The Evolution of Central Retinal and Choroidal Thickness in Acute Anterior Uveitic Patients with Spondyloarthropathy.

PURPOSE: To describe and correlate the degree of anterior segment inflammation with central retinal and choroidal thickness throughout the treatment period (in the course of follow-up) in the eyes affected with acute anterior uveitis in the patients with seronegative spondyloarthropathy (subgroup: ankylosing spondylitis). METHODS: Thirty eyes of 30 consecutive Caucasian patients with HLA-B27-associated acute anterior uveitis were included in this study. The flare, AC cell number, and central retinal/choroidal thickness were determined at each visit by optical coherence tomography and laser flare photometry. Treatment consisted of topical corticosteroids. Statistical analysis was performed by MathWorks Matlab software. RESULTS: In the follow-up period, central retinal thickness was increased in the first 9-10 days and then decreased until stabilization (after 5-6 weeks). The flare and AC cell number decreased rapidly at the beginning of the treatment, in the first 10 days, and thereafter, slower decrease could be observed until complete resolution of inflammation. Statistically significant, positive correlation was found between initial laser flare value and maximal central retinal thickness (r=0.881, p < 0.001). Positive correlation between flare and retinal thickening was observable throughout the treatment period. Central choroidal thickness was decreased also significantly during the follow-up (p < 0.001). CONCLUSIONS: The retina and choroid may play a biomarker function in the anterior segment inflammation of the eye in the patients with seronegative spondyloarthropathy.

The Effect of Tear Supplementation with 0.15% Preservative-Free Zinc-Hyaluronate on Ocular Surface Sensations in Patients with Dry Eye.

PURPOSE: To evaluate the effect of tear supplementation with preservative free 0.15% zinc-hyaluronate on ocular surface sensations and corneal sensitivity in dry eye patients. METHODS: Ocular surface sensations were assessed using the ocular surface disease index (OSDI) questionnaire and by recording ocular sensations during forced blinking in parallel with noninvasive tear film breakup time measurement in 20 eyes of 20 dry eye patients. Corneal sensitivity thresholds to selective stimulation of corneal mechano-, thermal- and chemical receptors were measured using the Belmonte gas esthesiometer. All baseline measurements were repeated after 1 month of treatment with 0.15% zinc-hyaluronate. RESULTS: After 1 month, a significant decrease in mean OSDI score (from 35.66 ± 12.36 to 15.03 ± 11.22; P < 0.001) and a significant improvement in tear film breakup time (from 3.83 ± 0.80 to 8.67 ± 4.50 s; P < 0.001) was observed compared to baseline. Sensory responses during the interblink period also significantly decreased after 1 month (P < 0.004). Corneal sensitivity thresholds to mechanical stimulation (90.61 ± 20.35 vs. 103.92 ± 17.97 mL/min; P < 0.025) and chemical stimulation (33.21 ± 0.51 vs. 33.58% ± 0.44% CO2; P < 0.025) significantly increased after 1 month, however sensitivity thresholds to thermal stimulation remained unchanged compared to baseline (P > 0.05). CONCLUSION: Prolonged use of 0.15% zinc-hyaluronate results in an improvement of tear film stability and a decrease of dry eye complaints. The decrease in corneal mechano-and polymodal receptor excitability suggests that zinc-hyaluronate helps to recover normal corneal sensitivity, and thus might have a beneficial additional effect on reducing ocular surface complaints in dry eye patients.

Anterior Segment Characteristics of Fuchs Uveitis Syndrome.

PURPOSE: To evaluate the differences in the biometric parameters of the anterior segment in Fuchs' uveitis syndrome (FUS). METHODS: 30 eyes of 15 consecutive patients with unilateral FUS were examined. Anterior segment parameters were measured by rotating Scheimpflug imaging camera. Central endothelial cell count was measured by noncontact specular microscopy. RESULTS: The central cornea was thinner (p < 0.001), the iridocorneal angle was significantly larger (p < 0.010), anterior chamber depth was deeper in the eyes with FUS (p < 0.006). The iris bowing was different between the affected eye and the healthy eye. The mean endothelial cell density of eyes with FUS was significantly lower than control eyes (p < 0.001). CONCLUSIONS: Scheimpflug imaging method is a useful tool to analyze the anterior segment parameters in FUS. Endothelial cell loss, as well as decreased percentage of endothelial hexagonal cells, is obtained by noncontact specular microscopy in patients with FUS.

Macular Changes Correlate with the Degree of Acute Anterior Uveitis in Patients with Spondyloarthropathy.

PURPOSE: To evaluate the correlation between anterior chamber inflammation and the central foveal thickness of the retina in a homogenous uveitic group (seronegative spondyloarthropathy (subgroup: ankylosing spondylitis)) of patients with the first acute anterior unilateral uveitic attack. METHODS: Central foveal thickness (FT) and perifoveal retinal thickness were recorded by optical coherence tomography (Optovue RTVue-100), and the difference between the two eyes was calculated. Statistical analysis was performed by Mathworks Matlab software. Anterior chamber inflammation was measured by laser flare photometry (Kowa FM-600). RESULTS: A statistically significant (p < .05) increase was found in retinal thickness in all OCT subfields in acute anterior uveitic eyes compared to healthy fellow eyes. There was a linear correlation between the degree of inflammation (laser flare photometry values) and central foveal thickness (r = .900, p < .001). CONCLUSIONS: We could demonstrate close correlation between macular thickness and inflammation in anterior uveitic patients with spondyloarthropathy.

The Effect of Tear Supplementation on Ocular Surface Sensations during the Interblink Interval in Patients with Dry Eye.

PURPOSE: To investigate the characteristics of ocular surface sensations and corneal sensitivity during the interblink interval before and after tear supplementation in dry eye patients. METHODS: Twenty subjects (41.88±14.37 years) with dry eye symptoms were included in the dry eye group. Fourteen subjects (39.13±11.27 years) without any clinical signs and/or symptoms of dry eye were included in the control group. Tear film dynamics was assessed by non-invasive tear film breakup time (NI-BUT) in parallel with continuous recordings of ocular sensations during forced blinking. Corneal sensitivity to selective stimulation of corneal mechano-, cold and chemical receptors was assessed using a gas esthesiometer. All the measurements were made before and 5 min after saline and hydroxypropyl-guar (HP-guar) drops. RESULTS: In dry eye patients the intensity of irritation increased rapidly after the last blink during forced blinking, while in controls there was no alteration in the intensity during the first 10 sec followed by an exponential increase. Irritation scores were significantly higher in dry eye patients throughout the entire interblink interval compared to controls (p<0.004). NI-BUT significantly increased after HP-guar (p = 0.003) but not after saline drops (p = 0.14). In both groups, either after saline or HP-guar the shape of symptom intensity curves remained the same with significantly lower irritation scores (p<0.004), however after HP-guar the decrease was significantly more pronounced (p<0.004). Corneal sensitivity to selective mechanical, cold and chemical stimulation decreased significantly in both groups after HP-guar (p<0.05), but not after saline drops (p>0.05). CONCLUSION: Ocular surface irritation responses due to tear film drying are considerably increased in dry eye patients compared to normal subjects. Although tear supplementation improves the protective tear film layer, and thus reduce unpleasant sensory responses, the rapid rise in discomfort is still maintained and might be responsible for the remaining complaints of dry eye patients despite the treatment.