Dry eye in rheumatoid arthritis patients under TNF-inhibitors: conjunctival goblet cell as an early ocular biomarker.

Dry eye disease (DED) is common in Rheumatoid Arthritis (RA) patients. The application of conjunctival goblet cell count as a clinical biomarker to diagnose and respond to treatment can take place in rheumatoid arthritis patients under TNF-inhibitors (TNFi) therapy. This study aimed to investigate the ocular surface parameters and the long-term effects of TNFi therapy on ocular surface features and goblet cell count of rheumatoid arthritis patients. At baseline, rheumatoid arthritis patients eligible to TNFi were compared to healthy controls (similar age/gender), regarding Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, tear break-up time test, vital dye staining of the ocular surface, and conjunctival impression cytology. DED severity grade, impression cytology score, and goblet cell count were analyzed. Rheumatoid arthritis patients were followed after three (3 M) and 12 months (12 M), during TNFi treatment. Sixteen rheumatoid arthritis patients and 24 controls were compared: a higher frequency of abnormal OSDI (68.8% vs. 16.7%, p = 0.002), Schirmer's test < 10 mm (37.5% vs. 8.3%, p = 0.042), meibomian gland dysfunction (50% vs. 8.3%, p = 0.007), abnormal impression cytology (75% vs. 8.3%, p < 0.001), and mild to moderate DED (81.3% vs. 4.2%, p < 0.001) were observed in rheumatoid arthritis patients, who also had lower goblet cell count [325 (274-707) cells/mm2 vs. 742 (562-863) cells/mm2, p = 0.004]. The presence of Meibomian gland dysfunction was associated with higher disease activity scores (p < 0.05). The prospective early observation of these patients at 3 M showed an increase improvement in tear production by Schirmer's test [13 (7.5-17.5) vs. 23.5 (16-35); p = 0.001], and an improvement in impression cytology score [1 (0.5-2) vs. 1 (0-1), p = 0.031] and in goblet cell count [325 (274-707) vs. 931 (656-1,244), p < 0.001]. Eight RA responders to TNFi were also re-evaluated at 12 M with further improvement in goblet cell count [393 (275-827) vs. 872 (502-1,185) vs. 1,079 (867-1,244), p = 0.047]. Multifactorial DED is frequent in RA patients, comprising aqueous, lipid, and mucin components. TNFi prompt improves tear production and recovers the goblet cells, which can be a biomarker of the pathological process and response to therapy in this population.

Improvement of conjunctival cytological grade and tear production in Ankylosing Spondylitis patients under TNF inhibitors: a long-term follow-up.

Dry eye disease can compromise the patient's quality of life. Few studies assessed the ocular surface (OS) in Ankylosing Spondylitis (AS) patients. This study aimed to evaluate the clinical and cytological findings of the OS in patients with AS, classify dry eye disease (DED) severity grade and conjunctival impression cytology (IC), and the effects of TNF inhibitors (TNFi) in a one-year follow-up. A baseline (BL) evaluation included 36 AS patients and 39 healthy controls. They fulfilled the Ocular Surface Index Disease questionnaire and underwent the Schirmer I test, break-up time, vital staining, and conjunctival IC. A DED severity grade, as well as IC rating, was applied. Fourteen of these patients received TNFi and analysis of ocular and systemic AS disease parameters occurred at BL and three months (3 M), and 12 months (12 M) after treatment. The AS patients presented a higher frequency of DED (p = 0.01), a worse score of severity (p = 0.001), and a higher frequency of altered IC (p = 0.007) when compared to controls. The 14 patients under TNFi presented an improvement in all the clinical disease activity parameters throughout the one-year treatment (p < 0.05) even as a concomitant increase in the Schirmer test (p = 0.04), and a significant amelioration in the altered IC to a normal IC (p = 0.006). DED is a frequent and under-diagnosed ocular disease in AS patients. The long-term parallel improvement of disease activity and OS parameters in AS patients receiving TNFi suggests that the OS can be an additional target of systemic inflammation in AS.

Sjögren's syndrome: An underdiagnosed condition in mixed connective tissue disease.

OBJECTIVE: To determine the prevalence of sicca symptoms, dry eye, and secondary Sjögren's syndrome and to evaluate the severity of dry eye in patients with mixed connective tissue disease. METHODS: In total, 44 consecutive patients with mixed connective tissue disease (Kasukawa's criteria) and 41 healthy controls underwent Schirmer's test, a tear film breakup time test, and ocular surface staining to investigate dry eye. In addition, the dry eye severity was graded. Ocular and oral symptoms were assessed using a structured questionnaire. Salivary gland scintigraphy was performed in all patients. Classification of secondary Sjögren's syndrome was assessed according to the American-European Consensus Group criteria. RESULTS: The patients and controls had comparable ages (44.7±12.4 vs. 47.2±12.2 years) and frequencies of female gender (93 vs. 95%) and Caucasian ethnicity (71.4 vs. 85%). Ocular symptoms (47.7 vs. 24.4%) and oral symptoms (52.3 vs. 9.7%) were significantly more frequent in patients than in controls. Fourteen (31.8%) patients fulfilled Sjögren's syndrome criteria, seven of whom (50%) did not have this diagnosis prior to study inclusion. A further comparison of patients with mixed connective tissue disease with or without Sjögren's syndrome revealed that the former presented significantly lower frequencies of polyarthritis and cutaneous involvement than did the patients without Sjögren's syndrome. Moderate to severe dry eye was found in 13 of 14 patients with mixed connective tissue disease and Sjögren's syndrome (92.8%). CONCLUSIONS: Sjögren's syndrome, particularly with moderate to severe dry eye, is frequent in patients with mixed connective tissue disease. These findings alert the physician regarding the importance of the appropriate diagnosis of this syndrome in such patients.

Sjogren's syndrome: An underdiagnosed condition in mixed connective tissue disease

OBJECTIVE: To determine the prevalence of sicca symptoms, dry eye, and secondary Sjögren's syndrome and to evaluate the severity of dry eye in patients with mixed connective tissue disease. METHODS: In total, 44 consecutive patients with mixed connective tissue disease (Kasukawa's criteria) and 41 healthy controls underwent Schirmer's test, a tear film breakup time test, and ocular surface staining to investigate dry eye. In addition, the dry eye severity was graded. Ocular and oral symptoms were assessed using a structured questionnaire. Salivary gland scintigraphy was performed in all patients. Classification of secondary Sjögren's syndrome was assessed according to the American-European Consensus Group criteria. RESULTS: The patients and controls had comparable ages (44.7±12.4 vs. 47.2±12.2 years) and frequencies of female gender (93 vs. 95%) and Caucasian ethnicity (71.4 vs. 85%). Ocular symptoms (47.7 vs. 24.4%) and oral symptoms (52.3 vs. 9.7%) were significantly more frequent in patients than in controls. Fourteen (31.8%) patients fulfilled Sjögren's syndrome criteria, seven of whom (50%) did not have this diagnosis prior to study inclusion. A further comparison of patients with mixed connective tissue disease with or without Sjögren's syndrome revealed that the former presented significantly lower frequencies of polyarthritis and cutaneous involvement than did the patients without Sjögren's syndrome. Moderate to severe dry eye was found in 13 of 14 patients with mixed connective tissue disease and Sjögren's syndrome (92.8%). CONCLUSIONS: Sjögren's syndrome, particularly with moderate to severe dry eye, is frequent in patients with mixed connective tissue disease. These findings alert the physician regarding the importance of the appropriate diagnosis of this syndrome in such patients. .

Alteraçöes eletrorretinográficas na Distrofia de Cones / Eletroretinogram alterations in Cone Dystrophy

Este trabalho tem como objetivo estudar as alteraçöes eletrorretinográficas na Distrofia de Cones. Trez pacientes portadores de Distrofia de Cones foram analisados no Departamento de Oftalmologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo. Dentre eles, 5 dos sexo masculino e 8 do sexo feminino. Quatro dos 13 pacientes apresentavam Distrofia Progressiva de Cones com a alteraçäo macular típica em "olho de boi". Em 9 pacientes o fundo de olho se apresentou normal ou discretamente alterado. Este estudo os considerou portadores de Acromatopsia. Foi feita uma detalhada descriçäo e análise das alteraçäo eletrorretinográficas discutindo-as e comparando-as com a literatura. A conclusäo foi que nossos achados estäo compatíveis com os já descritos na literatura...

Ferimento perfurante de globo ocular na infância / Perforating eye injuries in children

The author studied 140 cases of perforating eye injury in children up to 15 years old admitted at the Clinic Hospital of the Medical College of the University of São Paulo (Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo) from January 1989 to December 1993. These cases represent 24.71 of the total of the perforating eye injuries seen during this period, showing a ratio of 76.42 of males, a ratio of 2/1 in the group from 0 to 6 years old, 7/1 in the group from 7 to 11 years old and a ratio of 3/1 in the group from 12 to 15 years old. The most common perforating eye injuries were due to sharp objects (54.71), contusion (20), explosions (7.85) and flying objects (5.71). The relation between the severity of the injury and the prognosis is emphasized. Safety precautions should be effective in order to reduce frequence and morbidity of these perforating ocular injuries.

Efeito do maleato de timolol sobre a pressäo intra-ocular no glaucoma congênito / Timolol maleate effects on intraocular pressure in congenital glaucoma

Foram estudados 19 olhos de 11 pacientes portadores de glaucoma congênito hereditário simples, ou primário (média etária de 19 anos). Todos os olhos já haviam sido operados (no mínimo uma vez e no máximo 3 vezes)para tratamento da doença. Estavam sob uso de colírio de maleato de timolol 0,5 por um perodo näo inferior a 4 meses, prescrito em virtude de näo apresentarem pressäo intra-ocular devidamente controlada pela(s) cirurgia(s). Foram determinadas as medidas tonométricas nos horários de 8 - 11 e 14 hs. A medicaçäo ocular foi entäo suspensa por um período de 15 dias tendo após este tempo sido determinado novamente os valores da pressäo intra-ocular nos mesmos horários anteriormente considerados. Os valores tonométricos obtidos com mediçäo foram comparados com os valores sem medicaçäo. As variaçöes tonométricas percentuais também foram determinadas. observou-se diferença significativa dos valores tonométricos com medicaçäo em relaçäo aos valores sem medicaçäo, sendo mais baixos os valores obtidos sob o uso da droga. Os resultados mostraram que o maleato de timolol 0.5 pode ser pode ser efetivo em reduzir a pressäo intra-ocular no glaucoma congênito hereditário simples, com a doença näo devidamente controlada cirurgicamente.

Ferimento perfurante ocular: 400 casos admitidos na clínica oftalmológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo / Penetrating ocular injury: 400 cases admitted in the ophthalmologic clinic of the Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo

Foi realizado um estudo retrospectivo de 400 casos de ferimento perfurante ocular admitidos na Clínica Oftalmológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de janeiro de 1991 a dezembro de 1992. Houve maior incidência de ferimento perfurante no sexo masculino (79,5 por cento) e o grupo etário de 21 a 30 anos foi o mais exposto ao trauma. Os acidentes de trânsito representaram 30,8 por cento, seguidos pelos acidentes domésticos (27,8 por cento), ocupacionais (22,8 por cento), lazer e esporte (10,2 por cento) e violência (8,5 por cento). O atendimento inicial ocorreu no primeiro dia para 82,6 por cento dos casos e após o terceiro dia para 8,2 por cento dos pacientes. Os ferimentos perfurantes oculares constituíram causa importante de incapacidade visual funcional: apenas 61 de 283 olhos alcançaram acuidade visual de 20/40 ou melhor. Medidas preventivas necessitam ser tomadas para reduzir a indicência de perfurações oculares.

Carcinoma metatástico de íris: descriçäo de 2 casos / Metastic carcinoma of the iris: 2 case reports

Descrevemos 2 casos de carcinoma metastático para o segmento anterior ocular. Apesar da raridade desta patologia é importante suspeitar de tal diagnóstico ao avaliar tumoraçöes em segmento anterior e proceder a investigaçäo clínica adequada. Nos 2 casos descritos, a hipótese diagnóstica de metástase foi feita pelo exame oftalmológico. Os pacientes näo apresentavam queixa sistêmica e näo tinham o diagnóstico do tumor primário. Em um dos casos, o diagnóstico foi confirmado pela biópsia aspirativa, sugerindo ser um instrumento valioso no diagnóstico desta patologia

Fibrohistiocitoma maligno da órbita / Malignant fibrous histiocytoma of the orbit

Este trabalho relata o caso de uma paciente de 70 anos com um fibrohistiocitoma maligno da regiäo inferior da órbita, totalmente removido através de uma orbitotomia anterior. Revisamos a literatura enfatizando a raridade deste tumor. Discutimos os principais diagnósticos diferenciais e a conduta frente a este tipo de afecçäo