Coexistence of neuropathic corneal pain, corneal nerve abnormalities, depression, and low quality of life.

PURPOSE: To evaluate the quality of life (QoL), mental health conditions and corneal morphology in neuropathic corneal pain (NCP) subjects without a significant ocular surface disease. METHODS: A composite questionnaire was administered to 228 consecutive subjects, assessing the pain intensity, duration, and quality using a modified version of the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) and Pain Detect (PD) questionnaires. Subjects diagnosed with possible central NCP and two sub-groups of patients diagnosed with peripheral ocular pain completed an additional battery of mental health questionnaires and were examined by In Vivo Confocal Microscopy (IVCM). RESULTS: Of the 76 subjects that reported chronic ocular pain (duration >1 month), 53 were classified with probable NCP. Nine subjects without signs that justify the pain and non-responding to topical anaesthesia, were considered affected by central NCP. In these patients, a significant negative correlation was found between the presence pain and the mental component of the QoL (R2 = 0.733), and a positive correlation between the severity of pain the presence post-traumatic stress disorder (R2 = 0.83) and depression (R2 = 0.93). Although neuromas and sprouting had higher frequency in the central NCP group compared the control groups, these differences was not statistically different. CONCLUSIONS: The assessment of ocular pain characteristics using multiple questionnaires and IVCM may help to recognize differences between nociceptive and neuropathic pain. An association between pain intensity and mental health condition may guide the therapeutical choices.

Cornea verticillata in Fabry disease: a comparative study between slit-lamp examination and in vivo corneal confocal microscopy.

PURPOSE: To compare the diagnostic power of slit-lamp examination with the in vivo corneal confocal microscopy (IVCM) as the gold standard in assessing the presence of corneal epithelial deposits in patients with Fabry disease (FD). METHODS: Fourteen patients with FD (4 males, 10 females; mean age, 46.8 years) and eight healthy controls (4 males, 4 females; mean age, 36.75 years) were included. All subjects underwent slit-lamp examination and IVCM of both central and peripheral corneal quadrants with the Heidelberg Retina Tomograph-III in combination with the Rostock Cornea Module. RESULTS: In patients with FD, 9 of 28 eyes (32%) showed the presence of cornea verticillata at the slit-lamp examination and 25 eyes (89%) showed the presence of epithelial hyper-reflective deposits at the IVCM. Of the 19 eyes negative at the slit-lamp examination, 16 eyes showed the presence of epithelial deposits at the IVCM. Compared with controls, patients with FD had a significantly reduced number, density and length of nerve fibres at the level of corneal sub-basal nerve plexus, but a significantly higher grade of fibres tortuosity. CONCLUSIONS: The slit-lamp examination has a limited diagnostic power in the detection of epithelial deposits in patients with FD when compared with the IVCM. In fact, the slit-lamp examination suffers from a high number of false negative results and, consequently, from a low negative predictive value (16%). IVCM allows the detection of corneal microstructural changes in patients with FD and may represent a reliable tool for the early diagnosis and follow-up of the disease.

Mitomycin C-assisted photorefractive keratectomy in high myopia: a long-term safety study.

PURPOSE: To evaluate the long-term corneal safety of topical mitomycin C (MMC) used during photorefractive keratectomy to prevent haze formation in highly myopic eyes. METHODS: Twenty-eight patients with bilateral high myopia underwent photorefractive keratectomy. One eye was randomly assigned to intraoperative 0.02% MMC and the fellow eye to conventional treatment. Each eye was checked at baseline and at 5 years after surgery using in vivo corneal confocal microscopy. RESULTS: At baseline, the endothelial cell density was 2970 ± 295 cells per square millimeter in the MMC-treated eyes and 2839 ± 323 cells per square millimeter in the control eyes. At 5 years, it was 2803 ± 307 and 2780 ± 264 cells per square millimeter, respectively (P = 0.27). The number of corneal nerve fibers was 3.9 ± 1.6 in the MMC-treated eyes and 4.4 ± 1.3 in the control eyes. At 5 years, it was 3.0 ± 1.6 and 2.7 ± 1.3, respectively (P = 0.15). The density of corneal nerves was 9600 ± 2915 µm/mm(2) in the MMC-treated eyes and 11,352 ± 3898 µm/mm(2) in the control eyes. At 5 years, the density was higher in the MMC-treated eyes (6790 ± 2447 µm/mm(2)) than in the control eyes (6024 ± 2977 µm/mm(2)) (P = 0.003). The number of nerve beadings at baseline was 12.9 ± 1.7/100 µm in the MMC-treated eyes and 12.3 ± 2.0/100 µm in the control eyes. At 5 years, it was 9.9 ± 2.6/100 and 9.4 ± 2.9/100 µm, respectively (P = 1.00). At 5 years, corneal nerve branching and tortuosity were similar in the 2 groups (P = 0.88 and 0.54, respectively). Epithelium thickness remained statistically unchanged (P = 0.69). CONCLUSIONS: Intraoperative use of topical 0.02% MMC compared with standard treatment does not induce significant long-term corneal changes, as assessed by in vivo corneal confocal microscopy.

Topical 1% 5-fluorouracil in ocular surface squamous neoplasia: a long-term safety study.

BACKGROUND/AIMS: The aim of this study was to evaluate the long-term corneal toxicity of topical chemotherapy with 1% 5-fluorouracil (5-FU) as a sole or adjuvant treatment of ocular surface squamous neoplasia (OSSN). METHODS: Forty-one consecutive cases of OSSN were included in this prospective study. Patients underwent topical chemotherapy with 1% 5-FU four times/day for 4 weeks (one course). Adjunctive courses were repeated until clinical and cytological tumour regression. Clinical confocal microscopy was used to check for 5-FU long-term corneal toxicity. RESULTS: Mean follow-up was 89.7±14.4 months (range 63-122 months). Twenty-two patients (53.7%) underwent topical 5-FU as a sole treatment, and 19 patients (46.3%) as adjuvant and/or debulking therapy. The mean number of 5-FU cycles was 1.9 (range 1-5 cycles). Three tumours (7.3%) treated with 5-FU alone recurred during follow-up. Recurrences were successfully treated with additional 5-FU courses. Clinical confocal microscopy showed no long-term difference between the treated eye and fellow (control) eye in: endothelial cells count, pleomorphism and polymegatism, anterior stromal keratocyte density, sub-basal nerve plexus fibre number, density, and beadings and central cornea epithelium thickness (p=NS). CONCLUSION: Topical 5-FU, as a sole or combined therapy, must be considered a long-term safe and effective treatment for patients affected by OSSN.

Comparación de la morbimortalidad entre recién nacidos prematuros pequeños y adecuados para la edad gestacional de acuerdo a estándares de crecimiento neonatales y fraccionales / Comparison of the morbimortality between small premature newborns and adequate for gestational age in agreement to standards of neonatal and fractional growth

Objetivo: Evaluar eventos neonatales adversos en recién nacidos prematuros ≤ 34 semanas pequeños y adecuados para su edad gestacional de acuerdo a estándares de crecimiento neonatales y fraccionales. Material y métodos: Estudio de una cohorte hospitalaria de recién nacidos prematuros con una edad gestacional ≤ 34 semanas, admitidos a la unidad de cuidados intensivos neonatales, desde el 1/1/98 hasta el 31/12/08. Las variables estudiadas fueron: mortalidad, enfermedad de membrana hialina, displasia broncopulmonar, hemorragia intraventricular (todos los grados), enterocolitis necrotizante y retinopatía del prematuro (todos los estadios). Las mismas se analizaron en un modelo de riesgo estimado mediante el cálculo del OR con IC95 por ciento. Resultados: La prevalencia de recién nacidos pequeños para la edad gestacional de acuerdo a los estándares de crecimiento neonatales fue de 56/218 (25,7 por ciento IC95 por ciento 19,6 a 31,7), mientras que de acuerdo a los estándares fraccionales fue de 78/218 (35,8 por ciento IC95 por ciento 29,2 - 42,4, p = 0,029). Cuando los recién nacidos prematuros pequeños para la edad gestacional fueron comparados a los adecuados para la edad gestacional de acuerdo a los estándares fraccionales presentaron un riesgo significativamente aumentado para mortalidad (OR 3 IC95 por ciento 1,2-7,7); enfermedad de membrana hialina (OR 2,7 IC95 por ciento 1,1-6,9), displasia broncopulmonar (OR 1,9 IC95 por ciento 1,1-3,7) y hemorragia intraventricular (OR 3,8 IC95 por ciento 2-6,9), mientras que el cotejo con estándares neonatales no arrojó diferencias. Conclusión: Las curvas fraccionales identificaron un aumento significativo en el riesgo de eventos adversos en prematuros pequeños para la edad gestacional, en comparación con las curvas neonatales.

Objective: To evaluate neonatal and fractional growth standards in determining charges of mortality and morbidity between premature small for gestational age infants. Material and methods: Hospital-based cohort study of singleton newborns of ≤ 34 weeks gestational age admitted to neonatal intensive care unit between January 1, 1998 and December 31, 2008. Outcome variables include: mortality, hyaline membrane disease, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis and retinopathy of prematurity. For each variable bivariate analysis were performed (OR CI95 per cent). Results: The prevalence of small for gestational age according to neonatal growth standards was 56/218 (25.7 per cent, CI95 per cent 19.6-31.7) and according to fractional standards was 78/218 (35.8 per cent CI95 per cent 29.2-42.4, p= 0.029). According to fractional growth standards, when small for gestational age was compared with adequate for gestational age, it was associated with an increased risk of mortality (OR 3 CI95 per cent 1.2-7.7), hyaline membrane disease (OR 2, 7, CI95 per cent 1.1-6.9), bronchopulmonary dysplasia (OR 1.9 CI 95 per cent 1.1-3.7) and intraventricular hemorrhage (OR 3.8 CI95 per cent 2-6.9). Neonatal growth standard was not associated with an increased risk of mortality or morbidity. Conclusions: Fractional growth standards identifying an increased risk of adverse neonatal outcomes between preterm SGA infants, than neonatal standards.