Comparative role of 20% cord blood serum and 20% autologous serum in dry eye associated with Hansen's disease: a tear proteomic study.

BACKGROUND: To compare the role of topically applied serum therapy with preservative-free artificial tear (AT) drops in patients with moderate to severe dry eye in Hansen's disease along with change in tear protein profile. METHODS: 144 consecutive patients were randomly divided into three groups. After a baseline examination of clinical parameters, each of the patients received designated modality of topical therapy six times a day for 6 weeks. Post-treatment documentation of clinical parameters was done at 6 weeks, and then at 12 weeks after discontinuation of topical therapy. Analysis of three tear proteins using gel electrophoresis (sodium dodecyl sulfate polyacrylamide gel electrophoresis) was done at baseline, at the first and second post-treatment visits. RESULTS: In the cord blood serum (CBS) group, except for McMonnies score and staining score, all other clinical parameters showed continued improvement in the first and second post-treatment analyses. In the autologous serum (ALS) group, all the clinical parameters except Schirmer's I showed significant improvement in the first post-treatment analysis .This was sustained at a significant level in the second analysis except for tear film break-up time (TBUT) and conjunctival impression cytology grading. In the AT group, all the parameters improved at a non-significant level except for TBUT in the first analysis. In the next analysis, apart from McMonnies score and TBUT, other clinical parameters did not improve. In the ALS and CBS groups, tear lysozyme, lactoferrin levels improved in both post-treatment measurements (statistically insignificant).Total tear protein continued to increase at statistically significant levels in the first and second post-treatment analyses in the CBS group and at a statistically insignificant level in the ALS group. In the AT group, the three tear proteins continued to decrease in both the analyses. CONCLUSIONS: In moderate to severe dry eye in Hansen's disease, serum therapy in comparison with AT drops, improves clinical parameters and causes betterment in tear protein profile. TRIAL REGISTRATION NUMBER: CTRI/2013/07/003802.

[Evaluation of the conjunctiva of leprosy patients using impression cytology].

OBJECTIVE: To evaluate ocular surface disorders (OSD) similar to cicatricial pemphigoid in leprosy patients. SUBJECT AND METHOD: Sixteen leprosy patients were examined. They were under treatment as inpatients at the Tama Zenshoen National Sanatorium, an institution for the treatment of leprosy. In addition to routine ophthalmological examinations, the patients conjunctival goblet cells were examined using impression cytology. OSD similar to ocular cicatricial pemphigoid were defined as the presence of at least two items of the following: symblepharon, cicatricial contraction of the conjunctival sac, corneal neovascularization, and palpebral entropion. RESULTS: OSD was present in 8 of the 16 patients (50%). Goblet cells were either decreased in number or absent in 7 cases(44%), and included 4 cases with OSD. Six of the 7 cases(86%) with reduced or absent goblet cells had been diagnosed as leprosy prior to 1944. CONCLUSION: Reduction or absence of goblet cells is a frequent feature in leprosy patients, particularly in longstanding ones of 56 years or more. Insufficient initial treatment appears to be a major cause of this finding.

Conjunctival biopsy in patients with leprosy.

The authors examined the eyes of 120 leprosy patients comprising of 30 cases each of tuberculoid, indeterminate, borderline and lepromatous leprosy. The investigation included biopsy of the bulbar conjunctiva on the upper temporal quadrant of the right eye. The study patients included both who were untreated, those that were being treated and those who were in observation after the end of treatment. The aim of the study was to identify the presence of M. leprae in the conjunctiva. Four such cases were found: one borderline patient with no treatment and three lepromatous patients who were being treated with MDT.

Alteraciones conjuntivales en pacientes con Lepra: estudio clínico histológico e inmunohistoquímico / Conjunctivals alterations in patients with Leprosy: histological clinical e immunohistochemical

La lepra es una infección granulomatosa crónica que afecta la inmunidad celular y puede producir lesiones oculares. Por ese motivo realizamos un estudio clínico, histológico e inmunohistoquímico prospectivo para comparar las alteraciones clínicas con la respuesta celular de los pacientes afectados. En el servicio de Oftalmología del Hospital F.A. Rísquez, fueron seleccionados cuarenta (40) pacientes portadores de lepra de diferentes grupos, según la clasificación de Ridley, a los cuales se les evaluó desde el punto de vista oftalmológico, se les realizó biopsia conjuntival para evaluar las alteraciones presentes, y estudio inmunohistoquímico para detectar y cuantificar células de Langerhans a nivel epitelial con anticuerpo monoclonal HLA-DR. Obtuvimos como resultado que la razón global de complicaciones oftalmológicas fue de 1.9 por paciente, siendo estadísticamente superior para el sexo masculino, la raza blanca, para los pacientes del polo LL para los pacientes mayores de 70 años de edad y para los que tenían mayor tiempo de evolución con la patología, no presentándose ninguna complicación en menores de 10 años de evolución a partir del diagnóstico. Desde el punto de vista histológico, todos los pacientes tenían alteraciones a nivel epitelial y estromal no específicas y no se obtuvo diferencias estadísticamente significativas entre los diferentes tipos de lepra. En el estudio inmunohistoquímico encontramos ausencia de células de Langerhans en todos los pacientes. Con esto podemos concluir que la alteración inmunológica de estos pacientes, los predispone notablemente a complicaciones de tipo ocular. No encontramos diferencias estadísticamente significativas entre los diversos tipos de lepra. La ausencia de células de Langerhans nos hace sugerir que se trate de un factor que incremente la susceptibilidad de los individuos a adquirir la enfermendad

Ocular leprosy in nine-banded armadillos following intrastromal inoculation.

Leprosy shows a higher percentage of ocular involvement than any other systemic infection. In humans, the cornea is the first ocular tissue affected. Our previous studies in armadillos with naturally acquired and experimental disseminated leprosy showed that 44% had corneal infection. Mycobacterium leprae is found in armadillo burrows in Louisiana, U.S.A., and ocular abrasions may be the portal of entry for these organisms in wild armadillos. To test the cornea as a route of infection, we injected eight armadillos intrastromally with 2 x 10(6) M. leprae in 1 microliters. Two and 4 months later, the armadillos were sacrificed and their eyes processed for light- and electron-microscopy. After 2 months, M. leprae were found in histiocytes mainly in the corneal limbus, sclera and bulbar conjunctiva. At 4 months, however, there was a visible corneal leproma in one animal. Microscopically, it was found to be a histiocytic granuloma with heavy M. leprae invasion. In addition, cells were seen in the anterior chamber. Leprosy is endemic in regions where other corneal infections which compromise the epithelial barrier property are prevalent and where leprosy bacilli are found in the environment. The entry of leprosy bacilli into the cornea may produce lesions which spread posteriorly in the eye.

Encontro de bacilos da doença de hansen na conjuntiva, corpo vítreo e retina em um olho enucleado de paciente portador da forma Virchowiana / Presence of Hansen's bacili in conjunctiva, vitreous body and retina in an eye of a patient bearing the Virchowiane form

Estudo histopatológico de um globo ocular enucleado de paciente portador da Doença de Hansen da forma Virchowiana, em atividade, no qual foi encontrada a presença de bacilos de Hansen na conjuntiva, esclera, córnea, íris, corpo ciliar, corpo vítreo e retina

Polychromatic corneal and conjunctival crystals secondary to clofazimine therapy in a leper.

A 67-year-old man had a diagnosis of dapsone-resistant lepromatous leprosy. He received clofazimine (Lamprene) at a dosage of 100 mg twice daily. After 3 years of therapy, results of slit-lamp examination disclosed myriad polychromatic crystals diffusely involving the cornea and perilimbal conjunctiva of both eyes. Thick sections (1 micron) from a conjunctival biopsy showed numerous rectangular-to-rhomboidal crystals within stromal fibroblasts and macrophages. By electron microscopy, these cells contained elongated, membrane-bound, cleft-like spaces that corresponded to the sites where crystals had been present previously. Additionally, complex lipid inclusions were observed in mesenchymal cells as well as in endothelial cells and pericytes of blood vessels. The ocular side effects of clofazimine therapy are reviewed. Clofazimine-induced keratopathy should be included in the differential diagnosis of patients with polychromatic crystalline deposits in the corneas. To the best of the authors' knowledge, this complication of clofazimine therapy has not been described previously.

Biópsia conjuntival em portadores da doença de Hansen / Conjunctival biopsy in leprosy

O autor realizou investigaçäo em 120 pacientes hansenianos, divididos igualmente entre as formas clínicas da doença, com 30 pacientes na forma Tuberculóide, 30 pacientes na forma Indeterminada, 30 pacientes na forma Dimorfa e 30 pacientes na forma Virchowiana. A investigaçäo foi feita através de biopsia da conjuntiva bulbar no quadrante temporal superior do olho direito, tanto em pacientes virgens de tratamento, como em pacientes em tratamento e em alta medicamentosa. O estudo procurou identificar a presença do M. leprae na conjuntiva desses pacientes, e conseguiu tal intento em quatro casos, um (1) na forma Dimorfa, virgem de tratamento; e três (3) casos na forma virchowiana, um (1) virgem de tratamento e dois (2) em tratamento. O autor também procurou relacionar o achado do M. leprae com o nível do Indice Baciloscópico dos pacientes, mas neste estudo näo foi possível mostrar tal relaçäo. O estudo näo demonstrou que a biópsia conjuntival näo parece ser o método ideal para a pesquisa do M. leprae no olho, mas ofereceu subsídios importantes para comprometer a conjuntiva como via muito importante na penetraçäo e disseminaçäo do M. leprae no olho.