Conjunctival impression cytology, ocular surface and tear-film changes in patients with lichen planus.

BACKGROUND: Lichen planus (LP) is an immune-mediated chronic mucocutaneous disease. Rarely, LP affects the conjunctiva, resulting in conjunctival inflammation, cicatrization and scarring of the subepithelium and cornea, causing keratitis and keratoconjunctivitis sicca. To date, there has been no case-control study examining the ocular findings in LP. AIM: To assess ocular surface health and tear-film changes in patients with LP. METHODS: In total, 20 patients and 24 healthy controls were enrolled in the study. Ocular surface changes were evaluated by conjunctival impression cytology, while tear-film functions were measured by the Schirmer test, break-up time, and fluorescein and lissamine green scoring. RESULTS: There was a significant difference in Schirmer test results, conjunctival lissamine green staining scores, and conjunctival impression-cytology grades between the groups. CONCLUSIONS: LP may cause ocular surface changes and reduction in tear production, therefore it seems reasonable to evaluate these patients for symptoms and signs of dry-eye disease. We consider that LP should be included in the differential diagnosis of dry-eye disease, as this has important therapeutic and prognostic implications.

Protective effects of antithrombin III on retinal ischemia/reperfusion injury in rats: a histopathologic study.

PURPOSE: To investigate the effect of antithrombin III (AT III) on retinal ischemia/reperfusion (I/R) injury in rats. METHODS: The study was carried out on 10 Wistar albino rats (20 eyes) and four-vessel occlusion method was employed to induce retinal ischemia in this study. Rats were divided into two groups: Group I (control group, 10 eyes) and Group II (AT III, 10 eyes). In both groups, vertebral arteries were occluded bilaterally an electric needle coagulator under an operating microscope. A total of 48 hours after the initial procedure, the rats were re-anesthetized and both common carotid arteries were clamped to interrupt blood flow. In Group II, rats were injected intravenously with 250 U/kg of AT III 5 minutes before the induction of ischemia. Duration of ischemia was 30 minutes. At the end of this period, clamp was removed for the reperfusion of the eye for 4 hours. Following the reperfusion period, the animals were killed by decapitation. Retinal sections were evaluated under light and electron microscope. The signs of I/R injury at the microscopic level, i.e., cellular degeneration, vacuolization between retinal layers, increase in the retinal thickness due to edema, mononuclear cell infiltration, and apoptotic cells, were recorded for each group. RESULTS: Retinal sections obtained from the rats in the AT III group revealed a well preserved retinal structure. When average thickness values of the two groups were compared to each other, the difference was significant with respect to inner nuclear and inner plexiform layers indicating increased retinal thickness values in Group I due to tissue edema resulting from I/R injury. Similarly, mononuclear cell infiltration and apoptotic cell counts were found to be significantly higher in control group compared to AT III group showing the inhibitory effect of AT III on leukocyte infiltration and apoptotic cell death in rat retina. CONCLUSIONS: Antithrombin III attenuated I/R injury in rat retina.

Confocal microscopy in the iridocorneal endothelial syndrome.

AIMS: To report the appearances of iridocorneal endothelial (ICE) syndrome from real time, white light confocal microscopy. METHODS: Three consecutive patients, each with ICE syndrome, were examined prospectively. Corneal specular and confocal microscopic examinations were performed in all three patients. In the first patient, a penetrating keratoplasty was performed and the cornea was examined by light and scanning electron microscopy. No surgery was performed in the remaining two patients. RESULTS: In the first patient corneal oedema prevented endothelial specular microscopy. Confocal microscopy performed before penetrating keratoplasty successfully revealed abnormal epithelial-like endothelial cells. Histological examinations of the cornea following penetrating keratoplasty revealed the presence of multilayered endothelial cells with epithelial features (microvilli). In the remaining two patients, specular microscopy showed the presence of ICE cells with typical dark/light reversal. Confocal microscopy demonstrated groups of endothelial cells with epitheloid appearances. In all three patients, the contralateral endothelial appearance was normal by specular and confocal microscopy, except for moderate endothelial polymegathism in one patient. Epithelial-like endothelial cells were characterised by prominent nuclei on confocal microscopy. CONCLUSIONS: The application of confocal microscopy indicates that the ICE syndrome is characterised by epitheloid changes in the endothelium. Confocal microscopy may be used to diagnose the ICE syndrome by demonstrating epithelial-like endothelial cells with hyperreflective nuclei. This technique is especially of value in cases of corneal oedema, since specular microscopy may fail to image the endothelium in such cases.

Corneal thickness measurements with the Orbscan Topography System and ultrasonic pachymetry.

PURPOSE: To compare corneal thickness measurements obtained with a new instrument, the Orbscan Topography System, with those obtained with the DGH ultrasonic pachymeter and to assess the agreement and repeatability of the two devices. SETTING: LSU Eye Center, New Orleans, Louisiana, USA. METHODS: Measurement agreement was assessed in 51 eyes of 26 normal volunteers using both Orbscan and ultrasonic pachymetry. Repeatability for the instruments was measured in 10 eyes of 5 additional volunteers. Corneal thicknesses were compared using the analysis of variance (ANOVA). The relationship between the devices was assessed by analysis of regression (ANOR). RESULTS: In the measurement agreement experiment, the mean corneal thickness was 571.3 microm +/- 6.21 SEM with the Orbscan system and 543.3 +/- 7.49 microm with ultrasonic pachymetry; these values were significantly different (F test, ANOVA, P = .0048). In the repeatability experiment, the mean thickness was 561.1 +/- 8.42 microm with the Orbscan system and 537.4 +/- 5.84 microm with ultrasound pachymetry; these values were also significantly different (F test, ANOVA, P = .0003). Analysis of regression showed a significant linear regression between the values obtained with the devices (P = .0001, F test, ANOR). CONCLUSIONS: In both studies, the Orbscan system obtained statistically significantly different and higher values for corneal thickness. Regression analysis suggests that over the range of values in this study, the two devices differ by a constant amount (intercept and slope). The nonzero intercept of this regression shows that the values from the devices differ and cannot be directly substituted for each other. We therefore conclude that in this study, Orbscan system measurements of corneal thickness were 23 to 28 microm greater than ultrasonic pachymeter measurements. Linear regression equations may be developed for the results of measurements from the two devices and used as a precise transformation factor for the values obtained with the two devices.

In vivo confocal imaging of corneal neovascularization.

PURPOSE: To investigate the cellular dynamics of vessel formation during corneal neovascularization in the living eye by confocal microscopy. METHODS: Corneal neovascularization was initiated by placing a 7-0 silk suture through the corneal stroma 3 mm from the limbus at the 12 o'clock position in both eyes of 10 New Zealand white rabbits. The corneas were examined for vessel ingrowth at intervals from 1 to 15 days after suture placement using a tandem scanning confocal microscope with a 20X water immersion objective, as well as a slit-lamp biomicroscope. Changes in the limbal vessels were recorded on videotape for later analysis. As early vessel growth appeared to be associated with corneal nerves, the total number of sprouts and the number of sprouts along nerves were counted in confocal images, and the results analyzed for statistical significance. Vessel growth and the structural relationship between vascular buds and the deep stromal nerves were examined by light and transmission electron microscopy. RESULTS: The early events of cell migration from the limbal microvessels were found to be associated with the deep stromal nerves; although this association was easily visualized by confocal microscopy, it could not be documented by slit-lamp biomicroscopy. By 18 h after suture placement, the limbal vessels were dilated and the first vascular buds appeared as short, pointed, or flat-topped protrusions from the deep limbal capillaries. By 96 h, the capillary buds had increased in density and had begun to form lumens. Movement of red blood cells was established between 72 and 80 h after the first signs of bud formation, at the same time that cells of immune origin were seen. Confocal microscopy revealed and transmission electron microscopy verified that new bud formation began with the formation of vascular tubes by endothelial migration along the deep stromal nerves. The total number of sprouts and the number of sprouts associated with stromal nerves were similar on days 1 and 2 but differed on days 3-7, suggesting an association between sprouts and nerves in the early stages of neovascularization. CONCLUSION: Using real-time white light confocal microscopy, we were able, for the first time, to observe the process of corneal neovascularization in the living eye, from the earliest stages within hours after initiation to 2 weeks. The deep stromal nerves appear to serve as a focus for the growth of new vessels, by attracting and supporting vessel growth and/or by providing a potential space for movement of the endothelial cells. Confocal microscopy may provide a new approach to achieving a better understanding of the mechanisms involved in corneal neovascularization.

Comparison of tear function tests and impression cytology with the ocular findings in acne rosacea.

PURPOSE: The aim of this study was to determine the correlation between tear function tests and impression cytology results and the clinical findings in ocular rosacea. METHODS: Patients with a histopathologic and clinical diagnosis of acne rosacea were studied. Ocular examination consisted of best-corrected visual acuity measurement, slitlamp examination, tear break-up time (BUT), basal Schirmer test, and rose Bengal staining. Impression cytology was done two days later. Ocular findings and symptoms were checked and scored. Age-matched controls were assessed using the same parameters. RESULTS: The most frequent symptoms were itching (80%), redness (68%), burning (64%), and photophobia (60%). The most frequent clinical findings were meibomitis (92%), telangiectasis (88%), blepharitis (84%), superficial punctate keratopathy (72%), and hyperemia (60%). Mean tear BUT was 9.6+/-3.1 (SD) seconds (range 5-17 seconds). Mean Schirmer test measured 11.4+/-1.6 mm (SD) (range 8-15 mm). Mean rose Bengal staining scored 1.8+/-0.1. Mean tear BUT, Schirmer test and rose Bengal staining scores were lower in the rosacea group than the control group (p<0.003, p=0.04, p< or =0.038, respectively). Staining was pathologic in 18 patients (36%) and the highest staining score was 4. No significant difference was found between the stages of the nasal and temporal conjunctival impression cytologies in each eye, and there was no relationship between impression cytology stages and rose Bengal scores (p>0.05). A significant relation was observed between the stages of impression cytology and the severity of meibomitis (Fisher's test, chi2=9.625, p=0.001). The Schirmer test gave lower results in patients with severe blepharitis (Mann-Whitney U Test, U=180.5, p=0.034). CONCLUSIONS: Early diagnosis prevents serious ocular complications and chronic dry eye in rosacea. We suggest that in addition to tear function tests, rose Bengal staining and impression cytology can be successfully used in the early diagnosis of dry eye and in monitoring medical treatment in ocular rosacea. Meibomian glands play an important role in the pathogenesis of the ocular disease.

Systematic, combined treatment approach to nasolacrimal duct obstruction in different age groups.

PURPOSE: To report the outcome of a step-by-step treatment approach for congenital nasolacrimal duct obstruction (CNDO). METHODS: Three-hundred and fifty eyes with CNDO were included in the study. A number of treatment methods were applied systematically until a successful outcome was achieved. Listed in order from simple to more complex, the following methods were used: conservative management (massage and topical antibiotics), high-pressure syringing, probing, and silicone intubation. Treatment efficacy was determined according to age (Group 1: 0-6 months, Group 2: 7-12 months, Group 3: 13-24 months, Group 4: 25-72 months) and success rates were compared. RESULTS: Conservative management was applied only in children less than 1 year of age, and was successful in 91.8% of Group 1 and 60% of Group 2 eyes. The difference between these two success rates was significant (p = 0.003). High-pressure syringing was performed in children under 24 months of age, with success rates of 41.7% in Group 1, 33.3% in Group 2, and 12.5% in Group 3. The overall success rate for first probing in all groups was 76.1%, with a range of 69.4% to 80.9%. After second probing, the overall cure rate for the entire cohort was 88.0%, with a range of 74.9% to 94.8%. There was no real difference in probing cure rates relative to age (p > 0.05). Silicone intubation was indicated and performed in two eyes of Group 2 children, three eyes of Group 3, and nine eyes of Group 4. Two ducts in Group 4 eyes remained obstructed after silicone intubation. CONCLUSIONS: The systematic treatment approach to CNDO, including conservative management and minimally invasive procedures such as high-pressure syringing, probing, and silicone intubation, is highly successful. In this study, the cure rate for this combined approach was 100% in youngsters under 2 years of age and 94.5% in children 2 to 6 years old.

Subconjunctival ecchymosis due to rhinoplasty.

Orbital complications of rhinoplasty show a wide range from minor complications like periorbital edema and ecchymosis to severe complications like blindness. Also, subconjunctival ecchymosis is one of the orbital complications due to rhinoplasty. A prospective study was set out to assess the incidence and progression of subconjunctival ecchymosis and to find out mechanisms of this complication. The incidence of subconjunctival ecchymosis was found to be 19.1%. Typically it appeared unilaterally or bilaterally over the temporal subconjunctival area in the first two days after the operation. Complete resolution of subconjunctival ecchymosis took approximately 11 +/- 3 days. No other ocular symptoms were found. Subconjunctival ecchymosis only prolonged the recovery period of the patient from the rhinoplasty.

Decreased photoreceptor inner segment/outer segment junction reflectivity in patients with idiopathic epimacular membrane.

PURPOSE: To assess the effects of idiopathic epimacular membrane (IEMM) on retinal pigment epithelium (RPE), photoreceptor inner segment/outer segment (IS/OS) junction, and external limiting membrane (ELM) reflectivities to determine functional alterations in these layers using optical coherence tomography (OCT) image analysis. METHODS: Fifty eyes of 50 patients with untreated IEMM and 41 eyes of 41 age- and sex-matched healthy controls with normal OCT scans were retrospectively reviewed. A single masked physician analyzed OCT images randomly. Reflectivity values of RPE, IS/OS junction, and ELM were obtained using 'plot profile' mode of a medical image processing computer software. RESULTS: The study comprised 50 patients with untreated IEMM and age- and sex-matched 41 control subjects (P > 0.05). Image analysis demonstrated that IS/OS junction and ELM had significantly lower reflectivity in patients with IEMM compared with those of the control eyes (P = 0.008, P = 0.009, respectively). However, RPE reflectivity did not differ between two groups (P = 0.100). Correlation analyses showed no significant associations between reflectivity values and corrected visual acuity (P > 0.05). CONCLUSION: In patients with IEMM, photoreceptor IS/OS junction and ELM seem to have lower reflectivity, which might indicate impaired functionality even though these layers are not apparently damaged on OCT imaging.

Factors affecting outcomes of corneal collagen crosslinking treatment.

PURPOSE: To assess the effects of preoperative patient characteristics on clinical outcomes of corneal crosslinking (CXL) treatment in patients with progressive keratoconus. METHODS: This retrospective study comprised 96 eyes of 96 patients who had unilateral CXL treatment for progressive keratoconus. All patients underwent a complete ophthalmological examination and corneal topography at baseline and 1 year. Subgroup analyses were performed according to the age (<30 and ≥ 30 years), gender, preoperative corrected distance visual acuity (CDVA, <0.3 and ≥ 0.3 logMAR (log of the minimum angle of resolution)), preoperative maximum keratometry (K, <54 and ≥ 54 D), baseline topographic cone location (central, paracentral, and peripheral), and preoperative thinnest pachymetry (<450 and ≥ 450 µm) to determine the associations between preoperative patient characteristics and outcomes (changes in visual acuity and maximum keratometry) of CXL treatment. RESULTS: In the entire study population, mean CDVA and maximum K significantly improved after CXL treatment (P<0.001). Patients with a preoperative CDVA of 20/40 Snellen equivalent or worse (≥ 0.3 logMAR) experienced more visual improvement after CXL treatment (P<0.001). However, an age ≥ 30 years and a baseline thinnest pachymetry less than 450 µm were found significantly associated with more flattening in maximum keratometry (P=0.024, P=0.005 respectively). Gender, preoperative maximum K, and baseline topographic cone location did not show significant effect on postoperative visual acuity and maximum keratometry (P>0.05). CONCLUSIONS: In patients with progressive keratoconus, age, baseline visual acuity, and baseline thinnest pachymetry seem to affect the success of the CXL treatment.

Protective effects of antithrombin III on retinal ischemia/reperfusion injury in rats: A histopathologic study.

PURPOSE: To investigate the effect of antithrombin III (AT III) on retinal ischemia/reperfusion (I/R) injury in rats. METHODS: The study was carried out on 10 Wistar albino rats (20 eyes) and four-vessel occlusion method was employed to induce retinal ischemia in this study. Rats were divided into two groups: Group I (control group, 10 eyes) and Group II (AT III, 10 eyes). In both groups, vertebral arteries were occluded bilaterally an electric needle coagulator under an operating microscope. A total of 48 hours after the initial procedure, the rats were re-anesthetized and both common carotid arteries were clamped to interrupt blood flow. In Group II, rats were injected intravenously with 250 U/kg of AT III 5 minutes before the induction of ichemia. Duration of ischemia was 30 minutes. At the end of this period, clamp was removed for the reperfusion of the eye for 4 hours. Following the reperfusion period, the animals were killed by decapitation. Retinal sections were evaluated under light and electron microscope. The signs of I/R injury at the microscopic level, i.e., cellular degeneration, vacuolization between retinal layers, increase in the retinal thickness due to edema, mononuclear cell infiltration, and apoptotic cells, were recorded for each group. RESULTS: Retinal sections obtained from the rats in the AT III group revealed a well preserved retinal structure. When average thickness values of the two groups were compared to each other, the difference was significant with respect to inner nuclear and inner plexiform layers indicating increased retinal thickness values in Group I due to tissue edema resulting from I/R injury. Similarly, mononuclear cell infiltration and apoptotic cell counts were found to be significantly higher in control group compared to AT III group showing the inhibitory effect of AT III on leukocyte infiltration and apoptotic cell death in rat retina. CONCLUSIONS: Antithrombin III attenuated I/R injury in rat retina.

Systematic, combined treatment approach to nasolacrimal duct obstruction in different.

PURPOSE: To report the outcome of a step-by-step treatment approach for congenital nasolacrimal duct obstruction (CNDO). METHODS: Three-hundred and fifty eyes with CNDO were included in the study. A number of treatment methods were applied systematically until a successful outcome was achieved. Listed in order from simple to more complex, the following methods were used: conservative management (massage and topical antibiotics), high-pressure syringing, probing, and silicone intubation. Treatment efficacy was determined according to age (Group 1: 0-6 months, Group 2: 7-12 months, Group 3: 13-24 months, Group 4: 25-72 months) and success rates were compared. RESULTS: Conservative management was applied only in children less than 1 year of age, and was successful in 91.8% of Group 1 and 60% of Group 2 eyes. The difference between these two success rates was significant (p = 0.003). High-pressure syringing was performed in children under 24 months of age, with success rates of 41.7% in Group 1, 33.3% in Group 2, and 12.5% in Group 3. The overall success rate for first probing in all groups was 76.1%, with a range of 69.4% to 80.9%. After second probing, the overall cure rate for the entire cohort was 88.0%, with a range of 74.9% to 94.8%. There was no real difference in probing cure rates relative to age (p > 0.05). Silicone intubation was indicated and performed in two eyes of Group 2 children, three eyes of Group 3, and nine eyes of Group 4. Two ducts in Group 4 eyes remained obstructed after silicone intubation. CONCLUSIONS: The systematic treatment approach to CNDO, including conservative management and minimally invasive procedures such as high-pressure syringing, probing, and silicone intubation, is highly successful. In this study, the cure rate for this combined approach was 100% in youngsters under 2 years of age and 94.5% in children 2 to 6 years old. (Eur J Ophthalmol 2000; 10: 324-9).