin staining. The total number of hair follicles, the phase of each hair follicle in a normal hair cycle, the number of terminal hairs, intermediate hairs, vellus hairs, and hair follicular unit were also included in this study and compared to those in previously described reports. RESULTS: Of our 20 studied cases, the mean numbers of total hair follicle counts, terminal, intermediate, and vellus hair follicles were 28.3 +/- 9.2, 16.5 +/- 8.4, 5.0 +/- 4.6, and 6.9 +/- 7.0 respectively. The density of hair follicles in our study was statistically less than those found in Caucasians (p-value = 0.002) but more than those in African-Americans (p-value = 0.004) and in Koreans (p-value < 0.001). CONCLUSION: Data collected from previous publications provided only the number of hair follicles in other ethnic groups, but not from the Thai population. The number of hair follicles described in those studies may be unreliable and invalid in the interpretation of scalp biopsies in alopecia Thai patients. They may lead to a misdiagnosis of the disease. The density of hair follicles in Caucasians, African-Americans, Koreans, and Thai population were authentically different according to their ethnic backgrounds. This is important because the number of hair follicles should be considered when a pathologist evaluates the scalp biopsy specimens of alopecia patients.