Tear Opiorphin Levels in Ocular Pain Caused by Corneal Foreign Body.

PURPOSE: Opiorphin is an endogenous inhibitor of enkephalin-degrading enzymes. It has a strong analgesic effect in chemical and mechanical pain models. We aimed to evaluate the tear opiorphin levels in ocular pain caused by corneal foreign bodies and demonstrate whether there is any correlation with pain levels obtained from the Visual Analog Scale (VAS) score and tear opiorphin level. METHODS: Thirty-two healthy individuals and 34 individuals diagnosed with corneal foreign bodies were included in this study. Tear opiorphin levels were measured by the ELISA method using a commercially available kit. The difference in tear opiorphin levels between the patient and control groups were evaluated using the Mann-Whitney U test. The correlation between VAS scores and tear opiorphin levels was evaluated using the Spearman rank correlation coefficient. RESULTS: The median values of tear opiorphin levels of the patient and control groups were 134 pg/mL (86.86-296.25) and 109.80 pg/mL (66.15-191.49), respectively. The Mann-Whitney U test showed a statistically significant difference in tear opiorphin levels between patient and control groups (P < 0.05). No ocular pain was reported in the control group. The median VAS score of the patient group was 6 points (1-9). No correlation was found between VAS scores and tear opiorphin levels in the patient group. CONCLUSIONS: The cornea is the most densely innervated tissue, and the highest opiorphin concentrations have been observed in tear. It is, therefore, expected that the stimulation or damage to the nerve endings in cornea would cause an increase in opiorphin secretion as a pain relief mechanism.

MIRAgel: the immunohistochemical expression of CD3, CD34, and CD68 in the surrounding capsule.

PurposeTo study the immunohistochemical features of the capsule tissue surrounding MIRAgel episcleral buckles.Patients and methodsThis Institutional interventional clinical cohort study examined a consecutive series of 21 referred patients who required MIRAgel removal from July 2009 to July 2013. All patients with hydrated and fragmented MIRAgel episcleral buckles were included in this study. Capsule biopsies from MIRAgel episcleral buckles were obtained from all patients. Capsule specimens of seven patients with extruded silicone bands were processed as controls. Paraffin-embedded specimens were examined using light microscopy and immunohistochemistry (via the PAP horseradish peroxidase technique) to detect the expression of CD3, CD20, CD34 and CD68, and S-100 protein.ResultsInflammation with granuloma, which was primarily related to sutures, was found in all (n=36) of the MIRAgel specimens and foreign body granulomas with multinucleated giant cells, histiocytes, and macrophages (CD68+ cells) surrounded the MIRAgel fragments. Average number of CD68+ cells was higher (P<0.001) for MIRAgel than for silicone rubber. The lymphocytic inflammatory infiltrate related to the MIRAgel fragments was CD3+ and CD20- (delayed T cell-mediated immune response). Moderate neoangiogenesis was indicated by the presence of CD34+ cells.ConclusionsThe immunohistochemical analysis revealed that the immune system is able to identify the fragments of MIRAgel (after its hydrolytic degradation) as a foreign body during a delayed T cell-mediated immune response. The phagocytosis by macrophages likely triggers and perpetuates local disease. Removal of MIRAgel explants before hydrolysis should be considered.

Occult orbito-cranial penetrating injury by pencil: role of beta tracer protein as a marker for cerebrospinal fluid leakage.

Orbito-cranial foreign bodies present a treacherous situation that can escape detection. The only evidence of these foreign bodies may be the entry wound in the form of a small lid laceration. A two-year-old boy presented with right upper lid laceration following a fall two hours back. Analysis of the fluid around the wound revealed a beta-tracer protein (beta-TP) value of 33.5 mg/l suggestive of cerebrospinal fluid (CSF). Three-dimensional computed tomography (CT) scan revealed a foreign body measuring 4.2 cm x 0.8 cm passing from the orbital roof to the frontal lobe. The foreign body tract was explored through the eyelid laceration and a broken pencil was removed followed by dural patch graft. The patient developed no ocular or intracranial complications. Beta-TP, a highly specific marker of CSF is routinely used in screening patients of neurosurgery and otolaryngology with CSF leaks, however, its use has never been reported in ophthalmic literature based on an online PubMed search.

Vascular endothelial growth factor in aqueous humor of patients with perforative eye injuries.

Considering that VEGF is the key factor for angiogenesis stimulation, we wanted to establish if VEGF level is increased in aqueous humor of patients with open globe eye injury. The study included 20 patients with open globe injury. During the surgery, aqueous humor samples were taken out and VEGF levels were measured by ELISA. VEGF levels were significantly higher in the aqueous humor of patients with open globe eye injury and uveitis, in patients with wound bigger than 2 mm and in patients where from injury to surgery passed more than 4 hours. VEGF levels were also higher, but not significantly, in patients with intrabulbar foreign body. Considering that VEGF levels were significantly higher in patients with open globe eye injury with uveitis, wound larger than 2 mm and in patients where from injury to surgery passed more than 4 hours, anti VEGF therapy might have application in these conditions.

[The role of interleukin-2 in iron powder-induced intraocular inflammation].

OBJECTIVE: To investigate the role of interleukin 2 (IL-2) in iron powder-induced intraocular inflammation in rabbits. METHODS: Twelve New Zealand rabbits were randomly divided into 3 groups: paracentesis of the anterior chamber was performed in the control group, and either iron powder or iron powder with soluble interleukin-2 receptor (SIL-2R) were separately injected into the anterior chamber in the other two groups. The inflammatory reaction of the anterior chamber was observed and the levels of IL-2 in aqueous humor were measured by ELISA at 3, 5, 7, and 10 days after the injections. Pathological sections with HE staining and iron staining from different eyes enucleated 10 days after the iron powder injections were compared. RESULTS: The inflammatory reaction of the anterior chamber was diminished and IL-2 concentrations in aqueous humor were significantly (P < 0.01) reduced in iron powder with SIL-2R injection group at 3, 5, 7, and 10 days (41.7 +/- 2.38, 102.3 +/- 2.46, 79.4 +/- 2.49, 31.6 +/- 1.80 pg/ml, Mean +/- SD, n = 8, respectively) when compared with iron powder injection group (158.5 +/- 4.76, 659.6 +/- 1.84, 511.7 +/- 3.35, and 79.4 +/- 2.85 pg/ml, Mean +/- SD, n = 8, respectively). Compared with control group, the levels of IL-2 were significantly (P < 0.05) increased in both iron powder and iron powder plus SIL-2R group. CONCLUSIONS: Our results suggest that IL-2 play an important role in iron powder-induced intraocular inflammation that can be diminished by the inhibition of IL-2 receptor. The levels of IL-2 in the aqueous humor were significantly related to the degree of inflammation in anterior chamber.

Plastic particles at the LASIK interface.

PURPOSE: To investigate the origin, composition, and persistence of the interface particles that frequently are observed after LASIK. DESIGN: Small case series and experimental animal study. METHODS: Four patients received LASIK using a Schwind Supratome (Schwind, Kleinostheim, Germany) and a MEL 70 G-Scan excimer laser (Asclepion, Jena, Germany) and were examined over the course of 1 year using slit-lamp and in vivo confocal microscopy. Four rabbits received a monocular microkeratome incision and were examined immediately after surgery without lifting the flap. After monthly evaluation for 4 months using in vivo confocal microscopy, 2 corneas were processed for histologic analysis and were sectioned serially. To measure the iron content, atomic absorption spectrometry was performed on 2 operated and 2 unoperated rabbit corneas. The chemical composition of the metal and plastic parts of the microkeratome blade was identified using energy dispersive x-ray fluorescence (metal part), and Raman and infrared spectroscopy (plastic part). Before and after oscillation in air, the microkeratome blade and motor-head were examined using light and fluorescence microscopy. In serial sections, interface particles were identified by fluorescence microscopy and their chemical composition was determined using Coherent Antistokes Raman Scattering microscopy. RESULTS: In LASIK patients, thousands of brightly reflecting particles (up to 30 micro m) were observed throughout the interface. The highest particle density was detected where the microkeratome blade had first entered the cornea. Both in the center and at the flap edge, the morphologic features, distribution, and density of these particles remained unaltered throughout the 1-year observation period. In rabbit corneas, interface particles were observed immediately after the microkeratome incision, even though the flap had not been lifted. These particles were similar to those observed in humans and persisted unaltered throughout the study. The operated and unoperated rabbit corneas had comparable iron content, demonstrating that the particles were not fragments of the uncoated steel blade. Only a few particles were observed on the unused microkeratome motor head and blade, whereas numerous fluorescent particles were detected after oscillation in air, the amount of particles increasing with oscillation time. Interestingly, the only fluorescent part of the microkeratome was the plastic segment of the blade. This plastic (polyetherimide) emitted fluorescence identical to that of the observed particles, whereas all metal parts of the microkeratome blade and motor head were nonfluorescent. In serial sections, interface particles showed fluorescent properties equivalent to polyetherimide and exhibited molecular resonance at 1780 and 3100 cm(-1), in accordance with the Raman spectrum of polyetherimide. CONCLUSIONS: Numerous plastic particles are generated during microkeratome oscillation and are deposited at the interface during LASIK. The particles persist unaltered for at least 1 year.

Detection of endogenous 12-hydroxyeicosatrienoic acid in human tear film.

PURPOSE: Increased production of 12-hydroxyeicosatetraenoic acid [12(R)-HETE] and 12-hydroxyeicosatrienoic acid [12(R)-HETrE] positively correlates with the in vivo progression of ocular surface inflammation in rabbits. Tear film was collected from human subjects with inflamed eyes to determine whether these eicosanoids could be detected from endogenous sources. METHODS: Control and inflamed eyes were assessed and assigned a subjective inflammatory score. Tears were collected and extracted with an internal standard. Single-ion-monitoring gas chromatography-mass spectrometry (SIM-GC-MS) was performed to quantitate endogenous levels of 12-HETE and 12-HETrE. RESULTS: 12-HETrE was detected in the tear film of both control and inflamed eyes, with the mean level being seven times higher in inflamed tears. 12-HETE was not detected in control tears and was detected in only 6 of 38 inflamed-eye tear samples. CONCLUSIONS: The current findings demonstrate that the human eye produces detectable amounts of 12-HETrE, which is released into the tear flow. The increased levels of 12-HETrE associated with ocular surface inflammation suggest that this eicosanoid may contribute to inflammation of the ocular surface in humans.

[Changes in the vascular wall in the conjunctiva of patients with diabetes mellitus]. / Modificari ale peretelui vascular în conjunctiva bolnavilor cu diabet zaharat.

Venous capillary wall in type II diabetic patients' conjunctiva was examined. The study was performed on conjunctiva fragments removed from diabetic patients during the operation of senile cataract. The fragments were fixed in Lillie's solution then studied by using optical microscopy with usual but histochemical stainings, too. Conjunctiva fragments removed from patients of the same age, being operated by senile cataract and one conjunctiva from ten years old patient were examined by using the same techniques as they could be compared. Computer determinations of the external and internal diameter of the same capillary in all three groups were performed. Venous capillary wall thickening by type IV collagen hyperproduction in all the aged patients was noted. This kind of thickening is more revealed in aged diabetic person. Type I-III collagen presence in the capillary wall of the diabetic patients was noted, too. The average value of the differential between the external and internal diameter was increased in the diabetic patients with diabetic retinopathy. Venous capillary wall thickening in the diabetic patients is due to the basal membrana both by means of the type IV collagen hyperproduction and presence of the I-III collagen, too.

Penetration of piperacillin into the vitreous after intravenous administration.

PURPOSE: Penetration of piperacillin into the vitreous cavity after intravenous administration was investigated in humans. METHODS: Forty-five eyes undergoing vitrectomy between November 1993 and December 1994 were included. Each patient received a single intravenous dose of piperacillin 4 g 2 hours before ocular incision. A 0.2-mL vitreous sample was aspired at the beginning of vitrectomy, a blood sample was obtained, and piperacillin level was assessed. RESULTS: There were no detectable drug concentrations in 25 eyes. Mean vitreous drug concentration in the remaining evaluable eyes (n = 14) was 2.33 microg/mL (+/-0.76). We divided samples into two groups: 23 uninflamed (Group 1) and 16 inflamed (Group 2) eyes. Mean vitreous drug concentration was 0.42 microg/mL in Group 1 and 4.95 microg/mL in Group 2 (P < 0.2). Piperacillin concentration was higher than the minimum inhibitory concentration for gram-positive bacteria in 13% of uninflamed and 69% of inflamed eyes (P < 0.001). CONCLUSION: Studies show that intravenously administered piperacillin can penetrate the vitreous cavity in rabbits. Our study suggests that a single dose of piperacillin can produce intravitreal concentrations sufficient to kill gram-positive bacteria in inflamed eyes. The poor intraocular penetration of systemically administered piperacillin in uninflamed eyes raises questions about its usefulness as a prophylactic agent in ophthalmic surgery.

A long-term follow-up of metallic intraocular foreign bodies, employing diagnostic x-ray spectrometry.

We describe 10 eyes harboring metallic intraocular foreign bodies (IOFBs) for 9 to 46 years that had undergone diagnostic x-ray spectrometry to measure metal dissolution 9 years before this study. Findings from the present clinical and laboratory examinations, including perimetry, electroretinography, electrooculography, and diagnostic x-ray spectrometry examinations are reported. Deterioration in visual acuity consequent to metal dissolution of the IOFB was found in only one eye. Visual fields and electrophysiologic performances deteriorated in two other eyes for reasons that were probably unrelated to IOFB dissolution. Visual functions remained stable during the follow-up period in seven eyes, although excess copper levels were demonstrated in one of them. Eight of 10 eyes retained visual acuity of 6/24 or better. Diagnostic x-ray spectrometry confirmed siderosis in one patient and ruled out metallosis in the two patients with deteriorated vision for reasons that were unrelated to metallosis. The favorable outcome of this series of patients may influence one to consider a more conservative approach in the decision to remove IOFBs. A careful, life-long follow-up might be considered with periodic electroretinographic and diagnostic x-ray spectrometry examinations; the IOFB should be promptly removed if and when metallosis with damage to visual functions is demonstrated.

Lenticular chalcosis--electron microscopic and microprobe analysis. A case report.

A patient with a retained intra-ocular foreign body had a lens extraction for lenticular chalcosis. The lens capsule, examined under an electron microscope, showed copper particles deposited in the basement membrane. The lens capsule and foreign body were examined with an electron microprobe beam. This method proved to be an efficient method of qualitative and quantitative analysis of the contents of the foreign body.

Particulate matter contamination in the corneal stroma of severe eye burns in humans.

Corneal buttons obtained from keratoplasty were examined by energy dispersive x-ray analysis (EDXA) combined with scanning electron microscopy (SEM). This method enables to assay the mineral composition of minute parts of tissue samples identified in SEM images. Samples were cut from paraffin embedded corneae, deparaffinized in xylol, dried in aceton, critical-point desiccated, covered by evaporating with a thin layer of carbon and examined by SEM. In healthy human donor eyes, only some iron particles had been found. In the 22 patients samples high amounts of different particles were identified, materials from rubber stoppers, chromesteel, titanium pigments, talcum, barium and glass. Furthermore a lot of different metal particles containing varying amounts of Na, Mg, Al, Si, P, S, Cl, K, Ca, Fe, Cu, Cr, Zn, La and Ce were detected. Some particles may be caused by the initial trauma, others by therapy. Such contaminations might have supported leucocyte and fibrocyte invasion increasing the inflammatory reaction in the burnt cornea.

[Trace iron and free radical analysis in intraocular ferreous foreign body injury].

Within 7 days after implantation of ferreous foreign body into the vitreous of rabbit eyes, ERG amplitudes decreased and local retinal degeneration was discernible under light and electron microscope. The iron ion concentration in aqueous and vitreous of the experimental eyes began to increase 4 hours after implantation and became significantly higher than that in the control eyes after 24 hours (P less than 0.01 or 0.05). The value of malondialdehyde (MDA) in the retina was closely correlated with the iron concentration in the vitreous (r = 0.86). 24 hours after iron implantation, the level of MDA in the experimental eyes was 1.3 times that in the control eyes (P less than 0.05). On the 28th day, the level of MDA was about 2 times that in the control eyes. The clinical significance of early trace iron analysis of the aqueous and the mechanism of retinal degeneration were discussed.

Electrophysiology and metallosis: support for an oxidative (free radical) mechanism in the human eye.

Nine cases of metal intraocular foreign body are presented. This study investigates the use of electrodiagnostic techniques in the diagnosis of metallosis and as a prognostic indicator. The electro-oculogram (EOG) and the electoretinogram (ERG) indicate that there are two mechanisms of metallosis, one of which involves cytotoxic damage by siderosomes, and the other lipid peroxidation of photoreceptor outer segments and retinal pigment epithelium. The evidence suggests that the location of the foreign body in the eye determines whether either or both of these mechanisms occur. We propose that these tests can help the ophthalmologist decide when a foreign body has to be removed and give information as to the mechanism of the pathological process.