Tear protein analysis in patients with primary acquired nasolacrimal duct obstruction treated with lacrimal passage intubation.

PURPOSE: The pathophysiology of nasolacrimal duct obstruction (NLDO) may involve quantitative as well as qualitative changes in tears. We measured tear protein concentrations in patients with primary acquired NLDO and compared them with the tear proteins in healthy individuals and patients with dry eye disease. STUDY DESIGN: Case-control study. METHODS: Twenty-four patients diagnosed with primary acquired NLDO who underwent endoscopic lacrimal passage intubation were included in the study. Tear fluid was collected with Schirmer's test strips three times: before intubation, after intubation while the nasolacrimal tube was in place, and after extubation. At the same time, 24 age-matched normal controls and 24 patients with dry eye were selected from subjects whose tears were collected during the same study period. We measured the following components of tear fluid: total protein, lactoferrin, albumin, and interleukin 6 (IL-6) levels. RESULTS: Total proteins and albumin levels in tears of the NLDO group were significantly lower than those of the control group (P < 0.001 and P = 0.014, respectively, Mann-Whitney U test). Total proteins, albumin, and lactoferrin levels were significantly increased after extubation of nasolacrimal tube (P < 0.001, P = 0.004, and P = 0.029, respectively, Wilcoxon matched-pairs signed-rank test). There were no statistically significant differences in total protein, albumin, lactoferrin and IL-6 levels between patients with NLDO after lacrimal passage extubation and controls. CONCLUSIONS: Our study shows distinct differences in protein composition of tear fluid in NLDO eyes and demonstrates that these can be normalized by nasolacrimal tube placement.

UTILITY OF INTRAOPERATIVE OPTICAL COHERENCE TOMOGRAPHY IN ACUTE ENDOPHTHALMITIS.

PURPOSE: To evaluate the efficacy of intraoperative optical coherence tomography (OCT) during vitrectomy for acute endophthalmitis. METHODS: The intraoperative and postoperative images of an 87-year-old woman with acute endophthalmitis after uncomplicated cataract surgery were analyzed. RESULTS: At presentation, the vision of the patient was 20/2000, and the preoperative OCT was unable to obtain clear images because of vitreous opacities. Intraoperative OCT showed that the inner retinal layer was hyperreflective because of diffuse retinal edema. Cystic changes were also present in the retina. A fibrin-like epiretinal membrane that was connected to the hyperreflective inner retinal layer was detected, and the retinal microstructures were well preserved. Intravitreal injections of vancomycin and ceftazidime were given at the end of the surgery. Postoperative examination showed that the epiretinal membrane-like tissue disappeared on the OCT image 1 month after the surgery, and the vision improved to 20/30. CONCLUSION: Intraoperative OCT can be useful to examine the structural alterations of the retina in eyes with vitreous opacities that prevent preoperative OCT examinations. Evaluations of intraoperative OCT images can provide information on what surgical procedures are needed.

Tear protein analysis in presumed congenital alacrima.

OBJECTIVES: It is often hard to reach a definitive diagnosis of congenital alacrima because of the difficultly in proving the lack of lacrimal tissue. We report here the distinct tear protein profile in presumed congenital alacrima. PATIENTS AND METHODS: A 13-year-old girl with presumed congenital alacrima and 15 healthy volunteers aged 23-35 years were included in this study. Tears were collected using Schirmer strips, and tear protein analyses were performed. Tear samples were collected from the patient with alacrima before and after surgical punctal occlusion of both the upper and lower puncta, and tear protein extract was fractionated using HPLC. Lactoferrin and albumin concentrations in the tears were separately determined using ELISA. RESULTS: The chromatogram in the patient greatly differed from that in normal subjects with low concentrations of secretory IgA, lipocalin-1, and lysozyme. ELISA results indicated that the tear fluid in the patient contained a high concentration of albumin but a minimal concentration of lactoferrin. Punctal occlusion improved the ocular surface findings, but major lacrimal protein concentrations remained low and tear albumin concentrations further increased. CONCLUSION: The tear protein profile of a patient with presumed congenital alacrima greatly differed from that of normal subjects. Tear protein analysis may be useful in making a diagnosis of congenital alacrima and in assessing the efficacy and mechanism of punctal occlusion.

[Corneal astigmatism in children with congenital cataract].

PURPOSE: To investigate corneal astigmatism in children with congenital cataract before surgery. MATERIALS AND METHODS: We retrospectively reviewed the charts of 99 eyes of 62 patients (74 paired eyes and 25 single eyes) who had undergone congenital cataract surgery from March, 2000 to April, 2012. The mean age at surgery was 32.1 +/- 26.9 months. All eyes were examined using an autorefract-keratometer. Cases were divided into 3 groups according to the axis of astigmatism (with-the-rule, against-the-rule and oblique astigmatism). RESULT: The mean corneal astigmatism was 2.45 +/- 1.28 diopters (D) (range 0.25-6.87D). The prevalence of corneal astigmatism of 2.0 D or more was 65.7%. The most frequent was astigmatism with-the-rule (83.8%) (mean 2.64 +/- 1.25 D), oblique astigmatism was 11.1% (mean 1.43 +/- 0.98 D), and 5.1% of the cases had astigmatism against-the-rule (mean 1.55 +/- 1.07 D). The mean corneal astigmatism of the eye with cataract (2.46 D) was significantly higher than that of the normal eye (1.66 D) in unilateral cases. CONCLUSIONS: Children with congenital cataract had a high prevalence of large corneal astigmatism > or = 2.00D, that was generally with-the-rule. In the unilateral cataract patients, cataract eyes had higher corneal astigmatism than normal eyes.