What empiric treatment should be given for suspected bacterial keratitis in Northern Italy?

There is a lack of epidemiological studies reporting bacteria profiles, susceptibility, and suggested empiric (first line) treatment in Northern Italy. Our internal audit of corneal scraping for microbial keratitis at University of Brescia reports 116 bacterial strains isolated between January 1, 2013, and December 31, 2020. All cases had at least an epithelial defect of 1 mm in diameter. 36.2% (42) were Gram-positive, while 63.7% (74) Gram negative. In our results Gram-negatives are sensitive to ciprofloxacin in 94.5% and Pseudomonas in 95%. Grampositives are sensitive to teicoplanin in 91,1%. Those data may help to establish empiric treatment in case of bacterial keratitis.

Green Tea Catechins Attenuate Human Primary Pterygium Cell Survival and Migration Via Modulation of ERK p42/p44 and p38 Pathways.

Pterygium belongs to an ocular surface disease with triangular-shaped hyperplastic growth, characterized by conjunctivalization, inflammation, and connective tissue remodeling. We previously demonstrated neoplastic-like properties of pterygium cells. Green tea catechin, (-)-epigallocatechin gallate (EGCG), has been shown to possess antitumorigenic properties; herein, we aimed to determine the effects of green tea catechins on human primary pterygium cell survival and migration and compared to that on patients' conjunctival cells. Both human primary pterygium and conjunctival cells expressed EGCG receptor, the 67 kDa laminin receptor. Seven-day treatment of green tea extract (Theaphenon E; 16.25 µg/mL) and EGCG (25 µM) attenuated pterygium cell proliferation by 16.78% (p < 0.001) and 24.09% (p < 0.001) respectively, without significantly influencing conjunctival cells. Moreover, green tea extract (16.25 µg/mL) and EGCG (25 µM) treatments also hindered pterygium cell migration by 35.22% (p < 0.001) and 25.20% (p = 0.019), respectively, but not conjunctival cells. Yet, green tea extract and EGCG treatments did not significantly induce pterygium cell apoptosis. Furthermore, green tea extract and EGCG treatments significantly increased the phosphorylation of p38 protein but reduced the phosphorylation of p42/p44 protein in pterygium cells. In summary, this study revealed that green tea extract and EGCG attenuated human primary pterygium cell survival and migration in vitro without damaging conjunctival cells, suggesting a novel potential therapeutic approach for primary pterygium treatment.

Periorbital ecchymosis and subconjunctival hemorrhage due to leech therapy for headache / Equimose periorbital e hemorragia subconjuntival devido à terapia com sanguessugas para dor de cabeça

ABSTRACT A 62-year-old woman was admitted to our clinic with the complaints of periorbital ecchymosis and subconjunctival hemorrhage that are visible, especially on the right eye. We noted that her complaints began the day after she underwent leech therapy on the glabella area for headache. On the glabella, 2 leech bites were observed close to the right side. Examination revealed ecchymosis on the bilateral eyelids and subconjunctival hemorrhage on the inferolateral and medial limbus on the right eye. No treatment was initiated, rather control measures were recommended. The follow-up after 1 month revealed that the patient's complaints had disappeared.(AU)

RESUMO Uma paciente de 62 anos procurou nosso ambulatório com queixas de equimose periorbital e hemorragia subconjuntival, visíveis principalmente no olho direito. Descobrimos que suas queixas começaram no dia seguinte a um tratamento para dor de cabeça com sanguessugas na área da glabela. Na glabela, 2 mordidas de sanguessuga foram encontradas próximas ao lado direito. Durante os exames da paciente, foram detectadas equimoses nas pálpebras bilaterais e hemorragia subconjuntival no limbo ínfero lateral e medial do olho direito. Nenhum tratamento foi iniciado, sendo recomendado apenas controle. No acompanhamento, observou-se que as queixas da paciente desapareceram em cerca de um mês.(AU)

Effect of long-term topical administration of prostaglandins on bulbar conjunctival thickness in rabbits / 中华实验眼科杂志

Objective:To investigate the effect of long-term application of prostaglandin analog drops on bulbar conjunctival thickness in rabbits.Methods:Twenty-four healthy New Zealand white rabbits were randomly divided into latanoprost group, carteolol group and blank control group using the random number table method, with 8 rabbits in each group.The left eyes of rabbits were taken as experimental eyes.The rabbits in the latanoprost group and carteolol group were given latanoprost eye drops or carteolol eye drops once a day for 2 months according to grouping.The bulbar conjunctival thickness of left eyes of the latanoprost group and carteolol group were measured by optical coherence tomography (OCT) at baseline and two months after administration, respectively.The conjunctival tissue of the three groups were extracted to investigate the protein and mRNA expression level of matrix metalloproteinases-1 (MMP-1) and MMP-3 by Western blot and real-time fluorescence quantitative polymerase chain reaction (PCR). The study protocol was approved by an Ethics Committee of Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (No.2017-0014). The use and care of the experimental animals complied with the ARVO Statement.Results:In the latanoprost group, the conjunctival thickness was significantly reduced from baseline (178.88±5.23)μm to (124.19±11.29)μm at 2 months after administration ( P<0.01). In the carteolol group, there existed no significant difference in the conjunctival thickness between baseline (184.94±11.85)μm and (183.31±8.71)μm at 2 months after administration ( P>0.05). The conjunctival thickness at 2 months after administration of the latanoprost group was significantly thinner than that of the carteolol group ( P<0.01). The protein and mRNA expression levels of MMP-1 and MMP-3 in conjunctival tissue of the latanoprost group were significantly higher than those of the blank control group and carteolol group (all at P<0.01). Conclusions:The long-term topical use of prostaglandin analog drops can significantly reduce the bulbar conjunctival thickness in rabbits.The mechanism may be related to the elevated expression levels of MMP-1 and MMP-3 in the bulbar conjunctival tissue.

Reliability of Conjunctival Biopsy for Diagnosis of Ocular Mucous Membrane Pemphigoid: Redetermination of the Standard for Diagnosis and Outcomes of Previously Biopsy-Negative Patients.

Purpose: To demonstrate the reliability of conjunctival biopsy analyzed by direct immunofluorescence (DIF) and supplemented with avidin-biotin complex immunoperoxidase (ABC) in diagnosing oMMP, and report therapy response in biopsy-positive patients, particularly when previously biopsy-negative elsewhere.Methods: Retrospective outcomes review of 136 consecutive patients after conjunctival biopsy for suspected oMMP.Results: Among 136 patients, 66% were diagnosed with oMMP by DIF and 13% via supplemental ABC immunoperoxidase. Sensitivity increased from 79.6% with DIF to 95.6% with supplemental ABC. Among 57 biopsy-positive patients, 77% were in remission at 1-year follow-up and 88% after 2 years. Of 34 previous biopsy-negative but now biopsy-positive patients with a 2-year follow-up, 91% achieved remission, including all 16 diagnosed via DIF and ABC.Conclusion: Conjunctival biopsy analyzed by histopathology and DIF supplemented by ABC has high reliability for diagnosing oMMP and is a useful tool to use before starting long-term immunomodulatory therapy in a patient with suspected oMMP.

Povidone iodine treatment is deleterious to human ocular surface conjunctival cells in culture.

OBJECTIVE: To determine the effect of povidone iodine (PI), an antiseptic commonly used prior to ocular surgery, on viability of mixed populations of conjunctival stratified squamous and goblet cells, purified conjunctival goblet cells and purified conjunctival stromal fibroblasts in primary culture. METHODS AND ANALYSIS: Mixed population of epithelial cells (stratified squamous and goblet cells), goblet cells and fibroblasts were grown in culture from pieces of human conjunctiva using either supplemented DMEM/F12 or RPMI. Cell type was evaluated by immunofluorescence microscopy. Cells were treated for 5 min with phosphate-buffered saline (PBS); 0.25%, 2.5%, 5% or 10% PI in PBS; or a positive control of 30% H2O2. Cell viability was determined using Alamar Blue fluorescence and a live/dead kit using calcein/AM and ethidium homodimer-1 (EH-1). RESULTS: Mixed populations of epithelial cells, goblet cells and fibroblasts were characterised by immunofluorescence microscopy. As determined with Alamar Blue fluorescence, all concentrations of PI significantly decreased the number of cells from all three preparation types compared with PBS. As determined by calcein/EH-1 viability test, mixed populations of cells and fibroblasts were less sensitive to PI treatment than goblet cells. All concentrations of PI, except for 0.25% used with goblet cells, substantially increased the number of dead cells for all cell populations. The H2O2 control also significantly decreased the number and viability of all three types of cells in both tests. CONCLUSION: We conclude that PI, which is commonly used prior to ocular surgeries, is detrimental to human conjunctival stratified squamous cells, goblet cells and fibroblasts in culture.

Effects of Qi Jing Mingmu decoction combined with artificial tears on the clinical results and cell aging of conjunctivochalasis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the effects of Qi Jing Mingmu decoction combined with artificial tears on the clinical results and cell aging of conjunctivochalasis. <p>METHODS: Forty cases(80 eyes)of grade II-Ⅳ CCH with liver-kidney Yin deficiency were randomly divided into two groups: combined treatment group and artificial tears group, which were treated with Qi Jing Mingmu decoction combined with artificial tears and simple artificial tears respectively. The international ocular surface disease index(OSDI), tear break-up time(BUT)and Schirmer Ⅰ test(SⅠt)were observed and the clinical effects were compared after 3mo treatment. For CCH patients with grade III or above, followed up for 3mo or more and willing to operate, the loose conjunctival tissue was removed and the cell aging related β-gal staining was performed on frozen sections. The results were statistically analyzed. <p>RESULTS: The OSDI score(14.53±2.68), BUT 9.25±3.02s and SⅠt(8.95±3.57mm/5min)of combined treatment group were significantly better than those of artificial tears group after 3mo treatment(all <i>P</i><0.05). After drug treatment, 7 cases(7 eyes)in artificial tears group and 4 cases(4 eyes)in combined treatment group of CCH patients were treated by operation. The positive rate of aging cells in combined treatment group was significantly lower than that in artificial tears group(16.00±7.84 <i>vs </i>39.00±14.09, <i>P</i>=0.013).<p>CONCLUSION: Qi Jing Mingmu decoction combined with artificial tears to treat CCH is more effective than simple artificial tears in relieving ocular symptoms, improving tear film and promoting tear secretion. Combined treatment can also reduce the cell aging in CCH, which can be used as a safe and effective treatment method in addition to surgical operation.

Effects of Qi Jing Mingmu decoction combined with artificial tears on the clinical results and cell aging of conjunctivochalasis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the effects of Qi Jing Mingmu decoction combined with artificial tears on the clinical results and cell aging of conjunctivochalasis. <p>METHODS: Forty cases(80 eyes)of grade II-Ⅳ CCH with liver-kidney Yin deficiency were randomly divided into two groups: combined treatment group and artificial tears group, which were treated with Qi Jing Mingmu decoction combined with artificial tears and simple artificial tears respectively. The international ocular surface disease index(OSDI), tear break-up time(BUT)and Schirmer Ⅰ test(SⅠt)were observed and the clinical effects were compared after 3mo treatment. For CCH patients with grade III or above, followed up for 3mo or more and willing to operate, the loose conjunctival tissue was removed and the cell aging related β-gal staining was performed on frozen sections. The results were statistically analyzed. <p>RESULTS: The OSDI score(14.53±2.68), BUT 9.25±3.02s and SⅠt(8.95±3.57mm/5min)of combined treatment group were significantly better than those of artificial tears group after 3mo treatment(all <i>P</i><0.05). After drug treatment, 7 cases(7 eyes)in artificial tears group and 4 cases(4 eyes)in combined treatment group of CCH patients were treated by operation. The positive rate of aging cells in combined treatment group was significantly lower than that in artificial tears group(16.00±7.84 <i>vs </i>39.00±14.09, <i>P</i>=0.013).<p>CONCLUSION: Qi Jing Mingmu decoction combined with artificial tears to treat CCH is more effective than simple artificial tears in relieving ocular symptoms, improving tear film and promoting tear secretion. Combined treatment can also reduce the cell aging in CCH, which can be used as a safe and effective treatment method in addition to surgical operation.

A Mechanism Study of Electroacupuncture for Dry Eye Syndrome by Targeting Conjunctival Cytokine Expressions.

Aim: To discuss the immunological mechanism in electroacupuncture (EA) treatment of dry eye syndrome (DES) by targeting the changes in conjunctival cytokine expression profile.Method: Eligible DES patients were randomized into an EA group (EAG) or an acupuncture group (AG). The ocular surface disease index (OSDI), amount of tear production, and tear film break-up time (BUT) were observed to evaluate the efficacy. Conjunctival cells were collected from both effective and invalid cases to observe the expressions of cytokines by protein microarray. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were used for functional cluster and signaling pathway analysis of the differentially expressed proteins. Enzyme-linked immunosorbent assay (ELISA) was used to verify the specific differential proteins.Result: After treatment, OSDI dropped and BUT extended in both groups, and the tear production increased only in the EAG (all P < .01). Compared with the AG, the improvement in tear production was more significant in the EAG (P < .01). There were 17 differentially expressed conjunctival cytokines between the effective and invalid cases in the EAG, and those expressed higher than the limit of detection (LOD) included monocyte chemoattractant protein 1 (MCP-1), macrophage colony-stimulating factor (M-CSF), regulated on activation in normal T-cell expressed and secreted (RANTES) and tissue inhibitor of metalloproteinases 1 (TIMP-1). GO analysis showed that the differential cytokines were mainly involved in cellular interaction, signaling pathways and reactions to stimuli. KEGG analysis revealed that the signaling pathways of these cytokines were mainly responsible for interactions between cytokines or between cytokines and their receptors, such as Jak-STAT signaling pathway, chemokine signaling pathway, and tumor necrosis factor signaling pathway.Conclusion: EA can effectively treat DES by improving the symptoms, increasing tear secretion and extending BUT, which is possibly related to its regulation on the conjunctival cytokine expressions.

Comparison among adjuvant treatments for primary pterygium: a network meta-analysis.

PURPOSE: Pterygium is a frequent ocular disease, where the major challenge is the high level of recurrence after its surgical removal. We performed a network meta-analysis to identify, among several adjuvant treatments for primary pterygium, which is the best to prevent recurrence. METHODS: A search was conducted using PubMed, Scientific Electronic Library Online, Latin American and Caribbean Centre on Health Sciences and Cochrane Eyes and Vision Group Trials Register between 1993 and 2015 for randomisedclinical trials (RCTs) comparing adjuvant treatments following primary pterygium surgery. RESULTS: 24 RCTs that studied 1815 eyes of 1668 patients were included and allowed direct and indirect comparison among 14 interventions through network meta-analysis. The rank from the best to worse treatment to prevent recurrence is: conjunctival autograft + ciclosporin 0.05% eye drops, bare sclera + intraoperativemitomycin C (MMC) <0.02%, bare sclera + beta therapy (2500 cGy single dose), conjunctival autograft + beta therapy (1000 cGy single dose), bare sclera + MMC 0.02% eye drops, conjunctival autograft, bare sclera + intraoperative MMC >0.02%, bare sclera + ciclosporin 0.05% eye drops, bare sclera + intraoperative 5-fluorouracil 5%, amniotic membrane transplantation, bare sclera + intraoperative MMC 0.02%, conjunctival autograft + bevacizumab 0.05% eye drops, bare sclera + bevacizumab 0.05% eye drops and bare sclera alone. CONCLUSION: The best adjuvant treatment to prevent recurrence after primary pterygium surgery is the association of conjunctival autograft and ciclosporin 0.05% eye drops. Bare sclera technique alone should be discontinued since it is associated with high recurrence rates.

Efficacy of eyedrops containing cross-linked hyaluronic acid and coenzyme Q10 in treating patients with mild to moderate dry eye.

PURPOSE: Dry eye disease (DED) is a common condition causing substantial burden. A randomized, controlled, single-masked study was performed in 40 patients with mild to moderate DED to evaluate the efficacy and safety of a collyrium based on crosslinked hyaluronic acid (XLHA) with coenzyme Q10 (CoQ10). METHODS: Enrolled subjects were divided into 2 groups: group A, treated with XLHA + CoQ10; and group B, treated with hyaluronic acid (HA). Eyedrops were administered 4 times daily for 3 months. The Ocular Surface Disease Index (OSDI) questionnaire, tear break-up time (TBUT), corneal and conjunctival staining, and meibomian gland assessment (MGD) were evaluated; furthermore, corneal aesthesiometry, in vivo corneal confocal microscopy, visual acuity, intraocular pressure (IOP), and fundus examination were performed. RESULTS: At the end of treatment, OSDI score significantly decreased in groups A and B (p<0.01 and p<0.05, respectively); the decrease was significantly higher in group A. Corneal staining decreased in both groups, with lower scores in group A. The MGD was significantly ameliorated in group A patients. No differences were found for corneal aesthesiometry or TBUT. Epithelial cell reflectivity was significantly reduced only in group A. For keratocytes and stromal matrix parameters, there was a significant improvement in group A. No changes were found for visual acuity, IOP, or fundus examination. CONCLUSIONS: The XLHA + CoQ10 treatment showed greater effectiveness in DED compared to HA alone, probably due to the longer permanency on ocular surface and the antioxidant activity of CoQ10. Therefore, XLHA + CoQ10 eyedrops could represent a new possibility in dry eye treatment.

Investigação oftalmológica pré-clínica do óleo essencial de Origanum vulgare L. Lamiaceae / Ophthalmological pre-clinical research about essential oil from the Origanum vulgare L. Lamiaceae

RESUMO Objetivo: Avaliar a irritação ocular aguda em coelhos, após a administração tópica de óleo essencial. Métodos: Para tanto, os animais foram divididos em três grupos, cada um com três coelhos, totalizando 6 olhos por grupo, e a diferença entre eles foi a concentração utilizada ( 1, 3 e 9%). Aplicou-se no saco conjuntival, de um dos olhos do animal, uma dose única de 0,1 ml do produto e o olho contralateral foi usado como controle. Analisou-se os efeitos causados pelo óleo essencial na conjuntiva, íris e córnea após 1, 24, 48, 72 horas e no final do sétimo dia após a aplicação tópica. As avaliações oftalmológicas foram feitas com o auxílio de um oftalmoscópio binocular indireto com e sem fluoresceína. As reações observadas foram graduadas segundo a escala de Draize. Foram realizados exames anatomopatológicos em todos os olhos estudados no final do experimento. Resultados: No grupo de animais submetidos à instilação ocular do óleo essencial a 1%, não se observou alterações. O tratamento com o óleo a 3% provocou alteração conjuntival no exame feito em 1 hora, o que foi reduzindo. A administração do óleo essencial a 9% induziu hiperemia conjuntival, não havendo qualquer alteração nos outros tempos de avaliação oftalmológica. Conclusão: A avaliação contribuiu para conhecer as alterações clínicas na superfície ocular. Desta forma, foi possível classificar o óleo a 1% como não irritante e nas concentrações de 3 e 9% como pouco irritante, tornando possível estudos clínicos, a fim de estabelecer o óleo como alternativa terapêutica em conjuntivites bacterianas.

ABSTRACT Objective: To evaluate acute eye irritation in rabbits following topical administration of essential oil. Methods: animals were divided into three groups, each containing three rabbits, with a total of 6 eyes per group. The difference between them was the concentration used (1, 3 and 9%). A single dose of 0.1 ml of the product was applied into the conjunctival sac of one eye of the animal, and the contralateral eye was used as control. The effects caused by the essential oil in the conjunctiva, iris and cornea were analyzed after 1, 24, 48 and 72 hours and at the end of the seventh day after topical application. Ophthalmologic evaluations were performed with the aid of a binocular indirect ophthalmoscope fluorescein and with and without the observed responses, before being graded according to the Draize scale. Pathological examinations were performed on all eyes studied at the end of the experiment. Results: in the group of animals subjected to the ocular instillation of 1% essential oil, there was no change. For treatment with 3% oil, conjunctival changes were found to be decreasing during the examination after 1 hour. Administration of the 9%essential oil induced conjunctival injection, without any change in the other ophthalmologic evaluation times. Conclusion: the evaluation contributed to meet the clinical changes in the ocular surface. Thus, it was possible to classify the oil at 1% as non-irritating and the concentration of 3% and 9 as mildly irritating, making it possible for clinical studies to establish the oil as an alternative therapy in bacterial conjunctivitis.

Comparison of 3 different anesthetic approaches for intravitreal injections: a prospective randomized trial / Comparação de três abordagens anestésicas diferentes para injeções intravítreas: um estudo prospectivo e randomizado

Purpose: To compare the anesthetic effectiveness of topical proparacaine drops, subconjunctival lidocaine, and 2% lidocaine gel. Methods: Ninety-two patients undergoing intravitreal injections were randomized to 1 of 3 groups: proparacaine 0.5% drops (Group Drops), proparacaine 0.5% drops plus subconjunctival lidocaine (Group SC), or 2% lidocaine gel (Group Gel). Patients were asked to score their pain experience using a visual analog scale of 0 to 10 immediately following the injections and 10 min, 1 h, 6 h, and 24 h after the injections. Patients also graded the overall injection experience as Excellent, Very Good, Fair, Poor, or Awful. The physician evaluated the patients’ eye movement during intravitreal injection on 3 levels: (0) none or minimal, (1) not compromising the injection, and (2) compromising the injection. Results: The patients in Group Drops had the worst mean pain scores during the injection and 10 min after, with the highest occurrence of movements compromising the procedure (Grade 2; 38.7%). The patients in Group SC had a higher percentage of good experiences (37.9%) but a higher incidence of chemosis (16.7%). The patients in Group Gel had similar overall pain scores to Group Drops patients but a higher incidence of keratitis (19.4%). There was no statistically significant correlation between the use of aspirin or anticoagulants and the occurrence of hyperemia or hyposphagma. Conclusion: Subconjunctival lidocaine was most effective in preventing pain and eye movements during intravitreal injections. Although 2% lidocaine gel produced a good overall experience for the patients, the incidence of keratitis was very high (19.4%). Therefore, we do not recommend 2% lidocaine gel as the first anesthetic choice for intravitreal injections. There is no evidence to suspend the use of aspirin or other anticoagulants drugs prior to intravitreal injections. .

Objetivo: Comparar a eficácia anestésica entre proparacaína tópica, lidocaína subconjuntival e lidocaína gel a 2%. Métodos: Noventa e dois pacientes em tratamento com injeções intravítreas foram randomizados para um de três grupos: proparacaína 0,5% gotas (Grupo gotas), proparacaína 0,5% gotas seguida de lidocaína subconjuntival (Grupo SC), ou lidocaína gel a 2%. (Grupo Gel). Os pacientes foram orientados a graduar a sua experiência de dor por uma escala visual analógica, numa escala de 0 a 10, imediatamente após as injeções, bem como 10 minutos, 1 hora, 6 horas e 24 horas após. Os pacientes também classificaram a experiência global de injeção como excelente, muito boa, regular, ruim ou horrível. O médico avaliou o movimento do olho do paciente durante a injeção intravítrea em três níveis: nenhuma ou mínima (0), não comprometendo a injeção (1), comprometendo a injeção (2). Resultados: Os pacientes do grupo gotas apresentaram uma graduação média de dor pior durante a injeção e 10 minutos após, com maior ocorrência de movimentos comprometendo a injeção (grau 2) (38,7%). Os pacientes do grupo SC, apresentaram maior percentual de boa experiência durante o procedimento (37,9%) e maior ocorrência de quemose (16,7%). Os pacientes do grupo Gel apresentaram escore de dor geral semelhante ao grupo Gotas e maior incidência de ceratite (19,4%). Não houve correlação estatisticamente significativa com o uso de aspirina ou anticoagulantes e a ocorrência de hiperemia ou hiposfagma. Conclusão: Lidocaína subconjuntival foi mais eficaz na prevenção da dor durante injeção intravítrea com movimentação ocular mínima. Embora os pacientes do grupo lidocaína gel a 2% tenham apresentado uma boa experiência, consideramos a incidência ceratite muito elevada (19,4%) e não recomendamos lidocaína gel a 2% como a primeira escolha como anestésico para injeções intravítreas. Não há evidência para a suspensão do uso de aspirina ou drogas anti-coagulantes em pacientes ...

Prevention of allergic conjunctivitis in mice by a rice-based edible vaccine containing modified Japanese cedar pollen allergens.

BACKGROUND/AIMS: To determine whether oral immunotherapy with transgenic rice seeds expressing hypoallergenic modified antigens suppresses cedar pollen-induced allergic conjunctivitis by eliciting immune tolerance in mice. METHODS: BALB/c mice were fed once a day for 20 days with 220 mg of transgenic rice expressing modified Japanese cedar pollen allergens Cry j 1 and Cry j 2 or with non-transgenic rice seeds as a control. They were then sensitised with two intraperitoneal injections of Japanese cedar pollen in alum before challenge twice with pollen in eye drops. Twenty-four hours after the second challenge, the conjunctiva, spleen, and blood were isolated for histological analysis, cytokine production assays, and measurement of serum immunoglobulin E concentrations, respectively. RESULTS: The numbers of eosinophils and total inflammatory cells in the conjunctiva were significantly lower in mice fed the transgenic rice than in those fed non-transgenic rice. The clinical score evaluated at 15 min after antigen challenge was also significantly lower in mice fed the transgenic rice than in those fed non-transgenic rice. The serum concentrations of both total and allergen-specific immunoglobulin E were also significantly lower in mice fed the transgenic rice. Oral vaccination with transgenic rice resulted in significant down-regulation of the allergen-induced production of interleukin (IL)-2, IL-4, IL-5, IL-12p70, interferon-γ, and IL-17A by splenocytes. CONCLUSIONS: Oral immunotherapy with transgenic rice expressing modified Japanese cedar pollen allergens suppressed pollen-induced experimental allergic conjunctivitis in mice by eliciting immune tolerance. This novel prophylactic approach is potentially safe and effective for allergen-specific oral immunotherapy in allergic conjunctivitis.

Effects of onion juice on the normal flora of eyelids and conjunctiva in an animal model.

BACKGROUND: Traditional medicine/complementary alternative medicine may suggest new ideas to modern medicine in order to face new challenges however these concepts should be acknowledged based on experimental studies. OBJECTIVES: We aimed to study the effects of onion (Allium cepa) juice on the normal flora of conjunctiva and eye lids, and to follow the histopathology changes of conjunctiva in an animal study. MATERIALS AND METHODS: Twenty-four rabbits were randomly classified into three equal groups. Groups 1, 2 and 3 received fresh red onion juice, as an eye drop, into the right eye twice daily for; one week, one month, and two months, respectively. Microbiological sampling by sterile swabs was performed before and after the intervention. Cultural characteristics, including the growth rate and the kind of organisms, are reported. At the end of the study, pathological samples were collected from the inferior fornix. RESULTS: After the intervention, the number of positive cultures in the samples, collected from both the conjunctiva and eyelid, had decreased. Group 3 demonstrated the lowest amount of growth after the administration of the onion juice and the bacterial isolation rates from each organism had decreased. All pathological samples revealed some degree of inflammation. There was no evidence of metaplasia or dysplasia. There was no significant difference between the growth rates of organisms in the experimental groups using statistical analysis. CONCLUSIONS: According to our experiment, onion has an inhibitory effect on the growth of normal eye flora; although the duration of onion juice instillation did not show any significant effect on the group results. Hence, this finding is an initiating point for further investigations into the antimicrobial properties of this herb to treat common eye infections, including conjunctivitis and blepharitis.

Diclofenac versus fluorometholone after strabismus surgery in children.

AIMS: To compare the effects of topical diclofenac sodium with those of fluorometholone on intraocular pressure (IOP) and conjunctival inflammation after strabismus surgery. METHODS: We retrospectively analysed 60 Korean children who underwent strabismus surgery for intermittent exotropia in an institutional referral centre. Patients received topical diclofenac 0.1% or fluorometholone 0.1% after surgery for up to 4 weeks. IOP, patient discomfort, conjunctival inflammation and conjunctival injection were evaluated at 1, 2, 3 and 4 weeks after surgery. RESULTS: In the fluorometholone group, 23% showed an increase of ≥10 mm Hg compared to the baseline IOP within 4 weeks of surgery. The fluorometholone group showed a significant change in IOP compared to baseline (p<0.001) at all follow-up time points, whereas the diclofenac group showed no significant increase in IOP. An increased risk of IOP elevation of ≥10 mm Hg was observed after fluorometholone use in patients under 7 years of age. There was no significant difference in patient discomfort, conjunctival inflammation or conjunctival injection between the two groups. Conjunctival injection was more pronounced with muscle resection than with recession at 1 month after surgery. CONCLUSIONS: Postoperative topical diclofenac is an excellent substitute for steroids, particularly in young children under 7 years of age.

Clinical observation on epidemic hemorrhagic conjunctivitis by optical coherence tomography / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe thickness and morphological changes of bulbar conjunctiva pre- and post epidemic hemorrhagic conjunctivitis ( EHC ) therapy by optical coherence tomography ( OCT) . METHODS: Observed morphological changes and measured the bulbar conjunctiva thicknesses of 29 cases (36 eyes) of incipient (1-2d) EHC patients, who were received and treated by department of ophthalmology, the Putuo Affiliated Hospital of Shanghai University of Traditional Chinese Medicine from May 2013 to December 2013, by OCT. Then measured the thickness again on 7, 14d after the therapy. RESULTS: Among 29 patients (36 eyes), 7d after the EHC therapy, in 27 cured eyes, the full-thickness ( before 344. 00±59. 91μm, after 230. 19±22. 16μm, t=11. 75, PCONCLUSION: The OCT is able to measure the thickness of bulbar conjunctiva in EHC patients. An significant increase was found in full, epithelial and stromal thickness of EHC patients' bulbar conjunctiva. With recovery from the disease, subepithelial fluid, interlaminar fluid and edema of the bulbar conjunctival stroma faded away firstly, which provide references for clinical therapies of the EHC.

Ocular melanoma.

Ocular melanomas comprise uveal and conjunctival sub-types, which are very different from each other. A large majority of uveal melanomas involve the choroid, with less than 10% being confined to the ciliary body and iris. They tend to metastasize haematogenously, almost always involving the liver. Therapeutic methods include various forms of radiotherapy, surgical resection and phototherapy, which are often used in combination. Conjunctival melanomas show many similarities to their cutaneous counterparts, often metastasizing by lymphatic spread. Treatment consists of excision of invasive melanoma with adjunctive radiotherapy and/or cryotherapy and topical chemotherapy for intra-epithelial disease. The management of patients with ocular melanomas demands a good understanding of the pathology of these tumours. Pathological examination of the tumour indicates the prognosis and hence the need for further investigation and treatment. The scope of the pathologist is enhanced thanks to advances in molecular biology.

A Case of Tarsal Fibroma

PURPOSE: To describe a case of tarsal fibroma in a patient with a tarsal conjunctival tumor. CASE SUMMARY: A 73-year-old male visited our clinic with sensations of irritation in his left upper eyelid that occurred one week prior. The patient did not have any evidence of external injuries, systemic inflammations, or any other specific findings except a history of hypertension. The best corrected visual acuity was 0.7 in the right and 0.8 in the left eye with normal IOP. On the slit-lamp biomicroscopic examinations, anterior segment showed no specific findings and the shapes and positions of the upper and lower eyelids were normal. Upon eversion of the upper eyelid, a definite solid 5 x 5-mm sized tumor with clear boundaries was observed in the upper tarsal conjunctiva. An excision biopsy was performed under local anesthesia. Gross examinations of the tumor revealed a 5 x 5 x 2-mm, gray, oval-shaped mass. On microscopic examinations, the tumor had minimal number of cells and was composed of dense collagens and scattered fibroblasts. Based on these findings, the patient was diagnosed with tarsal fibroma. The patient experienced no discomfort after the excision biopsy. At a one-year follow-up, there were no signs of recurrence. CONCLUSIONS: Although rare, tarsal fibroma should be considered in the differential diagnosis of solid tarsal lesions.

Flora bacteriana conjuntival após uso tópico de ciprofloxacino e gatifloxacino em cirurgia de catarata / Conjunctival bacterial flora after topical use of ciprofloxacin and gatifloxacin in cataract surgery

OBJETIVO: Avaliar alterações da flora conjuntival após uso dos colírios de ciprofloxacino e gatifloxacino 0,3 por cento na profilaxia dos pacientes submetidos à facectomia. MÉTODOS: Quarenta pacientes submetidos a facectomia foram alocados em dois grupos, conforme o colírio antibiótico utilizado: Grupo A: ciprofloxacino 0,3 por cento e Grupo B: gatifloxacino 0,3 por cento. Os pacientes usaram os colírios 1 hora antes da cirurgia e nos primeiros 14 dias pós-operatórios. Foi coletado material da conjuntiva em cinco momentos: 1 hora antes da cirurgia, sem medicações tópicas (t0); imediatamente antes da aplicação de iodopovidona (PVPI) (t1), antes do início da cirurgia, após iodopovidona (t2), 14 dias após a cirurgia (t3) e 28 dias após a cirurgia (t4). RESULTADOS: O uso de antibióticos no pré-operatório diminuiu a positividade das culturas anteriores ao uso do iodopovidona em ambos os grupos; no Grupo A esta redução não alcançou significância estatística (Grupo A - p=0,07 e Grupo B - p=0,04). A positividade das culturas foi reduzida nos dois grupos após aplicação de iodopovidona e 14 dias após a cirurgia (p<0,05). Em t4 a freqüência do Staphylococcus coagulase-negativo foi menor no grupo A quando comparado ao grupo B (p<0,05) e a sensibilidade ao ciprofloxacino em relação a t0 foi menor em todos grupos. CONCLUSÃO: O colírio de gatifloxacino aplicado 1 hora antes da cirurgia reduziu significantemente a positividade das culturas. Ambos antibióticos promoveram redução da flora quando administrados no pós-operatório.

PURPOSE: To evaluate alterations of the conjunctival flora after the use of 0.3 percent ciprofloxacin and gatifloxacin in the prophylaxis of patients undergoing cataract surgery. METHODS: 40 patients undergoing cataract surgery were distributed into two groups according to the use of antibiotic eye drops: Group A: 0.3 percent ciprofloxacin and Group B: 0.3 percent gatifloxacin. Both groups used antibiotic eye drops 1 hour before surgery and 14 days after surgery. Conjunctival material was collected at 5 time points: 1 hour before surgery, without any topical medication (t0); immediately before the application of povidone-iodine (PVPI) (t1), before the beginning of surgery, after povidone-iodine (t2), 14 days (t3) and 28 days after surgery (t4). RESULTS: Preoperative antibiotics reduced the positivity of the cultures before the use of PVPI in both groups, although in Group A this reduction was not significant (Group A - p=0.07 and Group B - p=0.04). The number of positive cultures was reduced in all groups after the use of povidone-iodine and on the 14th postoperative day (p<0.05). In t4 there was a reduction in the frequency of coagulase-negative Staphylococcus in Group A compared with Group B (p<0.05); the susceptibility to ciprofloxacin was also reduced in all groups, when compared with t0. CONCLUSIONS: Gatifloxacin eye drops applied one hour before surgery significantly reduced the number of positive conjunctival cultures. Both antibiotics reduced the conjunctival flora when administered in the postoperative period.