Primary basal cell carcinoma of the caruncle: case report and review of the literature

ABSTRACT We present a rare case of primary caruncle basal cell carcinoma (BCC), a condition with limited occurrences. Our patient, an 80-year-old woman without prior ocular pathological history, presented a 2x2mm pedunculated blackish nodular lesion on the caruncle of her left eye, without local conjunctival or cutaneous involvement. Histological analysis following complete excision confirmed the presence of basal cell carcinoma within the caruncle. Over a span of 30 months, no recurrence has been observed. While scant cases are documented in the literature, we conducted a review of these instances. Despite its infrequent manifestation, this condition should be taken into account when evaluating caruncular tumors, given its tendency to invade the orbit. Complete excision with free surgical margins is the treatment of choice, and adjuvant radiotherapy or chemotherapy might be considered.

Clinical signs of trachoma and laboratory evidence of ocular Chlamydia trachomatis infection in a remote Queensland community: a serial cross-sectional study.

OBJECTIVES: To compare the findings of standard clinical assessments and of complementary clinical and laboratory methods for determining whether community-wide treatment for trachoma is warranted in a remote Queensland community. DESIGN: Three cross-sectional screening surveys, 2019-2021, complemented by laboratory pathology testing. SETTING: Small community in northwest Queensland with geographic and cultural ties to Northern Territory communities where trachoma persists. PARTICIPANTS: Children aged 1-14 years; opportunistic screening of people aged 15 years or more. MAIN OUTCOME MEASURES: Prevalence of clinical signs of trachoma, Chlamydia trachomatis infection, ocular non-chlamydial infections, and seropositivity for antibodies to the C. trachomatis Pgp3 protein. RESULTS: During the three surveys, 73 examinations of 58 children aged 1-4 years, 309 of 171 aged 5-9 years, and 142 of 105 aged 10-14 years for trachoma were undertaken, as were 171 examinations of 164 people aged 15 years or more; 691 of 695 examinations were of Aboriginal or Torres Strait Islander people (99%), 337 were of girls or young women (48%). Clinical signs consistent with trachomatous inflammation-follicular were identified in 5-9-year-old children 23 times (7%), including in eleven with non-chlamydial infections and one with a C. trachomatis infection. One child (10-14 years) met the criteria for trachomatous scarring. Two of 272 conjunctival swab samples (all ages) were polymerase chain reaction-positive for C. trachomatis (0.7%). Two of 147 people aged 15 years or more examined in 2019 had trichiasis, both aged 40 years or more. Seven of 53 children aged 1-9 years in 2019 and seven of 103 in 2021 were seropositive for anti-Pgp3 antibodies. CONCLUSIONS: Despite the prevalence of clinical signs consistent with trachomatous inflammation-follicular among 5-9-year-old children exceeding the 5% threshold for community-wide treatment, laboratory testing indicated that childhood exposure to ocular C. trachomatis is rare in this community. Laboratory testing should be integrated into Australian trachoma guidelines.

MicroRNA and Their Potential Role in Conjunctival Disorders.

MicroRNAs (miRNAs) are the small noncoding RNA molecules which regulate target gene expression posttranscriptionally. They are known to regulate key cellular processes like inflammation, cell differentiation, cell proliferation, and cell apoptosis across various ocular diseases. Due to their easier access, recent focus has been laid on the investigation of miRNA expression and their involvement in several conjunctival diseases. The aim of this narrative review is to provide understanding of the miRNAs and describe the current role of miRNAs as the mediators of the various conjunctival diseases. A literature search was made using PubMed, Scopus, and Web of Science databases for studies involving miRNAs in the conjunctival pathological conditions. Original articles in the last 10 years involving both human and animal models were included. Literature search retrieved 27 studies matching our criteria. Pertaining to the numerous literatures, there is a strong correlation between miRNA and the various pathological conditions that occur in the conjunctiva. miRNAs are involved in various physiological processes such as cell differentiation, proliferation, apoptosis, development, and inflammation by regulating various signaling pathways, genes, proteins, and mediators. Pterygium was the most studied conjunctival disease for miRNA involvement, whereas miRNA research in allergic conjunctivitis is still in its early stages. Our review provides deep insights into the various miRNAs playing an important role in the various conjunctival diseases. miRNAs do have the potential to serve as noninvasive biomarkers with diagnostic, prognostic, and therapeutic implications. However, multitudinous studies are required to validate miRNAs as the reliable biomarkers in conjunctival pathologies and its targeted therapy.

Diagnóstico diferencial en el ojo rojo / Differential diagnosis in red eye

JUSTIFICACIÓN: la actuación del farmacéutico comunitario ante el ojo rojo es parte de la práctica clínica habitual del farmacéutico comunitario. Normalmente es de etiología multifactorial, siendo la conjuntivitis (infeccionas, alérgica o irritativa), ojo seco, hemorragia ocular o blefaritis las causas más habituales. Los signos y síntomas pueden ser bastante inespecíficos por lo que el abordaje de estos pacientes puede ser complicado.OBJETIVOS: proponer un protocolo de actuación clínica en el abordaje del paciente con ojo rojo que pueda servir de herramienta al farmacéutico comunitario para mejorar su práctica clínica diaria.MÉTODOS: se formó un grupo de trabajo al que se le encargó la revisión sistemática en PubMed usando los términos "Community Pharmacy Services"[Mesh], "Pharmacies"[Mesh] "Blepharitis"[Mesh], "Eye Infections"[Mesh, ("Eyelid Diseases"[Mesh],"Conjunctival Diseases"[Mesh], "Eye Hemorrhage"[Mesh]] y revisión de guías clínicas. Se seleccionaron 62 documentos que fueron estudiados en profundidad por los autores de esta comunicación. La información extraída se resumió y adaptó para ser incluida en el nuevo protocolo.RESULTADOS: en la parte de la amnnanesis se propone preguntar, en la parte de signos y síntomas, si hay picor, si la aparición fue unilateral o bilateral, si hay secreciones, y si las hay, de qué tipo son. También se preguntará por signos sistémicos de infección como fiebre, dolor de cuerpo o estornudos. Será motivo de derivación al médico la pérdida de visión, dolor medio o severo, secreción hiperpurulenta, purulenta o acuosa, hinchazón periorbital, erupciones, exolftalmos, dolor a la palpación de globo ocular, blanqueamiento corneal por infección, edema y pupila no reactiva. Muy importante valorar la localización de la hiperemia ya que la presencia de inyección ciliar o infiltraciones también es un motivo de derivación al médico. (AU)

Diagnóstico diferencial en la blefaritis / Differential diagnosis in blepharitis

JUSTIFICACIÓN: los síntomas menores en oftalmología son habitualmente tratados por el farmacéutico comunitario. Uno de los motivos de estas consultas puede ser la inflamación de los párpados, la llamada blefaritis. La blefaritis puede ser anterior, posterior y mixta. La anterior puede ser estafilococica o seborreica y suele estar asociada a dermatitis, mientras que la posterior suele asociarse a rosácea. También hay un tipo de blefaritis que está producido por la infestación de un parásito llamado demodex. Toda esta variabilidad convierte a la blefaritis en una situación clínica de complejo abordaje.OBJETIVOS: proponer un protocolo de actuación clínica en el abordaje del paciente con blefaritis que pueda servir de herramienta al farmacéutico comunitario para mejorar su práctica clínica diaria. Métodos: Se formó un grupo de trabajo al que se le encargó la revisión sistemática en PubMed usando los términos "Community Pharmacy Services"[Mesh], "Pharmacies"[Mesh] "Blepharitis"[Mesh] y revision de guías clínicas. Se seleccionaron 37 documentos que fueron estudiados en profundidad por los autores de esta comunicación. La información extraída se resumió y adaptó para ser incluida en el nuevo protocolo.RESULTADOS: en la parte de la amnanesis es importante preguntar por los signos y síntomas específicos: presencia de conjuntivitis papilar leve, hiperemia conjuntival crónica, “collaretes”, escamas duras y costras alrededor de la base de las pestañas, cicatrización, muescas del borde palpebral, madarosis, triquiasis y poliosis, así como borde palpebral hiperémico y con grasa, escamas blandas y adherencia de las pestañas entre sí. También debemos preguntar sobre película lagrimal aceitosa y secreciones excesivas y anormales exprimibles al presionar el borde palpebral, telangiectasias en el borde posterior del párpado e incluso acumulación de espuma. (AU)

Lirentelimab for severe and chronic forms of allergic conjunctivitis.

BACKGROUND: Allergic conjunctivitis (AC) is an ocular inflammatory disease with symptoms driven by eosinophils and mast cells. Allergic comorbidities are common. Current treatments are often ineffective in severe AC and limited by potential side effects. Lirentelimab is an anti-sialic acid-binding immunoglobulin-like lectin-8 mAb that depletes eosinophils and inhibits mast cells. OBJECTIVE: We sought to determine safety and preliminary efficacy of lirentelimab in an open-label, phase 1b study. METHODS: Patients with chronic, severely symptomatic atopic keratoconjunctivitis, vernal keratoconjunctivitis, and perennial AC, and who had history of topical or systemic corticosteroid use, were enrolled to receive up to 6 monthly lirentelimab infusions (dose 1: 0.3 mg/kg, dose 2: 1 mg/kg, subsequent doses: 1 or 3 mg/kg). Changes from baseline in peripheral blood eosinophils, changes in patient-reported symptoms (measured by daily Allergic Conjunctivitis Symptom Questionnaire, including atopic comorbidities), changes in investigator-reported ocular signs and symptoms (Ocular Symptom Scores), changes in quality of life, and changes in tear cytokine and chemokine levels were assessed. RESULTS: Thirty patients were enrolled (atopic keratoconjunctivitis n = 13, vernal keratoconjunctivitis n = 1, perennial AC n = 16), 87% of whom had atopic comorbidities. After lirentelimab treatment, mean improvement was observed in Allergic Conjunctivitis Symptom Questionnaire score (-61%; 95% CI, -75% to -48%) and Ocular Symptom Scores (-53%; 95% CI, -76% to -31%), consistent across atopic keratoconjunctivitis, vernal keratoconjunctivitis, and perennial AC groups. There was substantial improvement in atopic comorbidities, with -55% (95% CI, -78% to -31%), -50% (95% CI, -82% to -19%), and -63% (95% CI, -87% and -38%) reduction in symptoms of atopic dermatitis, asthma, and rhinitis, respectively. Levels of key mediators of inflammation were reduced in patient tears after lirentelimab treatment. The most common adverse effects were mild to moderate infusion-related reactions. CONCLUSIONS: Lirentelimab was well tolerated, improved severe AC and concomitant atopic symptoms, and reduced inflammatory mediators in patient tears.

Observation on efficacy of pterygium excision combined with autologous limbal epithelial bulbar conjunctival transplantation in the treatment of patients with pterygium / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the efficacy of pterygium excision combined with autologous limbal epithelial bulbar conjunctival transplantation in the treatment of patients with pterygium. METHODS:Prospective controlled study. A total of 102 patients(102 eyes)with pterygium treated in the hospital between October 2015 and October 2019 were selected as study subjects, and they were divided into observation group and control group according to the random number table method, with 51 cases in each group. The control group was treated with pterygium excision combined with amniotic membrane transplantation, and the observation group was given pterygium excision combined with autologous limbal epithelial bulbar conjunctival transplantation. The perioperative indicators(intraoperative blood loss, surgical time, corneal epithelial repair time)and clinical efficacy at 3mo after surgery were compared between the two groups, and the disease recovery-related indicators \〖tear film break-up time(BUT), uncorrected visual acuity(UCVA), Schirmer Ⅰ test(SⅠt), corneal astigmatism degree(CAD)\〗 before and 3mo after surgery, postoperative aesthetic degree and recurrence during follow-up were recorded.RESULTS:The corneal epithelial repair time in observation group was shorter than that in control group(4.14±1.35 <i>vs</i> 4.72±1.37d,<i>P</i><0.05), while the surgical time was longer than that in control group(32.24±6.69 <i>vs</i> 29.67±5.21min,<i>P</i><0.05), and there was no statistical significance in the intraoperative blood loss between the two groups(<i>P</i>>0.05). At 3mo after surgery, there was no statistical difference in the effective rate of treatment between the two groups(86.3% <i>vs</i> 78.4%, <i>P</i>>0.05). At 3mo after surgery, the BUT, UCVA and SⅠt in the two groups were significantly enhanced compared with those before surgery(all <i>P</i><0.05), and the UCVA and SⅠt in observation group were higher than those in control group(all <i>P</i><0.05), but there was no statistical difference in the BUT between the two groups(<i>P</i>>0.05). The CAD in the two groups was significantly lower than that before surgery(<i>P</i><0.05), but the difference was not significant between the groups(<i>P</i>>0.05). At 3mo after surgery, the scores of dimensions of aesthetic scale for pterygium treatment(ocular recovery, subjective symptoms)were significantly higher in observation group than those in control group(all <i>P</i><0.05), but there were no statistical differences in the scores of cleanliness of surgical area and congestion between the two groups(all <i>P</i>>0.05). There was no statistically significant difference in recurrence rate between the two groups during follow-up(<i>P</i>>0.05).CONCLUSION: Pterygium excision combined with autologous limbal epithelial bulbar conjunctival transplantation can effectively treat pterygium and prevent recurrence, and it has faster postoperative recovery and better aesthetic degree compared to pterygium excision combined with amniotic membrane transplantation.

Conjunctival pyogenic granuloma during pregnancy / Granuloma piogênico conjuntival durante a gravidez

ABSTRACT Pyogenic granuloma is a common benign, vascular lesion of the skin and mucosa. Our case was a 34-year-old woman at 28 weeks of gestation. She presented with a complaint of a growing and occasionally bleeding mass on the left lower eyelid conjunctiva for approximately 3 months. On examination, a red, pedunculated fragile lesion on the medial lower eyelid conjunctiva was observed. Ophthalmologic examination revealed that visual acuity was 20/20 in both eyes. Anterior and posterior segment examination was normal bilaterally. The lesion was excised completely under local anesthesia and sent for pathological examination. Histopathological examination revealed multiple vascular structures with small-diameters in the fibrous stroma. Vessels showed strong CD31 expression in immunohistochemical staining. Kaposi sarcoma was excluded due to negative HHV-8 staining. These findings were diagnostic of pyogenic granuloma. The frequency of pyogenic granuloma increases during pregnancy and surgical excision is important in diagnosis and treatment of these patients. This is the first reported case of conjunctival pyogenic granuloma during pregnancy.

RESUMO O granuloma piogênico é uma lesão vascular benígna comum da pele e da mucosa. Neste caso, uma mulher de 34 anos com 28 semanas de gestação, apresentou queixa de massa em crescimento e sangramento ocasional na conjuntiva inferior da pálpebra esquerda por cerca de 3 meses. No exame, detectou-se uma lesão frágil, pedunculada vermelha na conjuntiva na porção medial da pálpebra inferior No exame oftalmológico, a acuidade visual foi 20/20 em ambos os olhos. O exame dos segmentos anterior e posterior foi normal bilateralmente. A lesão foi excisada totalmente com anestesia local e enviada para exame patológico. No exame histopatológico, múltiplas estruturas vasculares de pequeno diâmetro foram observadas no estroma fibroso. Os vasos apresentaram forte expressão de CD31 na coloração imuno-histoquímica. O sarcoma de Kaposi foi excluído devido à negatividade da coloração do HHV-8. Esses achados foram diagnósticos para granuloma piogênico. A frequência de granuloma piogênico aumenta durante a gestação e a excisão cirúrgica é importante no diagnóstico e tratamento desses pacientes. Este é o primeiro caso relatado de granuloma piogênico conjuntival ocorrido durante a gestação.

A Review of Clinical Disease Scoring Systems for Cicatricial Diseases of the Conjunctiva.

Cicatricial conjunctival diseases (CCDs), are a diverse group of ocular surface diseases characterized by chronic scarring of the conjunctiva. These diseases can cause significant ocular morbidity. They are life-long once acquired and can be debilitating, painful diseases leading to visual loss. A recent international consensus of ocular surface disease experts have placed emphasis on the need of validated clinical disease scoring systems for CCDs, important for the objective evaluation of disease severity, outcomes of therapies, and longitudinal monitoring of disease. This review aims to describe the various published clinical disease scoring systems available for CCDs and evaluates the benefits and limitations of each system. It can be used as a guide for clinicians managing patients with CCDs and for researchers evaluating potential therapies in clinical trials.

Amniotic membrane graft after excision of widespread conjunctival concretions / Enxerto de membrana amniótica após remoção de concreções conjuntivais

ABSTRACT Conjunctival concretions are single or clustered lesions frequently found on the palpebral conjunctiva. They are commonly present in older individuals, despite being rarely symptomatic. This case report describes an 83-year-old man with multiple conjunctival concretions, which were surgically treated. The patient was symptomatic on presentation and did not respond to conservative treatment. For this reason, a surgical approach was considered. After wide excision of the conjunctival lesions, a piece of amniotic membrane was fitted using fibrin glue. During follow-up, a markedly improvement in patient's symptoms was observed, along with nearly complete absence of conjunctival concretions. This is the first case report addressing extensive conjunctival concretions with a surgical approach using amniotic membrane. The authors conceived the technique described after noticing the limited clinical options in the literature. This technique was easily performed and achieved satisfactory results.

RESUMO As concreções conjuntivais representam lesões amareladas, simples ou múltiplas, frequentemente encontradas na conjuntiva palpebral. São mais prevalentes em idades avançadas e raramente sintomáticas. Este relato de caso descreve o quadro clínico de um paciente de 83 anos com múltiplas concreções conjuntivais, cirurgicamente tratadas. Por se tratar de um paciente sintomático com resposta insuficiente ao tratamento conservador, foi considerada a abordagem cirúrgica. Após remoção das lesões, foi aplicado um enxerto de membrana amniótica, adaptado com cola de fibrina. No acompanhamento pós-operatório, verificou-se melhoria significativa dos sintomas, com desaparecimento quase total das concreções conjuntivais. Este é o primeiro caso que descreve uma abordagem cirúrgica com utilização de membrana amniótica na resolução desse tipo de lesões. A técnica, de fácil execução e com resultados muito favoráveis, foi desenvolvida pelos autores após constatarem a escassez de alternativas na literatura.

The in vitro efficacy of eye drops containing a bacteriophage solution specific for Staphylococcus spp. isolated from dogs with bacterial conjunctivitis.

BACKGROUND: The purpose of the study was to evaluate the in vitro antibacterial effect of experimental eye drops with bacteriophages in elimination of Staphylococcus spp. isolated from dogs with bacterial conjunctivitis.. The bacterial material was collected from dogs with independent clinical signs of bacterial conjunctivitis. Staphylococcus spp. were identified by phenotypic and genotypic methods (MALDI-TOF MS mass spectrometry). Antibiotic resistance was determined by the disc-diffusion method. Phage activity (Plaque forming units, PFU) was determined on double-layer agar plates. Phages with lytic titres > 108 PFU were used to prepare eye drops. The stability of the antibacterial titre was evaluated for preparations stored in sealed bottles as well as after opening and reclosing. RESULTS: The tests confirmed the occurrence of Staphylococcus spp. strains as etiological agents of bacterial conjunctivitis in dogs. A high percentage of strains were resistant to more than three antibiotics. The experimental phage eye drops used in the study exhibited 100% efficacy in vitro against the tested Staphylococcus isolates. Particularly noteworthy is the long duration of activity and constant antibacterial lytic titre of ≥108 PFU/mL of two eye drop solutions, nos. 7 and 12, after the bottle had been opened (21 days) and after hermetically sealed packaging (28 days) at 4-8 °C. CONCLUSIONS: The results represent the first stage of research and require continuation in vivo. If positive effects are obtained in animals, the results can be used in applied research in humans and animals.

[Ocular manifestations and surgical treatment of the linear nevus sebaceous syndrome].

Objective: To report the clinical and pathological features and surgical treatment of the linear nevus sebaceous syndrome. Methods: It was a retrospective case series study. The clinical records of 11 patients (14 eyes) who were diagnosed as linear nevus sebaceous syndrome between April 2009 and February 2018 at Beijing Tongren Hospital were analyzed. Data collected included sex, age, clinical manifestations, disease site, pathological features, surgical treatment and therapeutic effects. Results: There were six males and five females, aged 6 months to 7 years (mean, 2.8 years). The nevus sebaceous was located at the head (9 patients), face (5 patients) and neck (3 patients). The most common ocular manifestations were blepharocoloboma (13 eyes) and external ocular mass (9 eyes). Surgical treatment was performed in 9 patients (11 eyes), including lid reconstruction in all these eyes, corneal and conjunctival mass resection in four patients (4 eyes), eyelid tumor resection in 5 patients (5 eyes), and symblepharon separation and conjunctival sac reconstruction in 3 patients (5 eyes). Pathological examinations of the external ocular, corneal and conjunctival masses (6 eyes) confirmed the diagnosis of complex choristoma. All operated patients had improved appearance. Conclusions: Linear nevus sebaceous syndrome has characteristic cutaneous lesions and ocular manifestations. Histopathologically, all epibulbar lesions prove to be complex choristomas. The appearance of patients with linear nevus sebaceous syndrome can be significantly improved by oculoplastic surgery. (Chin J Ophthalmol, 2020, 56: 846-852).

Comparação dos meios de preparação e preservação de membrana amniótica humana para uso no tratamento de doenças da superfície ocular / Comparison of the preparation and preservation techniques of amniotic membrane used in the treatment of ocular surface diseases

Resumo Atualmente a membra amniótica (MA) tem obtido importância devido à comprovada capacidade de reduzir inflamação, auxiliar a cicatrização e epitelização, possuindo propriedades antimicrobianas e antivirais, além de baixa imunogenicidade. As indicações de seu uso na oftalmologia têm aumentado muito nas duas últimas décadas. Objetivo: Descrever a estrutura básica e as propriedades biológicas da MA em relação aos componentes da sua matriz extracelular e fatores de crescimento, as consequências de diferentes técnicas empregadas na sua preservação e esterilização, métodos para remoção do epitélio e a comparação dos custos dos diferentes meios de conservação atualmente empregados. Métodos: Pesquisa nas bases de dados do Portal da Biblioteca Virtual em Saúde (BVS), Pubmed, Cochrane, Scielo e Lilacs com as palavras-chave: membrana amniótica, transplante, reconstrução da córnea, doenças da conjuntiva. Resultados: A literatura é vasta na descrição dos efeitos de diversos agentes e técnicas na preparação da MA, dentre elas sua preservação, esterilização e desepitelização. A membrana desnuda tem sido a escolha para a reconstrução da superfície ocular, pois facilita a cicatrização. Em relação aos agentes conservantes, o glicerol é o meio mais utilizado mundialmente pelo baixo custo e facilidade de manuseio. Conclusão: A comparação das diversas técnicas nos guia na elaboração de protocolos de preparo da MA para uso oftalmológico. A membrana desnuda facilita a cicatrização em relação a com células epiteliais. O glicerol é o meio de conservação mais utilizado pelo baixo custo e facilidade de manuseio.

Abstract Currently, the amniotic membrane (AM) has obtained importance due to its ability to reduce inflammation, helping in the healing and epithelialization processes, having antimicrobial and antiviral properties and low immunogenicity. Its indications in ophthalmology have increased considerably in the past two decades. Objective: To describe the basic structure and biological properties of the AM, the components of the extracellular matrix and growth factors, the consequences of different techniques used in its preservation, and sterilization methods for the epithelium removal. To compare the costs of the different preservation solutions currently employed. Study design: literature review. Methods: Research in BVS databases, PubMed, Cochrane, Scielo and Lilacs with keywords: amniotic membrane transplantation, corneal reconstruction, conjunctival diseases. Results: The literature is vast in describing the effects of different agents and techniques used in the preparation of MA, including its preservation, sterilization and desepithelization. The naked membrane is the choice to reconstruct the ocular surface, as it facilitates the healing course. Regarding the preservatives, glycerol is the most used worldwide due its low cost and easy handling. Conclusion: Comparing different techniques guides us in developing a MA preparation protocol for ophthalmic use. The naked membrane facilitates the healing process compared with the presence of epithelial cells. The glycerol is the most used preservation method because of its low cost and easy handling.

Microbiological alterations in the conjunctiva of hot tub-soaking ophthalmologists (MACHO): a randomized double-blind clinical trial.

Background: To determine if there is a difference in the quantity of microbial flora of the conjunctiva in individuals practicing head submersion ("dunk") versus no head submersion ("no-dunk") during hot tub use. Methods: In this double-blind randomized clinical trial, healthy volunteers aged ≥ 18 years were recruited. Participants were randomized to head submersion versus no head submersion during a 15-minute hot tub soak. Study personnel, masked to the dunk or no-dunk group assignment, obtained conjunctival cultures before and immediately after hot tub use. De-identified specimens were submitted to the clinical microbiology laboratory for culture and analysis. The main outcome measure was the difference in the quantity of organisms cultured from the conjunctiva before and after hot tub exposure, as determined using a defined ordinal scale. A two-tailed Student's t-test was performed to compare the total microbial colony counts between the two arms. Simpson's diversity was used to measure the changes in organism diversity between the arms. Results: Of 36 enrolled subjects, 19 were randomly assigned to the dunk and 17 were assigned to the no-dunk groups. Water samples obtained from all hot tubs were culture negative. Eleven of 19 eyes (58%) from the dunk group and eight of 17 eyes (47%) from the no-dunk group had negative conjunctival bacterial cultures before and after hot tub exposure. However, six of 19 eyes (32%) and four of 17 eyes (24%) of the dunk and no-dunk groups, respectively, were culture-positive after, but not before hot tub exposure. The quantity of organisms before and after hot tub exposure was not significantly different between the two arms (P = 0.12). However, the dunk group only showed a small increase in the quantity of organisms after as compared to before hot tub use (P = 0.03). None of the samples from subjects or hot tubs were culture-positive for Acanthamoeba. Conclusions: Head submersion in a public hot tubs during a 15-minute soak does not appear to change conjunctival flora, as determined by culture plate yield, this does not eliminate the association between hot tub use and devastating and painful corneal blindness. Therefore, our recommendation is to remove contact lenses prior to hot tub use, avoid head submersion in a hot tub, and urgently seek ophthalmological help if any eye pain and/or decrease in vision is experienced after hot tub use.

Conjunctival Microbiome-Host Responses Are Associated With Impaired Epithelial Cell Health in Both Early and Late Stages of Trachoma.

Background: Trachoma, a neglected tropical disease, is the leading infectious cause of blindness and visual impairment worldwide. Host responses to ocular chlamydial infection resulting in chronic inflammation and expansion of non-chlamydial bacteria are hypothesized risk factors for development of active trachoma and conjunctival scarring. Methods: Ocular swabs from trachoma endemic populations in The Gambia were selected from archived samples for 16S sequencing and host conjunctival gene expression. We recruited children with active trachoma and adults with conjunctival scarring, alongside corresponding matched controls. Findings: In children, active trachoma was not associated with significant changes in the ocular microbiome. Haemophilus enrichment was associated with antimicrobial responses but not linked to active trachoma. Adults with scarring trachoma had a reduced ocular bacterial diversity compared to controls, with increased relative abundance of Corynebacterium. Increased abundance of Corynebacterium in scarring disease was associated with innate immune responses to the microbiota, dominated by altered mucin expression and increased matrix adhesion. Interpretation: In the absence of current Chlamydia trachomatis infection, changes in the ocular microbiome associate with differential expression of antimicrobial and inflammatory genes that impair epithelial cell health. In scarring trachoma, expansion of non-pathogenic bacteria such as Corynebacterium and innate responses are coincident, warranting further investigation of this relationship. Comparisons between active and scarring trachoma supported the relative absence of type-2 interferon responses in scarring, whilst highlighting a common suppression of re-epithelialization with altered epithelial and bacterial adhesion, likely contributing to development of scarring pathology.

Doença do Enxerto-versus-hospedeiro ocular: Revisão / Graft-versus-Host Disease: Review

Resumo Doença do Enxerto-versus-hospedeiro (do inglês Graft-versus-Host Disease - GVHD) é uma complicação importante e com altas taxas de morbidade e mortalidade nos pacientes submetidos ao transplante alogênico de células-tronco hematopoiéticas. O acometimento ocular, denominado GVHD ocular, pode acometer todas as estruturas dos olhos, porém a unidade lacrimal (glândulas lacrimais e superfície ocular) é o principal alvo da resposta inflamatória mediada por células T doadas. O desenvolvimento de doença do olho seco grave é a principal manifestação clínica ocular, e a associação de diversas opções terapêuticas se faz necessário. O objetivo desta revisão é descrever as manifestações clínicas, os critérios diagnósticos, o impacto na qualidade de vida, o tratamento atual e as perspectivas desta doença, que precisa de um acompanhamento multidisciplinar.

Abstract Graft-versus-host Disease (GVHD) is a major complication with high morbidity and mortality rates on patients undergoing hematopoietic stem cell transplantation. The ocular involvement, named ocular GVHD, may affect all structures of the eyes, but the lacrimal unit (lacrimal glands and ocular surface) is the main target of the inflammatory response mediated by the donor T cells. The development of dry eye disease is the main clinical ocular manifestation, and the association of a variety of therapeutics options is necessary. The aim of the review is to describe the clinical manifestations, diagnostic criteria, impact in quality of life, the current treatment and future perspectives of this disease that demands a multidisciplinary follow-up.

[Fornix reconstruction with conjunctival inclusion cyst marsupialization in severe symblepharon].

Objective: To report the efficacy of fornix reconstruction with conjunctival inclusion cyst marsupialization in severe symblepharon. Methods: Retrospective cases series study. Four patients (4 eyes) with Conjunctival Inclusion Cyst Marsupialization and severe Symblepharon during June 2016 to June 2018 at the PLA General Hospital were included. All of them were treated with Conjunctival Inclusion Cyst Marsupialization. The morphology, depth of the conjunctival sac and the degree of symblepharon before and after treatment were compared to observe the surgical results. Results: After operation, the conjunctival sacs were deepened, and the average depth was 4.75 mm. After follow-up, 2 cases of conjunctival sac were basically normal, and 2 cases of conjunctival sac became shallow, but still better than before surgery. Conclusions: For the patients with large Conjunctival Inclusion Cyst and severe symblepharon, the Conjunctival Inclusion Cyst Marsupialization have many positive effects of deepening conjunctival sac, relieving symblepharon, increasing the degree of eye movement, improving appearance and relieving dry eyes. At the same time, this operation can avoid recurrence due to incomplete cystectomy. (Chin J Ophthalmol, 2018, 54: 897-901).