Scheimpflug Imaging Parameters Associated with Tear Mediators and Bronchial Asthma in Keratoconus.

Purpose. To determine associations between mediators in tears in the whole spectrum of keratoconus (KC); to explore connections between mediators and Scheimpflug parameters; to examine correlations between Scheimpflug parameters and bronchial asthma. Methods. Tear samples were collected from 69 patients and 19 controls. Concentrations of mediators-IL-6, -10; CXCL8, CCL5; MMP-9, -13; TIMP-1; t-PA, PAI-1-were measured by Cytometric Bead Array. Measured Pentacam parameters include keratometry values (K 1, K 2, K max), corneal thickness (Pachy Pupil, Apex, Min), and elevations and indices (including Belin-Ambrósio deviation (BAD-D)). Results. A number of significant positive associations were observed between pairs of mediator concentrations. Significant positive correlations were found between BAD-D and CXCL8/MMP-9 and K 2 and MMP-9. Significant negative associations were explored between Pachy Min and CXCL8/t-PA. Significant associations were found between pairs of mediators (IL-6 and CXCL8; CCL5 and CXCL8/MMP-9; TIMP-1 and MMP-9/-13/t-PA; t-PA and CXCL8/CCL5/PAI-1) and the severity of KC. Significant positive correlation between asthma and the severity of KC was explored. Conclusion. Cooperation of different mediators in tears all taking part in the complex pathomechanism of keratoconus was revealed. Our research verifies that inflammation plays a crucial role in the pathogenesis of KC. Additionally this study confirms the effect of bronchial asthma on keratoconus.

Assessment of endothelial cell density and corneal thickness in corneal grafts an average of 5 years after penetrating keratoplasty.

BACKGROUND: Corneal transparency is a useful indicator for corneal function. Our aim was to investigate central corneal endothelial cells and corneal thickness in transplanted corneas at an average of 5.4 years after penetrating keratoplasty PATIENTS AND METHODS: The study involved 68 perforated keratoplasty patients with at least a 1 year follow-up. Post-operatively, the central corneal endothelial layer was observed using a contact specular microscope. Central endothelial cell density, corneal thickness and the coefficient of variation of endothelial size were statistically analysed. RESULTS: The post-operative follow-up time was ranging from 12 months to 23 years. Endothelial cell density (ECD) was 1,501 ± 249 cell/mm(2). The average cell size was 673.6 ± 98.3 µm(2), and the coefficient of variation of cell size was 0.61 ± 0.11. No difference in ECD was detected between diagnostic groups. Corneal thickness was 0.56 ± 0.06 mm. Correlation between ECD and post-operative time was not significant (r = 0.02; p = 0.85). CONCLUSION: Our study concluded that ECD showed a higher rate of decrease after penetrating keratoplasty with no relation to pre-operative diagnosis.

Effect of contact lens wear on the release of tear mediators in keratoconus.

OBJECTIVES: The release of different cytokines and mediators in tears of patients with keratoconus (KC) wearing contact lenses (CLs) may contribute to the pathology of KC. METHODS: Cohort study was established in patients with KC wearing rigid gas permeable (RGP) CL (group I), patients with ametropia wearing silicone hydrogel (Si-Hi) CL (group II) and ametropic patients wearing RGP CL (group III). RESULTS: Our findings indicate that before CL wear, the release of epidermal growth factor (EGF) and tissue-type plasminogen activator (t-PA) was attenuated, whereas matrix metalloproteinase (MMP)-9, interleukin (IL)-6, chemokine (C-C motif) ligand 5 (CCL5), IL-13, and plasminogen activator inhibitor (PAI)-1 were enhanced in KC compared with ametropes. An increasing linear trend over time was found for MMP-9, EGF, and CXCL8 in KC and MMP-9, MMP-13, IL-6, and CXCL8 in group III. Significant differences were observed in the linear trend over time between groups I and III for MMP-13 and tissue inhibitor of metalloproteinases (TIMP)-1; between groups I and II for MMP-9 and CXCL8; and between groups III and II for MMP-9, CXCL8, and MMP-13. In KC, the release of MMP-9 at week 6 and nerve growth factor (NGF) at 10 min was higher, but NGF at week 2 was lower than that in group II. The release of MMP-13 and NGF at week 2 and 6 were lower in the KC group as compared with group III, and similarly, with IL-6 and CXCL8 at week 2 and PAI at all time points. CONCLUSIONS: Contact lens wear can influence the levels and dynamics of various mediators in the tears of patients with KC that might have an impact on the progression of the disease.

Simultaneous dacryocystography and dacryoscintigraphy using SPECT/CT in the diagnosis of nasolacrimal duct obstruction.

Epiphora, an abnormal overflow of tears, is commonly caused by tear drainage system anomalies including nasolacrimal duct obstruction. To assess morphologic abnormalities, dacryocystography by CT is used when CT contrast material is syringed into the lacrimal drainage system. To evaluate the function of the system, dacryoscintigraphy is the most readily available noninvasive method. In the case presented, a 43-year-old man was referred to our clinic with an 8 months' history of indefinite left side epiphora. After performing dacryoscintigraphy, we acquired SPECT/CT images during dacryocystography by CT to establish the surgical indication.

Evaluation of the corneal endothelium in patients with diabetes mellitus type I and II.

BACKGROUND: The aim of the present study is to determine corneal physiology and endothelial morphology after proper image analysis technique in type I and II diabetic patients. The HbA1c level and the grade of retinopathy were also recorded and correlated with the endothelial parameters. METHODS: 41 eyes of 21 patients with type I and 59 eyes of 30 patients with type II diabetes mellitus (mean age was 40.97 ± 15.46 and 64.36 ± 10.47 years) were examined and compared to age-matched controls. Endothelial cell density (ECD), mean cell area, coefficient of variation of cell area, central corneal thickness, intraocular pressure, and grade of retinopathy were recorded. RESULTS: There was a statistically significant decreased endothelial cell density in type I disease (2428 ± 219 cell/mm2) in comparison with healthy subjects (2495 ± 191 cell/mm2, P=0.02). The diabetic corneas were thicker than normal (P=0.001). The HbA1c level was inversely correlated with the ECD (r=-0.60; P<0.0001) and correlated with the mean endothelial cell area (r=0.60, P<0.0001). Significant correlation was observed between the endothelial morphology and grade of diabetic retinopathy (r=-0.40, ECD; r=0.38, mean cell area; P=0.01 for both). In type II diabetes mellitus no significant difference was found in the evaluated values. CONCLUSIONS: The present study disclosed the alteration of the corneal endothelial morphology in type I diabetes mellitus as compared to normal subjects. The results indicated that type I diabetic corneas are more susceptible to environmental changes than type II corneas.

[Acanthamoeba keratitis]. / Az Acanthamoeba-keratitisrol.

Acanthamoeba infection is a more and more frequently occurring disorder all over the world and in Hungary as well. Beside diagnostic and therapeutic possibilities it may cause serious visual loss. The characteristics of the disease are summarized and presented. It mainly affects people wearing contact lenses with poor hygiene. The subjective signs of the disorder are pain, red eye, tearing and eyelid swelling. In the clinical appearance the ring-shaped ulcer invading the corneal stroma is typical. From differential diagnostic point of view bacterial, fungal, and herpes simplex infection should be excluded. In the diagnosis confocal corneal microscopy and specific laboratory tests are recommended. A wide range of conservative and surgical treatment options are available for treatment. However, early diagnosis and long-lasting adequate therapy are necessary for effective recovery. Prevention is the most important task of contact lens specialists, to inform the patients about adequate hygiene and up-to-date contact lenses and cleaning solutions.

[Morning glory syndrome -- a clinical study of two cases]. / Die Klinik des Morning-Glory-Syndroms -- Eine Falldarstellung.

BACKGROUND: Handmann was the first to describe the morning glory syndrome in 6 cases in 1929. In 1970 Kindler published some cases with an "unusual congenital anomaly of the optic disc". Since then, several authors have come to the conclusion that both authors described the same disease. PATIENTS AND METHODS: In January 2000, morning glory syndrome was diagnosed in two patients, mother and daughter. Ophthalmological and electrophysiological examinations, further brain scan and magnetic resonance imaging (MRI) of the orbit were performed. RESULTS: Malformation of the optic disc was bilateral in both cases. Optic disc abnormality was accompanied by no other anomalies or malformations. Ultrasound examination and MRI of the orbit did not detect posterior staphyloma in our cases. Thus, our two patients are the first to be described in the literature, where the anomaly of the optic disc occurred in isolation. DISCUSSION: Our cases are different from those described in the literature as far as the characteristic anomaly of the optic disc was bilateral and the occurrence was genetical. It is also noteworthy that no other ophthalmological or general malformations could be detected in our patients besides the anomaly of the optic disc. Morning glory syndrome occurred in isolation, which makes our cases unique.