Pediatric ocular surface disease associated with suspected abuse.

PURPOSE: To describe one of the largest case series of children whose ocular surface disease was strongly suspicious for nonaccidental injury (NAI). METHODS: This multicenter retrospective case series includes 4 patients whose presentations were concerning for anterior segment NAI. The history, examination, treatment, and outcomes of these patients is presented, along with a brief review of case reports in the literature. RESULTS: A broad spectrum of anterior segment findings was noted in our case series and in cases previously reported in the literature. NAI appears to be associated with bilateral and recurrent disease as well as improvement during hospitalization that is better than initially expected. CONCLUSIONS: Ocular surface NAI is a diagnosis of exclusion and necessitates a thorough history and examination. Clinician concern for ocular NAI should prompt examination or referral for signs of other bodily injuries, especially in young children. Siblings of patients who have received the diagnosis of NAI may also be at risk.

Dissection Versus Prosection: a Comparison of Laboratory Practical Examinations.

There is insufficient evidence supporting complete dissection as essential for medical student education. Due to physical constraints, we employed a hybrid teaching method. Gross anatomy practical examinations from two medical student classes were analyzed to determine performance on dissected versus student-prosected material. Overall, student performance on questions pertaining to personally dissected material was similar to performance on questions learned by studying student-prosected material. We found dissection time can be reduced without impacting medical student examination performance.

BB Gun-Related Open Globe Injuries.

PURPOSE: To describe the characteristics and outcomes of patients treated for BB and pellet gun-related open globe injuries. DESIGN: Retrospective case series. PARTICIPANTS: Patients presenting to a tertiary care trauma center with open globes secondary to BB or pellet gun injury from January 2002 to November 2017. METHODS: A retrospective chart review was conducted of all patients presenting with open globe injuries from January 2002 to November 2017. Charts were reviewed to isolate the mechanism of injury related to BB or pellet guns. Demographic data, injury type, presenting clinical examination findings, visual acuity (VA), secondary ocular complications, necessary surgical procedures and long-term outcome data were recorded. Additionally, the ocular trauma score (OTS) was calculated for all patients who had documented VA on presentation. MAIN OUTCOME MEASURE: Final VA. RESULTS: During the study period, 681 open globe injuries were identified, 16 of which met inclusion criteria. Fourteen cases were due to injury from a BB gun and 2 were due to a pellet gun. Fourteen of the 16 patients (88%) were males. The average age of patients at time of presentation was 14±6.4 years (range, 4-28 years). Common presenting complications included hyphema, traumatic cataract, and retinal detachment. Twelve of the 16 patients required at least one additional surgery after open globe repair. Fifteen (94%) patients had hand motion-only or worse vision at time of final presentation. Eight patients had no light perception vision in the injured eye at final follow-up. CONCLUSIONS: Open globe injuries related to BB or pellet guns result in devastating visual outcomes. They are often associated with multiple complications and the need for additional surgeries. Modern surgical techniques can increase the rate of globe salvage although final vision remains poor. The study findings highlight the risks associated with widely available BB and pellet guns and underscore the importance of eye protection in this setting.

Evidence of early ultrastructural photoreceptor abnormalities in light-induced retinal degeneration using spectral domain optical coherence tomography.

BACKGROUND: To study spatiotemporal in vivo changes in retinal morphology and quantify thickness of retinal layers in a mouse model of light-induced retinal degeneration using spectral domain optical coherence tomography (SD-OCT). METHODS: BALB/c mice were exposed to 5000 lux of constant light for 3 h. SD-OCT images were taken 3 h, 24 h, 3 days, 1 week and 1 month after light exposure and were compared with histology at the same time points. SD-OCT images were also taken at 0, 1 and 2 h after light exposure in order to analyse retinal changes at the earliest time points. The thickness of retinal layers was measured using the Bioptigen software InVivoVue Diver. RESULTS: SD-OCT demonstrated progressive outer retinal thinning. 3 h after light exposure, the outer nuclear layer converted from hyporeflective to hyper-reflective. At 24 h, outer retinal bands and nuclear layer demonstrated similar levels of hyper-reflectivity. Significant variations in outer retinal thickness, vitreous opacities and retinal detachments occurred within days of injury. Thinning of the retina was observed at 1 month after injury. It was also determined that outer nuclear layer changes precede photoreceptor segment structure disintegration and the greatest change in segment structure occurs between 1 and 2 h after light exposure. CONCLUSIONS: Longitudinal SD-OCT reveals intraretinal changes that cannot be observed by histopathology at early time points in the light injury model.

Cell-cell interaction with APC, not IL-23, is required for naive CD4 cells to acquire pathogenicity during Th17 lineage commitment.

Subpopulations of pathogenic or nonpathogenic Th17 cells were reported to develop when presensitized CD4 cells were activated with their target Ag during polarization by either IL-23 or IL-6 and TGF-ß, respectively. In this study, we generated two Th17 subpopulations by using a system in which naive CD4 cells from TCR transgenic mice specific to hen egg lysozyme (HEL) are polarized with IL-6/TGF-ß and, concurrently, are activated either with HEL presented by APCs, or with anti-CD3/CD28 Abs. Only the former cells were pathogenic, inducing inflammation in eyes expressing HEL. Naive CD4 cells activated by the anti-CD3/CD28 Abs acquired pathogenicity, however, when cocultured with HEL/APC. Importantly, the naive CD4 cells did not acquire pathogenicity when cocultured with APCs stimulated with LPS or when separated from the HEL-presenting cells by a semipermeable membrane. Unlike with presensitized Th17, soluble IL-23 does not participate in pathogenicity acquisition by naive CD4 cells; no pathogenicity was induced by adding IL-23 to cultures activated with anti-CD3/CD28 Abs. Furthermore, Abs against IL-23 or IL-23R did not inhibit acquisition of pathogenicity in cultures of naive CD4 cells activated by HEL/APC. Our data thus show that, unlike presensitized CD4 cells, naive CD4 cells polarized toward Th17 phenotype acquire pathogenicity only by direct interaction with APCs presenting the Ag, with no apparent involvement of soluble IL-23. We suggest that the Th17 lymphocytes derived from naive CD4 cells participate in pathogenic and other immune processes, along with the IL-23-dependent Th17 cells.

Antigen-specific Th9 cells exhibit uniqueness in their kinetics of cytokine production and short retention at the inflammatory site.

Recently reported lines of Th9 cells, producing IL-9 and IL-10, were generated by polarization with IL-4 and TGF-ß and activation with Abs against CD3 and CD28. In this paper, we analyzed features of Th9 lines similarly polarized but activated by the "natural mode" (i.e., exposure of CD4 cells to their target Ag, hen egg lysozyme [HEL] and APCs). Main observations are the following: 1) both IL-9 and IL-10 were expressed by the line cells, but with strikingly different kinetics, with IL-9 being produced rapidly, reaching a peak on day 3 in culture and declining sharply thereafter, whereas IL-10 production increased gradually, resembling IL-4 and IL-17 production by their corresponding lineage cells; 2) reactivation of Th9, following expansion, triggered faster and higher production of both IL-9 and IL-10; 3) incubating Th9 cells in polarizing media specific for other phenotypes stimulated moderate levels of phenotype switching to Th1 or Th17 but a massive switching to Th2; 4) Th9 cells induced moderate inflammation in HEL-expressing recipient eyes but only when producing high levels of IL-9; and 5) IL-9-producing donor cells were detected in the blood of Th9 recipients but not in their inflamed eyes, suggesting that similar to findings in culture, exposure to HEL in these eyes arrested the IL-9 production in Th9 cells. Collectively, these data provide new information concerning Th9 cells and reveal their uniqueness, in particular with regard to the unusual production kinetics of IL-9 and the short retention of these cells in affected target tissues.