Full Text Available Ocular chemical burns are common and serious ocular emergencies that require immediate and intensive evaluation and care. The victims of such incidents are usually young, and therefore loss of vision and disfigurement could dramatically affect their lives. The clinical course can be divided into immediate, acute, early, and late reparative phases. The degree of limbal, corneal, and conjunctival involvement at the time of injury is critically associated with prognosis. The treatment starts with simple but vision saving steps and is continued with complicated surgical procedures later in the course of the disease. The goal of treatment is to restore the normal ocular surface anatomy and function. Limbal stem cell transplantation, amniotic membrane transplantation, and ultimately keratoprosthesis may be indicated depending on the patients’ needs.
Full Text Available The ocular surface is exceptionally rich in complexity and functionality. Severe ocular surface disorders/conditions, such as chemical or thermal injuries, Stevens-Johnson syndrome (SJS, ocular cicatricial pemphigoid, neurotrophic keratopathy, chronic limbitis, and severe microbial keratitis cause significant morbidities and even corneal blindness. Hypofunction may be caused by Aniridia, Neurotrophy, Endocrine, Pterygium and Chronic limbitis Approximately 6000 patients are seen in Ocular Surface Clinic every year; almost 80% have some form of dry eyes. About 125 new patients of Stevens Johnson Syndrome are seen in a year of which approximately 25% may benefit from Cultured Epithelial Transplant and 75 new patients of thermal/chemical injury in a year of which almost 80% will benefit from Stem Cell Transplantation. Of the 128 severe vernal keratoconjunctivitis which were seen in the ocular surface clinic, 10% require stem cell transplantation. Nearly 30 new cases of Ocular cicatrical pemphigoid every year are seen and they may need stem cell transplantation. In addition, several patients with persistent epithelial defects may benefit from limbal stem cell transplantation to alleviate, maintain conjunctivalization regression and corneal avascularity limbal deficiency, and restore vision. Even if granted that this statistics is for a single large ophthalmic hospital, for a large country as India with 1.1 billion populations, the number of patients requiring corneal stem cell transplantation is enormous. Stem cells in the palisades of Vogt participate in regeneration and preservation of corneal transparency and avascularity. The diminished regenerative capacity seen in LSCD is characterized by persistent epithelial defects, erosion and ulceration, conjunctivalization and neovascularization, and chronic inflammation. Standard corneal transplantation for restoration of corneal clarity and avascularity is a contraindication in the surgical management
Full Text Available Ocular surface squamous neoplasia originates from conjunctiva epithelium and covers a broad spectrum of disease ranging from dysplasia to squamous cell carcinoma. Clinical features may vary from case to case. Traditional treatment of excision with no-touch technique combined with adjuvant therapies because of high recurrence rate. Main adjuvant treatments are cryotherapy and chemotherapy. In this review, clinical forms, differential diagnosis, American Joint Committee on Cancer classification and recent approaches to the management of ocular surface squamous dysplasia were described. (Turk J Ophthalmol 2014; 44: Supplement 8-14
Background: Ocular surface squamous neoplasia (OSSN)are aspectrum of lesions that arise from the squamous epithelium of the conjunctiva and cornea. They form the most frequent indication for orbital exenteration in Korle-bu Teaching Hospital, Accra. Poor management of early lesions leads to high rates of tumour ...
Riestra, A C; Alonso-Herreros, J M; Merayo-Lloves, J
The use of platelet-rich preparations has experienced a significant increase in recent years due to its role in tissue-repair and regeneration. The aim of this study is to examine the available evidence regarding the application of plasma rich in growth factors, and its variations, on the ocular surface. A review is also presented on the effects of platelet-derived growth factors, the implications of the preparation methods, and the existing literature on the safety and efficacy of these therapies in ocular surface diseases. Despite the widespread use of platelet preparations there is no consensus on the most appropriate preparation method, and growth factors concentration vary with different systems. These preparations have been used in the treatment of ocular surface diseases, such as dry eye or persistent epithelial defects, among others, with good safety and efficacy profiles, but further studies are needed to compare to the currently available alternatives. Copyright © 2016 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.
Bolaños-Jiménez, Rodrigo; Navas, Alejandro; López-Lizárraga, Erika Paulina; de Ribot, Francesc March; Peña, Alexandra; Graue-Hernández, Enrique O; Garfias, Yonathan
Sight is one of the most important senses that human beings possess. The ocular system is a complex structure equipped with mechanisms that prevent or limit damage caused by physical, chemical, infectious and environmental factors. These mechanisms include a series of anatomical, cellular and humoral factors that have been a matter of study. The cornea is not only the most powerful and important lens of the optical system, but also, it has been involved in many other physiological and pathological processes apart from its refractive nature; the morphological and histological properties of the cornea have been thoroughly studied for the last fifty years; drawing attention in its molecular characteristics of immune response. This paper will review the anatomical and physiological aspects of the cornea, conjunctiva and lacrimal apparatus, as well as the innate immunity at the ocular surface. PMID:26161163
Full Text Available Background - Ocular surface disorders due to limbal stem cell deficiency are an important cause of ocular morbidity and visual loss. Although autologous limbal stem cell transplants have helped in the management of unilateral disease, allografts in those with bilateral disease often fail due to immunological reasons. The use of autologous buccal epithelium cultivated on amniotic membrane has been described as a useful approach in the management of this condition. It is the purpose of this study to explore the feasibility of using a novel thermo-gelatin polymer (TGP as a substrate to culture these cells, and to characterize them using RNA extraction and RT-PCR. Methods - Oral cheek mucosal biopsies were obtained from 5 adult patients undergoing Modified Osteo-Odonto Keratoprosthesis surgery. The specimens were transported to the laboratory in transport medium. The cells were released using enzymatic digestion and seeded in both convention culture medium and TGP. The resulting cellular growth was characterized using RNA extraction and RT-PCR. Results - Cells could be cultured from 4 of the 5 specimens. In one specimen, contamination occurred and this was discarded. In the other specimens, the cheek epithelial cells could be cultured in both the conventional culture medium and TGP, with equal ease. RT-PCR revealed the presence of K3, a marker for epithelial cells, and GAPDH indicating the presence of some adipose tissue as well. Conclusions - It is possible to culture autologous cheek mucosal epithelial cells using TGP, a synthetic scaffold, without the need for other biological substrates. Since the specimens are obtained from the oral cavity, stringent asepsis is required. Further studies are required for histopathological characterization of the cultured cells and to create a model for delivery onto the ocular surface of eyes with bilateral surface disease due to limbal stem cell deficiency.
Babar, Tariq Farooq; Khan, Mohammad Naeem; Hussain, Mahfooz; Shah, Shafaqat Ali; Khan, Mohammad Younas; Khan, Mohammad Daud
To describe the pattern of ocular surface squamous neoplasia (OSSN), clinical presentations, the risk factors and treatment options. An observational case series. Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar, from April 2003 till August 2006. The study included 36 eyes of 35 patients with biopsy-proven ocular surface neoplasia. The details of patients regarding age, gender, laterality and risk factors were entered into a specially-designed proforma. Each patient was also assessed biomicroscopically for type and complications of ocular surface neoplasia. The frequency of OSSN was 0.37 among admitted hospital patients. Among 36 cases of OSSN, squamous cell carcinoma of the conjunctiva was the most common type of OSSN seen in 63.9%, followed by carcinoma in situ of conjunctiva in 25% and carcinoma in situ of cornea in 11.1%. Male patients outnumbered female (65.7% vs 34.3%) with 71.42% of patients above 60 years of age. The risk factors identified were: old age, ultraviolet B exposure and xeroderma pigmentosa. Treatment consisted of local resection with or without adjuvant therapy in 61.1%, exenteration in 30.5%, enucleation in 5.5% and chemo/radiotherapy in 2.7%. Intraocular invasion was seen in 5.5% and orbital spread in 30.5%. The frequency of OSSN was 0.37% among admitted patients. Identification of exact etiological factors will enable to formulate strategies that are likely to decrease the incidence of this disease and the associated morbidity and mortality.
Zhang, Xiaobo; M, Vimalin Jeyalatha; Qu, Yangluowa; He, Xin; Ou, Shangkun; Bu, Jinghua; Jia, Changkai; Wang, Junqi; Wu, Han; Liu, Zuguo; Li, Wei
Dry eye can damage the ocular surface and result in mild corneal epithelial defect to blinding corneal pannus formation and squamous metaplasia. Significant progress in the treatment of dry eye has been made in the last two decades; progressing from lubricating and hydrating the ocular surface with artificial tear to stimulating tear secretion; anti-inflammation and immune regulation. With the increase in knowledge regarding the pathophysiology of dry eye, we propose in this review the concept of ocular surface microenvironment. Various components of the microenvironment contribute to the homeostasis of ocular surface. Compromise in one or more components can result in homeostasis disruption of ocular surface leading to dry eye disease. Complete evaluation of the microenvironment component changes in dry eye patients will not only lead to appropriate diagnosis, but also guide in timely and effective clinical management. Successful treatment of dry eye should be aimed to restore the homeostasis of the ocular surface microenvironment.
Varsha Madanlal Rathi
Full Text Available Context: Boston ocular surface prosthesis (BOSP is a scleral contact lens used in the management of patients who are rigid gas permeable (RGP failures as with corneal ectasias such as keratoconus and in those patients who have ocular surface disease such as Stevens-Johnson syndrome (SJS. Aim: To report utilization of BOSP in a tertiary eye care center in India. Materials and Methods: We retrospectively reviewed charts of 32 patients who received BOSP from July 2008 to May 2009. Indications for fitting these lenses, improvement in visual acuity (VA before and after lens fitting and relief of symptoms of pain and photophobia were noted. Paired t-test was used for statistical analysis using SPSS version 16.0 for Windows. Results: Thirty-two patients (43 eyes received these lenses. These consisted of 23 eyes of 17 patients who failed RGP trials for irregular astigmatism and corneal ectasia such as keratoconus and post radial keratotomy and scar and 20 eyes of 15 patients with SJS. Mean age of RGP failures was 27.94 years. Pre- and post-BOSP wear mean LogMAR VA was 1.13 and 0.29, respectively, in RGP failures. The P value was statistically significant (P 2 lines in 7/20 eyes (35% with SJS, with improvement in symptoms. Conclusion: BOSP improves VA in patients who have irregular astigmatism as in ectasias and RGP failures and improves vision and symptoms in patients with SJS.
Rathi, Varsha Madanlal; Mandathara, Preeji Sudharman; Dumpati, Srikanth; Vaddavalli, Pravin K; Sangwan, Virender S
Context: Boston ocular surface prosthesis (BOSP) is a scleral contact lens used in the management of patients who are rigid gas permeable (RGP) failures as with corneal ectasias such as keratoconus and in those patients who have ocular surface disease such as Stevens–Johnson syndrome (SJS). Aim: To report utilization of BOSP in a tertiary eye care center in India. Materials and Methods: We retrospectively reviewed charts of 32 patients who received BOSP from July 2008 to May 2009. Indications for fitting these lenses, improvement in visual acuity (VA) before and after lens fitting and relief of symptoms of pain and photophobia were noted. Paired t-test was used for statistical analysis using SPSS version 16.0 for Windows. Results: Thirty-two patients (43 eyes) received these lenses. These consisted of 23 eyes of 17 patients who failed RGP trials for irregular astigmatism and corneal ectasia such as keratoconus and post radial keratotomy and scar and 20 eyes of 15 patients with SJS. Mean age of RGP failures was 27.94 years. Pre- and post-BOSP wear mean LogMAR VA was 1.13 and 0.29, respectively, in RGP failures. The P value was statistically significant (P 2 lines in 7/20 eyes (35%) with SJS, with improvement in symptoms. Conclusion: BOSP improves VA in patients who have irregular astigmatism as in ectasias and RGP failures and improves vision and symptoms in patients with SJS. PMID:21666311
Maudgil, A; Wagner, B E; Rundle, P; Rennie, I G; Mudhar, H S
Malignant melanoma of the eye is an uncommon condition that is important to recognise. We describe three cases in which ocular foreign bodies have masqueraded as ocular malignant melanoma. Interventional case reports. Case 1 describes diathermy-induced carbon particle implantation, during plaque therapy for the treatment of uveal melanoma, mimicking recurrence with extra-scleral invasion. Case 2 shows a foreign body called 'mullite' mimicking conjunctival melanoma. Case 3 demonstrates a conjunctival foreign body called 'illite' that mimicked a limbal melanocytic lesion, clinically thought to be either melanocytoma or melanoma. This report highlights the importance of careful history taking, examination, and appropriate biopsy in cases of suspected malignant melanoma, to prevent unnecessary and potentially radical treatment.
We describe a rare case of noninvasive OSSN involving the entire cornea in a human immunodeficiency virus‑negative patient. The patient was successfully treated with no recurrence, after intact surgical removal, mitomycin C treatment, and cryotherapy. Keywords: Noninvasive ocular surface squamous neoplasia, ocular ...
Full Text Available Dry eye is a common disorder caused by inadequate hydration of the ocular surface that results in disruption of barrier function. The homeostatic protein clusterin (CLU is prominent at fluid-tissue interfaces throughout the body. CLU levels are reduced at the ocular surface in human inflammatory disorders that manifest as severe dry eye, as well as in a preclinical mouse model for desiccating stress that mimics dry eye. Using this mouse model, we show here that CLU prevents and ameliorates ocular surface barrier disruption by a remarkable sealing mechanism dependent on attainment of a critical all-or-none concentration. When the CLU level drops below the critical all-or-none threshold, the barrier becomes vulnerable to desiccating stress. CLU binds selectively to the ocular surface subjected to desiccating stress in vivo, and in vitro to the galectin LGALS3, a key barrier component. Positioned in this way, CLU not only physically seals the ocular surface barrier, but it also protects the barrier cells and prevents further damage to barrier structure. These findings define a fundamentally new mechanism for ocular surface protection and suggest CLU as a biotherapeutic for dry eye.
Bauskar, Aditi; Mack, Wendy J; Mauris, Jerome; Argüeso, Pablo; Heur, Martin; Nagel, Barbara A; Kolar, Grant R; Gleave, Martin E; Nakamura, Takahiro; Kinoshita, Shigeru; Moradian-Oldak, Janet; Panjwani, Noorjahan; Pflugfelder, Stephen C; Wilson, Mark R; Fini, M Elizabeth; Jeong, Shinwu
Dry eye is a common disorder caused by inadequate hydration of the ocular surface that results in disruption of barrier function. The homeostatic protein clusterin (CLU) is prominent at fluid-tissue interfaces throughout the body. CLU levels are reduced at the ocular surface in human inflammatory disorders that manifest as severe dry eye, as well as in a preclinical mouse model for desiccating stress that mimics dry eye. Using this mouse model, we show here that CLU prevents and ameliorates ocular surface barrier disruption by a remarkable sealing mechanism dependent on attainment of a critical all-or-none concentration. When the CLU level drops below the critical all-or-none threshold, the barrier becomes vulnerable to desiccating stress. CLU binds selectively to the ocular surface subjected to desiccating stress in vivo, and in vitro to the galectin LGALS3, a key barrier component. Positioned in this way, CLU not only physically seals the ocular surface barrier, but it also protects the barrier cells and prevents further damage to barrier structure. These findings define a fundamentally new mechanism for ocular surface protection and suggest CLU as a biotherapeutic for dry eye.
Bauskar, Aditi; Mack, Wendy J.; Mauris, Jerome; Argüeso, Pablo; Heur, Martin; Nagel, Barbara A.; Kolar, Grant R.; Gleave, Martin E.; Nakamura, Takahiro; Kinoshita, Shigeru; Moradian-Oldak, Janet; Panjwani, Noorjahan; Pflugfelder, Stephen C.; Wilson, Mark R.; Fini, M. Elizabeth; Jeong, Shinwu
Dry eye is a common disorder caused by inadequate hydration of the ocular surface that results in disruption of barrier function. The homeostatic protein clusterin (CLU) is prominent at fluid-tissue interfaces throughout the body. CLU levels are reduced at the ocular surface in human inflammatory disorders that manifest as severe dry eye, as well as in a preclinical mouse model for desiccating stress that mimics dry eye. Using this mouse model, we show here that CLU prevents and ameliorates ocular surface barrier disruption by a remarkable sealing mechanism dependent on attainment of a critical all-or-none concentration. When the CLU level drops below the critical all-or-none threshold, the barrier becomes vulnerable to desiccating stress. CLU binds selectively to the ocular surface subjected to desiccating stress in vivo, and in vitro to the galectin LGALS3, a key barrier component. Positioned in this way, CLU not only physically seals the ocular surface barrier, but it also protects the barrier cells and prevents further damage to barrier structure. These findings define a fundamentally new mechanism for ocular surface protection and suggest CLU as a biotherapeutic for dry eye. PMID:26402857
Palamar, Melis; Egrilmez, Sait; Yilmaz, Suzan Guven; Polat, Suleyha Hilmioglu; Gunduz, Omur Ucakhan
Systemic voriconazole treatment was reported to cause photosensitivity and related cutaneous malignancies. The aim of this report is to demonstrate a graft-related Candida endophthalmitis case that developed ocular surface dysplastic changes after receiving topical 1% voriconazole treatment. Full ocular examination, photography, and in vivo confocal microscopy examination (Rostock Cornea Module/HRT II, Heidelberg, Germany) were performed. A 73-year-old male with graft-related Candida endophthalmitis that was on topical 1% voriconazole for 4 months developed a whitish gelatinous lesion on the cornea originating from the nasal limbus. In vivo confocal microscopy examination revealed mild dysplastic changes in the cornea epithelium. Topical voriconazole might trigger neoplastic changes on the ocular surface as reported with systemic use in other sun-exposed parts of the body. Further studies are needed to relate topical use of voriconazole with ocular surface dysplasia.
Conclusion: OSSN occurs in younger individuals, and is strongly associated with HIV infection in our environment. Early diagnosis and intervention can prevent severe ocular morbidity. Wide surgical excision with intra-operative cryotherapy and adjuvant treatment with topical MMC post-operatively seem to give good outcome in our patients.
Alex, Anastasia; Edwards, Austin; Hays, J. Daniel; Kerkstra, Michelle; Shih, Amanda; de Paiva, Cintia S.; Pflugfelder, Stephen C.
Purpose. To identify factors predicting the ocular surface response to experimental desiccating stress. Methods. The ocular surfaces of both eyes of 15 normal and 10 dry eye subjects wearing goggles were exposed to a controlled desiccating environment (15%–25% relative humidity and 2–5 L/min airflow) for 90 minutes. Eye irritation symptoms, blink rate, tear meniscus dimensions, noninvasive (RBUT) and invasive tear break-up time, and corneal fluorescein and conjunctival lissamine green-dye staining were recorded before and after desiccating stress. Pre- and postexposure measurements were compared, and Pearson correlations between clinical parameters before and after desiccating stress were calculated. Results. Corneal and conjunctival dye staining significantly increased in all subjects following 90-minute exposure to desiccating environment, and the magnitude of change was similar in normal and dry eye subjects; except superior cornea staining was greater in dry eye. Irritation severity in the desiccating environment was associated with baseline dye staining, baseline tear meniscus height, and blink rate after 45 minutes. Desiccation-induced change in corneal fluorescein staining was inversely correlated to baseline tear meniscus width, whereas change in total ocular surface dye staining was inversely correlated to baseline dye staining, RBUT, and tear meniscus height and width. Blink rate from 30 to 90 minutes in desiccating environment was higher in the dry eye than normal group. Blink rate significantly correlated to baseline corneal fluorescein staining and environmental-induced change in corneal fluorescein staining. Conclusions. Ocular surface dye staining increases in response to desiccating stress. Baseline ocular surface dye staining, tear meniscus height, and blink rate predict severity of ocular surface dye staining following exposure to a desiccating environment. PMID:23572103
Aragona, Emanuela; Rania, Laura; Postorino, Elisa Imelde; Interdonato, Alberto; Giuffrida, Roberta; Cannavò, Serafinella Patrizia; Puzzolo, Domenico; Aragona, Pasquale
Psoriasis is a skin disease with also systemic involvement: its impact on the eye is not well established and often clinically underestimated. Aim of this study was to investigate the presence of ocular discomfort symptoms and of ocular surface changes in a population of patients with psoriasis. For this cross-sectional, comparative study, 66 patients with psoriasis were subdivided according to the presence of arthritis and to the use of biological therapy. All patients underwent clinical evaluation with the following tests: Ocular Surface Disease Index Questionnaire, Tearscope examination, meibometry, tear film breakup time, corneal and conjunctival fluorescein staining, Schirmer I test, corneal aesthesiometry, meibomian gland dysfunction (MGD) assessment and conjunctival impression cytology. 28 healthy subjects were also enrolled and treated with the same clinical tests. A statistical analysis of the results was performed. Patients with psoriasis showed a significant deterioration of the ocular surface tests, if compared with healthy subjects, demonstrated by tear film lipid layer alteration, tear film instability, corneal and conjunctival epithelial suffering and mild squamous metaplasia at impression cytology. No differences were found in ocular surface test results of the psoriatic group when patients were divided according to the presence of arthritis, whereas the anti-inflammatory treatment with biological drugs demonstrated a significant improvement of corneal stain and MGD. Our findings suggest that the ocular surface involvement in patients with psoriasis indicates the need of periodic ophthalmological examinations to diagnose the condition and allow a proper treatment, so contributing to the amelioration of patients' quality of life. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Atallah, Marwan; Joag, Madhura; Galor, Anat; Amescua, Guillermo; Nanji, Afshan; Wang, Jianhua; Perez, Victor L; Dubovy, Sander; Karp, Carol L
Coexistence of an ocular surface disease can mask the typical features of ocular surface squamous neoplasia (OSSN). The purpose of this study was to evaluate high resolution optical coherence tomography (HR-OCT) as an adjunct in the detection and differentiation of OSSN within coexisting ocular surface pathologies. Retrospective study of 16 patients with ocular surface disease and lesions suspicious for OSSN that were evaluated with HR-OCT. HR-OCT images of the lesions were taken to look for evidence of OSSN. Biopsies were performed in all cases, and the HR-OCT findings were compared to the histological results. Of the 16 patients with OSSN and a coexisting ocular surface disease, 12 were found to have OSSN by HR-OCT and all were subsequently confirmed by biopsy. Two patients had OSSN with rosacea, one with pingueculum, two within pterygia, one with Salzmann' nodular degeneration, six with limbal stem cell deficiency (LSCD)/scarring. In all 12 cases HR-OCT images revealed classical findings of hyper-reflective, thickened epithelium and an abrupt transition from normal to abnormal epithelium. OSSN was ruled out by HR-OCT in four cases (2 Salzmann's, 1 mucous membrane pemphigoid, and 1 LSCD). Negative findings were confirmed by biopsy. HR-OCT was used to follow resolution of the OSSN in positive cases, and it detected recurrence in 1 case. While histopathology is the gold standard in the diagnosis of OSSN, HR-OCT can be used to noninvasively detect the presence of OSSN in patients with coexisting ocular conditions. Copyright © 2017 Elsevier Inc. All rights reserved.
Full Text Available Background. The aim of this study is to investigate the ocular thermographic profiles in age-related macular degeneration (AMD eyes and age-matched controls to detect possible hemodynamic abnormalities, which could be involved in the pathogenesis of the disease. Methods. 32 eyes with early AMD, 37 eyes with atrophic AMD, 30 eyes affected by untreated neovascular AMD, and 43 eyes with fibrotic AMD were included. The control group consisted of 44 healthy eyes. Exclusion criteria were represented by any other ocular diseases other than AMD, tear film abnormalities, systemic cardiovascular abnormalities, diabetes mellitus, and a body temperature higher than 37.5°C. A total of 186 eyes without pupil dilation were investigated by infrared thermography (FLIR A320. The ocular surface temperature (OST of three ocular points was calculated by means of an image processing technique from the infrared images. Two-sample t-test and one-way analysis of variance (ANOVA test were used for statistical analyses. Results. ANOVA analyses showed no significant differences among AMD groups (P value >0.272. OST in AMD patients was significantly lower than in controls (P>0.05. Conclusions. Considering the possible relationship between ocular blood flow and OST, these findings might support the central role of ischemia in the pathogenesis of AMD.
Mathews, Priya M.; Ramulu, Pradeep Y.; Friedman, David S.; Utine, Canan A.; Akpek, Esen K.
Purpose To evaluate the subjective and objective measures of ocular surface disease in patients with glaucoma. Design Cross-sectional study. Participants Sixty-four glaucoma subjects with bilateral visual field (VF) loss and 59 glaucoma suspects with normal VFs. Methods Consecutive patients were recruited prospectively from the Wilmer Eye Institute Glaucoma Clinic. Main Outcome Measures Tear film breakup time (TBUT), corneal staining score (0–15), and Schirmer’s test results were included as objective metrics, whereas the Ocular Surface Disease Index (OSDI) questionnaire was administered to assess symptoms. Total OSDI score, vision-related subscore (derived from questions about vision and task performance), and discomfort-related subscore (derived from questions about ocular surface discomfort) were calculated for each subject. Results Seventy-five percent (48/64) of glaucoma subjects and 41% (24/59) of glaucoma suspects were receiving topical medications. The corneal staining grade was greater in glaucoma subjects than in glaucoma suspects (6.4 vs. 4.1; P0.20 for both). Multivariate regression models showed that topical glaucoma therapy burden was associated with a significantly higher total corneal staining grade (β, +0.9 for each additional glaucoma drop; 95% confidence interval [CI], 0.5–1.3; P0.20 for both). Glaucoma subjects had significantly higher total OSDI scores than glaucoma suspects (16.7 vs. 7.9; Pglaucoma group (11.1 vs. 3.3; Pglaucoma therapy burden was not associated with higher total OSDI score or vision- or discomfort-related subscore (P>0.20 for all). Conclusions Glaucoma is associated with significant ocular surface disease, and topical glaucoma therapy burden seems predictive of corneal staining severity. However, OSDI is a poor metric for capturing ocular surface disease in glaucoma because symptoms seem to be related largely to VF loss. PMID:23714318
Lee, David; Lu, Qiaozhi; Sommerfeld, Sven D; Chan, Amanda; Menon, Nikhil G; Schmidt, Tannin A; Elisseeff, Jennifer H; Singh, Anirudha
Hyaluronic acid (HA) solutions effectively lubricate the ocular surface and are used for the relief of dry eye related symptoms. However, HA undergoes rapid clearance due to limited adhesion, which necessitates frequent instillation. Conversely, highly viscous artificial tear formulations with HA blur vision and interfere with blinking. Here, we developed an HA-eye drop formulation that selectively binds and retains HA for extended periods of time on the ocular surface. We synthesized a heterobifunctional polymer-peptide system with one end binding HA while the other end binding either sialic acid-containing glycosylated transmembrane molecules on the ocular surface epithelium, or type I collagen molecule within the tissue matrix. HA solution was mixed with the polymer-peptide system and tested on both ex vivo and in vivo models to determine its ability to prolong HA retention. Furthermore, rabbit ocular surface tissues treated with binding peptides and HA solutions demonstrated superior lubrication with reduced kinetic friction coefficients compared to tissues treated with conventional HA solution. The results suggest that binding peptide-based solution can keep the ocular surface enriched with HA for prolonged times as well as keep it lubricated. Therefore, this system can be further developed into a more effective treatment for dry eye patients than a standard HA eye drop. Eye drop formulations containing HA are widely used to lubricate the ocular surface and relieve dry eye related symptoms, however its low residence time remains a challenge. We designed a polymer-peptide system for the targeted delivery of HA to the ocular surface using sialic acid or type I collagen as anchors for HA immobilization. The addition of the polymer-peptide system to HA eye drop exhibited a reduced friction coefficient, and it can keep the ocular surface enriched with HA for prolonged time. This system can be further developed into a more effective treatment for dry eye than a
Full Text Available We investigated the effects of a visual picking system on ocular comfort, the ocular surface and tear function compared to those of a voice guided picking solution.Prospective, observational, cohort study.Institutional.A total of 25 young asymptomatic volunteers performed commissioning over 10 hours on two consecutive days.The operators were guided in the picking process by two different picking solutions, either visually or by voice while their subjective symptoms and ocular surface and tear function parameters were recorded.The visual analogue scale (VAS values, according to subjective dry eye symptoms, in the visual condition were significantly higher at the end of the commissioning than the baseline measurements. In the voice condition, the VAS values remained stable during the commissioning. The tear break-up time (BUT values declined significantly in the visual condition (pre-task: 16.6 sec and post-task: 9.6 sec in the right eyes, that were exposed to the displays, the left eyes in the visual condition showed only a minor decline, whereas the BUT values in the voice condition remained constant (right eyes or even increased (left eyes over the time. No significant differences in the tear meniscus height values before and after the commissioning were observed in either condition.In our study, the use of visually guided picking solutions was correlated with post-task subjective symptoms and tear film instability.
Klein-Theyer, Angelika; Horwath-Winter, Jutta; Rabensteiner, Dieter Franz; Schwantzer, Gerold; Wultsch, Georg; Aminfar, Haleh; Heidinger, Andrea; Boldin, Ingrid
We investigated the effects of a visual picking system on ocular comfort, the ocular surface and tear function compared to those of a voice guided picking solution. Prospective, observational, cohort study. Institutional. A total of 25 young asymptomatic volunteers performed commissioning over 10 hours on two consecutive days. The operators were guided in the picking process by two different picking solutions, either visually or by voice while their subjective symptoms and ocular surface and tear function parameters were recorded. The visual analogue scale (VAS) values, according to subjective dry eye symptoms, in the visual condition were significantly higher at the end of the commissioning than the baseline measurements. In the voice condition, the VAS values remained stable during the commissioning. The tear break-up time (BUT) values declined significantly in the visual condition (pre-task: 16.6 sec and post-task: 9.6 sec) in the right eyes, that were exposed to the displays, the left eyes in the visual condition showed only a minor decline, whereas the BUT values in the voice condition remained constant (right eyes) or even increased (left eyes) over the time. No significant differences in the tear meniscus height values before and after the commissioning were observed in either condition. In our study, the use of visually guided picking solutions was correlated with post-task subjective symptoms and tear film instability.
Holáň, Vladimír; Javorková, Eliška
Roč. 9, č. 5 (2013), s. 609-619 ISSN 1550-8943 R&D Projects: GA ČR GAP304/11/0653; GA ČR(CZ) GAP301/11/1568 Grant - others:GA MŠk(CZ) UK668012; GA MŠk(CZ) SVV 265211 Institutional support: RVO:68378041 Keywords : mesenchymal stem cell s * limbal stem cell s * ocular surface injuries Subject RIV: EC - Immunology Impact factor: 3.214, year: 2013
Schwab, Ivan R; Johnson, Nigel T; Harkin, Damien G
To review the potential health risks associated with bioengineered ocular surface tissue, which serves as a bellwether for other tissues. All clinical trials using bioengineered ocular surface tissue published between July 1, 1996, and June 30, 2005, were reviewed with respect to materials used and statements of risk assessment, risk remediation, adverse events, manufacturing standards, and regulatory oversight. Ninety-five percent of investigational protocols used 1 or more animal-derived products and an overlapping 95% used 1 or more donor human tissues. Consideration of risks reveals a very low probability of potential harm but a significant risk of disability or death if such an event were to occur. Details of ethics approval, patient consent, and donor serologic test results were not consistently provided. No references were made to risk assessment or to codes of manufacturing and clinical practice. While a degree of risk is associated with bioengineered ocular surface tissue, investigational reports of this new technology have yet to address issues of risk management and regulatory oversight. Attention to risk and codes of manufacturing and clinical practice will be required for advancement of the technology. We suggest the adoption of international standards to address these issues.
Liu, Zuguo; Hong, Jiaxu
Translational medicine emphasizes the application of the results of basic research to clinical practice and the solution of clinical issues through basic research. It is very important for the development direction of the medical field. Over the past decade, the translational medicine research in ocular surface disease has drawn international attention and developed rapidly. This field in China has made great progress, but overall there are still some gaps with the international advanced level. We need to establish the concept and the platform of translational research, explore scientific and effective methods, and create a whole chain to enhance our ocular research. It also requires research institutions and government departments to give full support. Finally, we need to explore a suitable way for the development of Chinese translational medical research.
Zhang, Aizhong; Salahura, Gheorghe; Kottaiyan, Ranjini; Yoon, Geunyoung; Aquavella, James V.; Zavislan, James M.
To study the relationship between the corneal lipid layer and the ocular surface temperature (OST), we conducted a clinical trial for 20 subjects. Subjects were clinically screened prior to the trial. Of the 20 subjects, 15 have Meibomian gland dysfunction (MGD), and 5 have aqueous-deficient dry eye (ADDE). A custom, circularly polarized illumination video tearscope measured the lipid layer thickness of the ocular tear film. A long-wave infrared video camera recorded the dynamic thermal properties of the ocular team film. The results of these two methods were analyzed and compared. Using principal component analysis (PCA) of the lipid layer distribution, we find that the 20 subjects could be categorized into five statistically significant groups, independent of their original clinical classification: thin (6 subjects), medium (5 subjects), medium and homogenous (3 subjects), thick (4 subjects), and very thick (2 subjects) lipids, respectively. We also conducted PCA of the OST data, and recategorized the subjects into two thermal groups by k-means clustering: one includes all ADDE subjects and some MGD subjects; the other includes the remaining MGD subjects. By comparing these two methods, we find that dry eye subjects with thin (lipids have significantly lower OST, and a larger OST drop range, potentially due to more evaporation. However, as long as the lipid layer is not thin (> 40 nm), there is no strong correlation between the lipid layer thickness and heterogeneity and the OST patterns.
Making oneself more beautiful has always been part of humans' civilized life. Accordingly, the side effects of various cosmetic product and cosmetic procedure long exist. The ocular-surface problems induced by cosmetology mainly include cornea and conjunctiva damages, and tear film damages. Specifically, cornea and conjunctiva damage included: (1) physical injury caused by nonstandard operational procedure, (2) toxic and side effect of cosmetic product, and (3) infection induced by using cosmetic contact lenses, while tear film damage included: (1) injury of normal eyelid structure, (2) decrease of tear production from lacrimal gland, and (3) function and morphology injury of meibomian gland. (Chin J Ophthalmol, 2018, 54: 84-86) .
Matteoli, Sara; Vannetti, Federica; Finocchio, Lucia
increasing temperature at t0 for P1 = 0.12 C 6 0.13 C). Therefore, these results suggest a response of the ocular hemodynamic to the peripheral vasoconstriction. The ocular surface temperature may represent a cheap, non-invasive and non-time-consuming test to evaluate ocular vaso-regulation.......An impairment of ocular blood flow regulation is commonly considered one of the main pathogenetic mechanisms involved in the development of several eye diseases, like glaucoma. The aim of this study was to investigate whether an alteration of ocular blood supply induced by peripheral...... vasoconstriction might be detected by measuring the ocular surface temperature. The ocular surface temperature was evaluated in a group of 38 healthy young subjects (28 males and 10 females; mean age: 25.4 6 4.1 years) by infrared thermography. For each subject, the experimental procedure consisted of two...
Rodriguez, Nelson A; Ascaso, Francisco J
Ethyl chloride (EC) is a fast-acting vapo-coolant spray that provides rapid, transient, local analgesia for minor invasive procedures. Although the application of EC has decreased, it can be used as a cryoanalgesic agent in minor surgical procedures. Despite the widespread use of EC as a local anesthetic, there are few reported cases of serious adverse side effects. We report a 67-year old otherwise healthy man who underwent excision of a papilloma on his superior right eyelid by a general practitioner at a primary care center. The lesion was removed by curettage after slight freezing with EC spray. This chemical agent was applied without the adequate eye protection, and eight hours later the patient presented an acute frost injury of ocular surface. Urgent treatment included copious irrigation of the affected eye, especially the conjunctival fornices, corticosteroid (prednisone) and antibiotic (neomycin) ointment. A week later, the eyelid lesion and keratoconjunctivitis had resolved but evidence of early cicatrization involving the inferior conjucntival fornix and symblepharon formation were present. To the best of our knowledge, this is the first reported case of an acute burn of the ocular surface following EC spray exposure. EC should be avoided for short-term local anesthesia in the periocular region to prevent this serious complication.
Jadidi, Khosrow; Ebrahimi, Ali; Panahi, Yunes; Alishiri, Ali; Hosseini, Bagher; Heydarzadeh, Sepideh; Akbarikia, Sona; Mafi, Mostafa
To evaluate the effectiveness of topical cyclosporine A 0.05% for treatment of mustard gas-induced ocular surface disorders with special attention to conjunctival goblet cell density in patients with severe dry eye. This prospective clinical study included 20 eyes of 20 patients previously exposed to mustard gas with dry eye syndrome unresponsive to artificial tears. Before and after treatment with topical cyclosporine A 0.05% twice daily for 3 months, subjects were evaluated for improvement in symptoms using the ocular surface disease index (OSDI) and signs by tear breakup time (TBUT), Schirmer test and measurement of superior bulbar conjunctival goblet cell density. Limbal stem cell deficiency (LSCD) and the degree of corneal squamous cell metaplasia were also assessed before and after treatment. Before treatment, mean OSDI score, Schirmer test I value and mean TBUT were 42.8 ± 6.1, 4.2 ± 1.2 mm and 2.5 ± 1.3 s, respectively. After 3 months of treatment with topical cyclosporine A, these scores reached 36.4 ± 5.2, 5.8 ± 1.6 mm and 4.9 ± 2.1 s, respectively showing a statistically significant improvement (P 0.05). Treatment with topical cyclosporine A 0.05% in patients with severe dry eye due to mustard gas injury increases goblet cell density in the bulbar conjunctiva and improves symptoms of the disease.
Full Text Available Purpose: To evaluate the effectiveness of topical cyclosporine A 0.05% for treatment of mustard gas-induced ocular surface disorders with special attention to conjunctival goblet cell density in patients with severe dry eye. Methods: This prospective clinical study included 20 eyes of 20 patients previously exposed to mustard gas with dry eye syndrome unresponsive to artificial tears. Before and after treatment with topical cyclosporine A 0.05% twice daily for 3 months, subjects were evaluated for improvement in symptoms using the ocular surface disease index (OSDI and signs by tear breakup time (TBUT, Schirmer test and measurement of superior bulbar conjunctival goblet cell density. Limbal stem cell deficiency (LSCD and the degree of corneal squamous cell metaplasia were also assessed before and after treatment. Results: Before treatment, mean OSDI score, Schirmer test I value and mean TBUT were 42.8 ± 6.1, 4.2 ± 1.2 mm and 2.5 ± 1.3 s, respectively. After 3 months of treatment with topical cyclosporine A, these scores reached 36.4 ± 5.2, 5.8 ± 1.6 mm and 4.9 ± 2.1 s, respectively showing a statistically significant improvement (P 0.05. Conclusion: Treatment with topical cyclosporine A 0.05% in patients with severe dry eye due to mustard gas injury increases goblet cell density in the bulbar conjunctiva and improves symptoms of the disease.
Jung, Se Ji; Mehta, Jodhbir S; Tong, Louis
The twenty-first century is fraught with dangers like climate change and pollution, which impacts human health and mortality. As levels of pollution increase, respiratory illnesses and cardiovascular ailments become more prevalent. Less understood are the eye-related complaints, which are commonly associated with increasing pollution. Affected people may complain of irritation, redness, foreign body sensation, tearing, and blurring of vision. Sources of pollution are varied, ranging from gases (such as ozone and NO 2 ) and particulate matter produced from traffic, to some other hazards associated with indoor environments. Mechanisms causing ocular surface disease involve toxicity, oxidative stress, and inflammation. Homeostatic mechanisms of the ocular surface may adapt to certain chronic changes in the environment, so affected people may not always be symptomatic. However there are many challenges associated with assessing effects of air pollution on eyes, as pollution is large scale and difficult to control. Persons with chronic allergic or atopic tendencies may have a pre-existing state of heightened mucosal immune response, hence they may have less tolerance for further environmental antigenic stimulation. It is beneficial to identify vulnerable people whose quality of life will be significantly impaired by environmental changes and provide counter measures in the form of protection or treatment. Better technologies in monitoring of pollutants and assessment of the eye will facilitate progress in this field. Copyright © 2018 Elsevier Inc. All rights reserved.
Chao, Cecilia; Stapleton, Fiona; Badarudin, Ezailina; Golebiowski, Blanka
To determine the repeatability of ocular surface threshold measurements using the Cochet-Bonnet esthesiometer on the same day and 3 months apart. Two separate studies were conducted to determine the repeatability of ocular surface threshold measurements made on the same day (n = 20 subjects) and 3 months apart (n = 29 subjects). The Cochet-Bonnet esthesiometer was used to measure corneal and inferior conjunctival thresholds using the ascending method of limits. The pressure exerted by the Cochet-Bonnet esthesiometer was determined using an analytical balance, for both the 0.08- and 0.12-mm-diameter filaments. This calibration was then used to convert filament length measurements to pressure. Repeatability was determined using a Bland and Altman analysis. The pressure exerted at each filament length differed between the two filament diameters. The measured pressure also differed from values provided by the manufacturer. Repeatability of threshold measurements at the central cornea was shown to be good, with better repeatability for same-day measurements (coefficient of repeatability [CoR] = ±0.23 g/mm²) than for those 3 months apart (CoR = ±0.52 g/mm²). Threshold measurements at the inferior conjunctiva, in contrast, were poorly repeatable (CoR = ±12.78 g/mm²). Cochet-Bonnet esthesiometry is repeatable when performed on the central cornea on the same day and 3 months apart, but this instrument is not recommended for conjunctival threshold measurements.
Vannetti, Federica; Matteoli, Sara; Finocchio, Lucia; Lacarbonara, Francesco; Sodi, Andrea; Menchini, Ugo; Corvi, Andrea
An impairment of ocular blood flow regulation is commonly considered one of the main pathogenetic mechanisms involved in the development of several eye diseases, like glaucoma. The aim of this study was to investigate whether an alteration of ocular blood supply induced by peripheral vasoconstriction might be detected by measuring the ocular surface temperature. The ocular surface temperature was evaluated in a group of 38 healthy young subjects (28 males and 10 females; mean age: 25.4 ± 4.1 years) by infrared thermography. For each subject, the experimental procedure consisted of two thermographic acquisitions both lasting 10 s, recorded before and during the immersion of both hands in a mixture of ice and water (1.6 °C ± 0.4 °C). Specifically, the second acquisition began 20 s after the hand immersion. Analysis of variance was used to compare the ocular surface temperature of the two profiles. The analysis of infrared images was carried out every 2 s: at the eye opening (t(0)) until 10 s (t(5)), for both profiles. Data showed that ocular surface temperature increased significantly (p-value temperature at t(0) for P(1) = 0.12 °C ± 0.13 °C). Therefore, these results suggest a response of the ocular hemodynamic to the peripheral vasoconstriction. The ocular surface temperature may represent a cheap, non-invasive and non-time-consuming test to evaluate ocular vaso-regulation.
Schargus, Marc; Kohlhaas, Markus; Unterlauft, Jan Darius
Promising healing effects by albumin eye drops (AED) on the corneal epithelium have been demonstrated. The aim of this study was to analyze retrospectively if AED are an effective treatment for severe ocular surface defects and if recurrences can be reduced. Seventeen patients with persistent epithelial defects (PED) and 30 patients with sterile corneal ulcers (CU) were treated either with 5% AED or 0.1% hyaluronan eye drops (HED) 8 times daily until complete epithelium closure. Sizes of the corneal defects, length of treatment and follow-up period, as well as recurrence rate were evaluated. Follow-up of PED was carried out for 126 ± 21 days in the AED group and 142 ± 39 days in the HED group. For CU cases, regular follow-up visits were performed for 117 ± 15 days in the AED group and 112 ± 28 days in the HED group. Nine patients in PED group were treated for 11 ± 4 days with AED and the HED group (8 patients) was treated for 10 ± 3 days until corneal epithelium was closed, with only one recurrence in the HED group (P = 0.67). Fifteen patients in CU group were treated for 18 ± 6 days with AED and the HED group (15 patients) was treated for 21 ± 7 days until epithelial closure, with 1 recurrence in the AED group and 8 in the HED group (P = 0.03). This comparative retrospective case-control study showed that AED are able to close corneal epithelial defects like CU and PED as good as HED. Even though times of healing were similar for both treatments, AED seem to reduce the recurrence of sterile CU. Our findings suggest that AED might be beneficial in the management of ocular surface epithelial damage; however, further larger studies are necessary to confirm these results.
Kobayashi, Masakazu; Nakamura, Takahiro; Yasuda, Makoto; Hata, Yuiko; Okura, Shoki; Iwamoto, Miyu; Nagata, Maho; Fullwood, Nigel J; Koizumi, Noriko; Hisa, Yasuo; Kinoshita, Shigeru
Severe ocular surface diseases (OSDs) with severe dry eye can be devastating and are currently some of the most challenging eye disorders to treat. To investigate the feasibility of using an autologous tissue-engineered cultivated nasal mucosal epithelial cell sheet (CNMES) for ocular surface reconstruction, we developed a novel technique for the culture of nasal mucosal epithelial cells expanded ex vivo from biopsy-derived human nasal mucosal tissues. After the protocol, the CNMESs had 4-5 layers of stratified, well-differentiated cells, and we successfully generated cultured epithelial sheets, including numerous goblet cells. Immunohistochemistry confirmed the presence of keratins 3, 4, and 13; mucins 1, 16, and 5AC; cell junction and basement membrane assembly proteins; and stem/progenitor cell marker p75 in the CNMESs. We then transplanted the CNMESs onto the ocular surfaces of rabbits and confirmed the survival of this tissue, including the goblet cells, up to 2 weeks. The present report describes an attempt to overcome the problems of treating severe OSDs with the most severe dry eye by treating them using tissue-engineered CNMESs to supply functional goblet cells and to stabilize and reconstruct the ocular surface. The present study is a first step toward assessing the use of tissue-engineered goblet-cell transplantation of nonocular surface origin for ocular surface reconstruction. ©AlphaMed Press.
Nicklin, Amanda M; McEntee, Margaret C; Ledbetter, Eric C
Latent canine herpesvirus-1 (CHV-1) infections are common in domestic dogs, but stimuli causing viral reactivation and recrudescent disease are poorly understood. Immunosuppressive pharmaceuticals are currently the only experimentally established triggers for recurrent ocular CHV-1 infection in dogs; however, ocular CHV-1 shedding has been reported clinically following strontium-90 beta radiotherapy of the ocular surface and it has been speculated that radiotherapy can directly induce viral reactivation. Strontium-90 is used as a beta radiation source for the treatment of a variety of neoplastic and immune-mediated canine ocular surface diseases. In the present study, the effects of ocular surface strontium-90 beta radiotherapy in dogs latently infected with CHV-1 were evaluated. Ten mature dogs with experimentally induced latent CHV-1 infections were randomly divided into two groups: one group received a single fraction 50 Gy radiation dose in one application from a strontium-90 ophthalmic applicator and the second group received sham radiotherapy. Dogs were then monitored for 45 days for recurrent ocular CHV-1 infection using clinical and virological outcome measures. Clinical ophthalmic examinations, ocular sample CHV-1 PCR assays, and serum CHV-1 virus neutralizing antibody assays were performed at specified intervals. No abnormalities suggestive of recurrent CHV-1 ocular disease were observed on clinical examination in any dog during the study. Ocular viral shedding was not detected and CHV-1 virus neutralizing titers remained stable in all dogs. A single fraction 50 Gy radiation dose administered to the ocular surface by strontium-90 beta radiotherapy did not result in detectable recurrent ocular CHV-1 infection in mature dogs with experimentally induced latent infection. Copyright © 2014 Elsevier B.V. All rights reserved.
Shah, Ankit; Espana, Edgar M; Singh, Arun D
To describe 2 cases of invasive squamous cell carcinoma that originated in the setting of severe atopic keratoconjunctivitis (AKC). Case one involved a 73-year-old male with atopic eczema and severe AKC who developed a limbal lesion suspicious for ocular surface squamous neoplasia (OSSN). Slit-lamp examination was significant for a new sessile lesion in the temporal limbal region of the left eye. The lesion was treated with excisional biopsy and cryotherapy. Topical therapy with mitomycin C, topical interferon alpha 2b, and topical 5-fluorouracil provided only partial control. Exenteration was eventually needed. Case two involved a 53-year-old male with history of severe AKC and eczema. Computed tomography imaging showed an infiltrative mass of the right orbit. Incisional biopsies confirmed conjunctival squamous cell carcinoma of both sides (invasive in the right eye, in situ in the left eye). Exenteration was needed for control of invasive carcinoma in the right eye. Squamous cell carcinoma was treated without success in spite of surgical excision and aggressive treatment with multiple topical agents and multiple applications of cryotherapy. Orbital exenteration was needed in both cases. Chronic inflammation associated with AKC may be a risk factor for the development of bilateral, diffuse, invasive, and recurrent OSSN that may require exenteration.
Yin, Vivian T; Merritt, Helen A; Sniegowski, Matt; Esmaeli, Bita
Eyelid cancers account for 5% to 10% of all cutaneous malignancies. The incidence of eyelid cancer is approximately 15 cases per 100,000 individuals per year. Basal cell carcinoma is by far the most common cutaneous malignancy in the periocular area; other cutaneous malignancies that occur in this area include, in decreasing order of frequency, squamous cell carcinoma, sebaceous carcinoma, melanoma, and Merkel cell carcinoma. The most common treatment for eyelid carcinomas is surgical resection with frozen section examination for margin control, but exenteration may be needed when there is orbital invasion. Adjuvant radiotherapy may be needed in patients at high risk for local recurrence; sentinel lymph node biopsy may be considered in patients at high risk for lymph node metastasis. Primary or residual in situ disease of the conjunctiva can be treated with topical chemotherapy, such as mitomycin C, 5-fluorouracil, or interferon alpha-2 b. For patients with metastatic or locally advanced basal cell or squamous cell carcinoma not amenable to surgical excision or radiotherapy, targeted therapy against the hedgehog pathway (for basal cell carcinoma) or epidermal growth factor receptor (for squamous cell carcinoma) has been shown to be effective in preventing disease progression. Patients with eyelid and ocular surface malignancies need to be monitored with careful clinical examination for at least 5years after surgical treatment, and additional investigations may be warranted in some cases. Copyright © 2015. Published by Elsevier Inc.
Full Text Available Stephen C Pflugfelder1, Christophe Baudouin2,3 1Ophthalmology-Ocular Surface Center, Baylor College of Medicine, Houston, TX, USA; 2Department of Ophthalmology, Quinze-Vingts Hospital, Paris, France; 3Vision Institute, Paris, France Abstract: Ocular surface disease (OSD is common among glaucoma patients. Clinical assessment of OSD can be challenging. This review focuses on some of the limitations relating to both subjective and objective measures of OSD, including dry eye. A survey of the literature was conducted to identify the caveats associated with different methods of assessing OSD. The effect of preservatives on the ocular surface, with respect to glaucoma patients in particular, was also reviewed. Objective methods for assessing ocular surface health and disease include the Schirmer test, tear break-up time, fluorescein turnover, corneal and conjunctival staining, tear osmolarity, and vital dyes. These measures all have limitations in terms of their ability to grade the severity of OSD. Previous studies using the OSD Index showed a mild-to-moderate correlation to dry eye disease severity. Other scoring systems for dry eye have shown a relationship to patient symptom scores or quality of life. Due to the challenges clinicians face concerning both subjective and objective ocular surface health assessments, discerning clinical improvement in ocular surface disease can be a challenge. Further research is needed in order to optimize existing clinical methods and/or identify alternative techniques for assessing OSD in the glaucoma population. Keywords: dry eye, glaucoma, ocular surface disease, ocular surface disease index, preservatives, tear break-up time
McMonnies, Charles W
A 2014 PubMed search for tear hyperosmolarity and corneal stain yielded 2960 results. Selections from those providing evidence of variations in osmolarity were used to refine the compartmentalization model of tear osmolarity over the ocular surface. This new model includes the low point of freshly produced isotonic tears in the upper conjunctival sac, with osmolarity increasing successively in the upper meniscus, the upper area of exposed ocular surface, the lower area of over-exposed ocular surface, the lower meniscus, and the lower conjunctival sac. Compartmentalization is used to explain epitheliopathy over the ocular surface as resulting from variable degrees of exposure to hyperosmolarity-induced insult and/or friction-related mechanical damage. Also recognized is the role of localized increases in osmolarity, which appear likely to occur in the black lines and tear breakup areas of the exposed ocular surface. Variables such as the influence of ambient conditions of air humidity, temperature and movement have been considered, as well as rates of complete and incomplete blinks and associated potential for over-exposure of the inferior area of the normally exposed ocular surface. The exacerbating contribution from contact lens wear has been included. Friction-related damage may be the primary basis for lid wiper epitheliopathy, but tear hyperosmolarity could have an important contributory role. Subcompartmental consideration of variation in osmolarity may improve understanding of different presentations of epitheliopathy. Copyright © 2015 Elsevier Inc. All rights reserved.
A 38-year-old female patient, a farmer by occupation, presented to the OPD with complaints of foreign body sensation, redness, and diminution of vision in the right ... acuity of the right eye was the only perception of light and projection of rays in all the quadrants. Intraocular pressure was digitally normal. Ocular movements ...
Shorter, Ellen; Harthan, Jennifer; Nau, Cherie B; Nau, Amy; Barr, Joseph T; Hodge, David O; Schornack, Muriel M
To describe current practice patterns regarding the use of scleral lens therapy in the management of corneal irregularity and ocular surface disease among eye care providers who fit scleral lenses. The Scleral Lenses in Current Ophthalmic Practice: an Evaluation (SCOPE) study group conducted an electronic survey of eye care providers from January 15 to March 31, 2015. Respondents ranked management options for corneal irregularity in the order in which they would generally consider their use. Respondents also ranked options for the management of ocular surface disease in the order in which they would use each of the treatments. Results for each option were analyzed as percentage first-place ranking; percentage first-, second-, or third-place ranking; and mean rank score. Survey responses were obtained from 723 providers who had fit 5 or more scleral lenses. Of these respondents, 629 ranked options for management of corneal irregularity and 612 ranked options for management of ocular surface disease. Corneal rigid gas-permeable lenses were the first option for management of corneal irregularity for 44% of respondents, and scleral lenses were the first option for 34% of respondents. Lubricant drops were the first therapeutic recommendation for ocular surface disease for 84% of respondents, and scleral lenses were ranked first by 6% of respondents. Scleral lenses rank second only to corneal rigid gas-permeable lenses for management of corneal irregularity. Scleral lenses are generally considered after other medical intervention and before surgery for the management of ocular surface disease.
Palamar, M; Kaya, E; Egrilmez, S; Akalin, T; Yagci, A
To evaluate the long-term efficacy of amniotic membrane transplantation for ocular surface reconstruction in the surgical management of ocular surface squamous neoplasia (OSSN). OSSN in 21 patients (7 female, 14 male patients) was managed with excisional biopsy, cryotherapy, corneal epitheliectomy with absolute alcohol application when the cornea is involved, lamellar sclerectomy and adjunctional absolute alcohol application to the base when episclera is involved, and ocular surface reconstruction with cryopreserved amniotic membrane transplantation. Tumor control and complications were evaluated. The mean age of the patients was 62.42 ± 20.9 (range, 16-84). The average diameter of the base of the tumors was 13.1 ± 4.8 (range, 9-21) mm and complete removal was achieved in all cases as revealed histopathologically. Ocular surface healing was achieved in all cases. At the postoperative period, limbal stem cell deficiency in three eyes and mild symblepharon in one eye were detected. In a mean follow-up of 30.95 ± 18.8 (range, 13-75) months, no recurrence was detected. For large or multifocal conjunctival tumors, the reconstruction of ocular surface and fornix is challenging. The amniotic-membrane use to repair conjunctival defects larger than 10 mm is a safe and effective technique with minimal complications allowing surgeons to make large enough excisions.
Full Text Available Matthew Sniegowski, Michael Erlanger, Raul Velez-Montoya, Jeffrey L Olson Ophthalmology Department, University of Colorado School of Medicine, Rocky Mountain Lions Eye Institute, Aurora, CO, USA Purpose: To assess the change in ocular surface temperature between healthy phakic and pseudophakic patients.Methods: We included patients with no history of ocular disease other than cataract. Patients were divided into three groups: clear lens, cataract, and pseudophakic. All patients had two ocular surface digital thermal scans. An average of five surface points was used as the mean ocular surface temperature. Results were analyzed with a one-way analysis of variance and a Tukey’s least significance difference test. The patients were further divided into phakic and pseudophakic groups. Correlation coefficients between several variables were done in order to assess dependencies.Results: Fifty-six eyes (28 cataracts, 12 clear lenses, 16 pseudophakic were enrolled. The mean ocular surface temperature in the cataract group was 34.14°C±1.51°C; clear lens: 34.43°C±2.27°C; and pseudophakic: 34.97°C±1.57°C. There were no statistical differences among the study groups (P=0.3. There was a nonsignificant negative correlation trend between age and surface temperature in the phakic group. The trend inverted in the pseudophakic group but without statistical significance.Conclusion: Although cataract extraction and intraocular lens implantation seem to induce a mild increase in ocular surface temperature, the effect is not clear and not significant. Keywords: digital thermal scans, intraocular lens implantation, cataract extraction
DETORAKIS, EFSTATHIOS T.; KYMIONIS, GEORGE; TSATSOS, MICHAEL; SPANDIDOS, DEMETRIOS A.
In the present study, we aimed to evaluate the co-existence of ophthalmic pterygium with other ocular surface lesions in a cohort of patients from the Cretan population. This is a retrospective evaluation of all pterygia in patients examined and treated at the Department of Ophthalmology of the University Hospital of Heraklion, Greece during an 8-year period (from June 2006 to June 2014). A total of 158 cases was examined. Ocular surface images and medical history were evaluated in order to d...
Detorakis, Efstathios T; Kymionis, George; Tsatsos, Michael; Spandidos, Demetrios A
In the present study, we aimed to evaluate the co-existence of ophthalmic pterygium with other ocular surface lesions in a cohort of patients from the Cretan population. This is a retrospective evaluation of all pterygia in patients examined and treated at the Department of Ophthalmology of the University Hospital of Heraklion, Greece during an 8-year period (from June 2006 to June 2014). A total of 158 cases was examined. Ocular surface images and medical history were evaluated in order to detect concomitant ocular surface pathological conditions. Concomitant lesions included conjunctival nevi (5 cases, 3.16%), iris nevi (4 cases, 2.53%), conjunctival papillomas (8 cases, 5.06%), conjunctival intraepithelial neoplasia (CIN; 4 cases, 2.53%) and 6 cases of hypertophy of the plica semilunaris (3.79%). Of note, pterygium was overlying the iris which was occupied by the iris nevus in 2 out of the 4 cases of iris nevus. Overall, our data indicate that ophthalmic pterygium may often co-exist with other clinically significant ocular surface lesions. The association of ophthalmic pterygium with conjunctival papillomas or CIN stresses the potential involvement of human papilloma virus in the pathogenesis of ophthalmic pterygium, whereas the topographical association of pterygium with iris nevus may offer support to the transcameral light pathway pathogenetic mechanism.
Ashraf, Nargis Nizam; Adhi, Muhammad Idrees
To determine the outcome of application of amniotic graft in ocular surface disorders. This cross-sectional study was conducted at Dow University of Health Sciences, Karachi, from January 2010 to December 2012, and comprised patients with ocular surface disorders. Patients' presenting symptoms and signs were recorded. Previously harvested and frozen amniotic graft was applied in different types of ocular surface disorders, such as corneal ulcers, pterygium, keratomalacia, Steven-Johnson syndrome, etc. Following the surgery, patients were assessed for improvement in symptoms and signs related to epithelialisation in corneal ulcers.. Of the 50 patients, 30(60%) were male and 20(40%) female. The overall mean age was 40±19.3 years (range: 9 months to 80 years). Out of the 18(36%) cases of pterygium, there was recurrence in 5(27.7%) cases. There were 26(52%) patients of corneal ulcers, of whom re-epithelialisation occurred in 21(80.7%) patients. Amniotic membrane grafting was found to be a safe procedure for ocular surface disorders.
Luana Paula Nogueira de Araújo BRANDÃO
Full Text Available ABSTRACT BACKGROUND Bariatric surgery is the most effective treatment for severe obesity, but the surgery increases the risk of developing nutritional deficiencies, such as vitamin A deficiency. In human metabolism, vitamin A plays a role in vision. OBJECTIVE To evaluate serum vitamin A, visual function and ocular surface of patients undergoing bariatric surgery. METHODS A cross-sectional and analytical study was conduced with 28 patients undergoing bariatric surgery for at least 6 months. Ophthalmologic evaluation was done through color vision test, contrast sensitivity test, ocular surface tests and confocal microscopy, as well as vitamin A serum measurement. RESULTS Vertical sleeve gastrectomy was performed in seven (25.0% patients and Roux -en-Y gastric by-pass in 21 (75.0%. Mean serum vitamin A level was 1.7±0.5 µmoL/L. Most patients (60.7% had symptoms of dry eye. Five (17.9% patients had contrast sensitivity impairment and 18 (64.3% color vision changes. In the group of patients undergoing Roux -en-Y gastric by-pass , mean vitamin A levels were 1.8±0.6 µmoL/L, whereas they were 1.7±0.5 µmoL/L in patients submitted to the restrictive technique vertical sleeve gastrectomy . The analysis of the influence of serum levels of vitamin A in the visual function and ocular surface was performed by Pearson correlation test and there was no significant correlation between any of the variables and vitamin A. CONCLUSION There was no influence of the bariatric surgery technique used on serum vitamin A levels, on the visual function or on the ocular surface. Moreover, there was no correlation between serum levels of vitamin A and the visual function or the ocular surface changes.
Brandão, Luana Paula Nogueira de Araújo; Vilar, Lucio; Cavalcanti, Bernardo Menelau; Brandão, Pedro Henrique Amorim; Arantes, Tiago Eugênio Faria E; Campos, Josemberg Marins
- Bariatric surgery is the most effective treatment for severe obesity, but the surgery increases the risk of developing nutritional deficiencies, such as vitamin A deficiency. In human metabolism, vitamin A plays a role in vision. - To evaluate serum vitamin A, visual function and ocular surface of patients undergoing bariatric surgery. - A cross-sectional and analytical study was conduced with 28 patients undergoing bariatric surgery for at least 6 months. Ophthalmologic evaluation was done through color vision test, contrast sensitivity test, ocular surface tests and confocal microscopy, as well as vitamin A serum measurement. - Vertical sleeve gastrectomy was performed in seven (25.0%) patients and Roux -en-Y gastric by-pass in 21 (75.0%). Mean serum vitamin A level was 1.7±0.5 µmoL/L. Most patients (60.7%) had symptoms of dry eye. Five (17.9%) patients had contrast sensitivity impairment and 18 (64.3%) color vision changes. In the group of patients undergoing Roux -en-Y gastric by-pass , mean vitamin A levels were 1.8±0.6 µmoL/L, whereas they were 1.7±0.5 µmoL/L in patients submitted to the restrictive technique vertical sleeve gastrectomy . The analysis of the influence of serum levels of vitamin A in the visual function and ocular surface was performed by Pearson correlation test and there was no significant correlation between any of the variables and vitamin A. - There was no influence of the bariatric surgery technique used on serum vitamin A levels, on the visual function or on the ocular surface. Moreover, there was no correlation between serum levels of vitamin A and the visual function or the ocular surface changes.
Akova Budak, Berna; Baykara, Mehmet; Kıvanç, Sertaç Argun; Yilmaz, Hakan; Cicek, Serhat
Vancomycin is the gold standard in combination therapy for severe and resistant gram-positive keratitis and in particular for Methicillin-resistant Staphylococcus aureus (MRSA) infections. The aim of this study was to report the ocular surface toxicity and scoring in patients whose treatment shifted to topical linezolid/ceftazidime from topical vancomycin/ceftazidime due to their vancomycin intolerance. A retrospective, interventional case series of bacterial keratitis was treated with topical linezolid (one drop of 0.2% solution per eye), administered hourly until epithelization and then gradually decreased. The number and extent of punctate epithelial erosions were noted across the entire surface of the cornea. Ocular discomfort was assessed by means of (a) patient-reported pain upon instillation of the medication (vancomycin/linezolid), (b) reported burning sensation between doses and (c) reported foreign-body sensation. No ocular surface toxicity related to linezolid use was noted. Patients were followed for at least 2 months after treatment between April and December 2013. Of the seven patients included in the study (age range: 2-88 years; five females, two males), complete epithelization and resolution was achieved in five patients. One patient was treated with linezolid after penetrating keratoplasty. The second culture of another patient with impending perforation despite linezolid/ceftazidime therapy yielded Fusarium spp., so he underwent tectonic keratoplasty. The mean ocular surface score was 9.4 ± 1.6 during vancomycin treatment and 5.9 ± 1.3 during linezolid treatment after discontinuation of vancomycin. The topical linezolid score was significantly lower (p = 0.027). Topical linezolid may be better tolerated, according to the mean ocular surface score, than topical vancomycin by some patients and can be considered an alternative for patients who do not well tolerate vancomycin.
Gibson, Emma J; Stapleton, Fiona; Wolffsohn, James S; Golebiowski, Blanka
Sex hormones are associated with the physiology and pathophysiology of almost all organs in the body, as well as most diseases. Interest in the associations between sex hormones and ocular tissues has increased in recent years. Androgens may have a positive effect on dry eye, whereas the effects of oestrogen on ocular conditions remain unclear. Intracrinology, the local synthesis and metabolism of hormones that is unique to humans, is of relevance to the eye and may help to explain why studies of the relationship between oestrogens and dry eye signs and symptoms are inconclusive. Knowledge of the pathways of hormone formation and metabolism is crucial to understanding the pathogenesis of ocular disease including dry eye. This review examines the mechanisms of steroidal sex hormone biosynthesis and reviews the significance of locally produced sex hormones, with a focus on ocular surface tissues. Much of the current literature is based on animal studies, which may not be transferable to humans due to the absence of intracrine production in animals. A large proportion of the human studies investigate systemic hormone levels rather than local levels. There is subsequently a need for additional studies to provide a better understanding of the local production of sex hormones within the human eye and ocular surface and to clarify the relationships between ocular levels of sex hormones and conditions including dry eye. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Sun, Z.Y.; Hong, J.; Liu, Z.Y.; Jin, X.D.; Gu, C.H. [China Medical University, Shenyang (China)
To observe the influence of coal dust on ocular surface of coal miners and rabbits with coal dust contiguity on expression TNF- and NF- Bp65 and dry eye occurrence. Expression TNF- and NF- Bp65 in ocular surface were determined. Results showed tear production, BUT and lysozyme decreased for coal miners and rabbits with coal dust contiguity. Coal dust exposure was linked to development of xerophthalmia, and induced a higher expression of NF- B p65 and TNF- perhaps as a mechanism to resist coal dust ocular surface injury.
Full Text Available PURPOSE To report the efficacy of topical Mitomycin-C in preventing local recurrences after incomplete surgical excision of ocular surface squamous neoplasia. METHODS An interventional case report on a 70-year-old female patient with unilateral ocular surface squamous neoplasia (OSSN. Excision biopsy revealed invasive squamous cell carcinoma. All margins were positive for neoplastic cells. Patient was treated with topical Mitomycin-C 0.04% one drop, four times per day in alternate weeks for 4 weeks to prevent recurrences. RESULT The patient was free of clinically detectable tumour & on impression cytology after a followup period of 10 weeks. Side effects included photophobia, mild redness & punctate epithelial keratopathy. CONCLUSION Postoperative topical Mitomycin-C application may be a useful adjunct to prevent recurrences in patients with incompletely excised OSSN.
Ramesh Murthy; Himika Gupta; Rahul Krishnatry; Siddhartha Laskar
Recurrent extensive ocular surface squamous neoplasia (OSSN) with orbital invasion can be successfully managed with external radiotherapy using electrons resulting in eye and vision salvage. We report a case of right eye recurrent OSSN in an immunocompetent adult Indian male, with extensive orbital involvement. The patient had two previous surgical excisions with recurrent disease. At this stage, conventionally exenteration is considered the treatment modality. However, he was treated with 50...
Aktaş, Serdar; Tetikoğlu, Mehmet; Koçak, Ahmet; Kocacan, Metin; Aktaş, Hatice; Sağdık, Hacı Murat; Özcura, Fatih
This study evaluated the effects of cigarette smoking on the ocular surface, tear function, and tear osmolarity. A total of 50 smokers with at least 5 years of heavy smoking (defined as 1 pack/day) and 51 nonsmoking, healthy individuals were enrolled. Tear osmolarity was measured with an osmometer (TearLab ™ Osmolarity System). Ocular surface examinations involved corneal fluorescein staining, measurement of the tear film breakup time (TBUT), the Schirmer 1 test, measurement of corneal sensitivity with a Cochet-Bonnet esthesiometer, and conjunctival impression cytology. Dry eye symptoms were scored using the Ocular Surface Disease Index (OSDI) questionnaire. The results were compared with those from an age and sex-matched control group. The Chi-squared and independent sample t-tests were used for statistical analyses. The smokers had significantly higher tear osmolarity values (305.38 ± 9.81 vs. 301.14 ± 7.04 mOsm/L; p = 0.014) and OSDI scores (34.13 ± 16.58 vs. 18.09 ± 9.61; p < 0.001) than the healthy controls. However, the TBUT, corneal sensitivity, and goblet cell density were significantly lower in smokers compared to healthy controls, but the fluorescein staining and Schirmer 1 test results were not statistically different between the smokers and controls. Smoking results in increased osmolarity of the tear film, which can damage the ocular surface and tear function.
Carvalho-Rêgo, Paulo Roberto de; Gomes, José Alvaro Pereira; Ballalai, Priscila Luppi; Cunha, Marcelo Carvalho; Sousa, Luciene Barbosa de; Erwenne, Clélia Maria
This study was designed to evaluate the use of human amniotic membrane for ocular surface reconstruction after conjunctival squamous cell carcinoma resection. Amniotic membrane was obtained at the time of cesarean section and was preserved at -80 masculineC in glycerol and cornea culture media at a ratio of 1:1. The inclusion criteria were patients presenting proliferating lesions suggestive of squamous cell carcinoma (flat or elevated white lesions resembling "fish meat") that involve the conjunctiva, limbus and cornea. Eight eyes of 8 patients with conjunctival "squamous cell carcinoma" underwent tumor resection with amniotic membrane transplantation. Three of these cases underwent total corneal epitheliectomy and amniotic membrane transplantation associated with limbal autograft. Mean follow-up time was 17.8 months (range, 10-35 months). In four patients (71.4%) surgical treatment was successful, with good ocular surface stability. In two patients (28.6%) results were partially successful, with mild cicatricial alterations. One patient was excluded from the study due to aggressive tumor recurrence with intraocular invasion that needed to be removed with exenteration. This study suggests that amniotic membrane transplantation is a good alternative for ocular surface reconstruction after conjunctival squamous cell carcinoma resection.
Schmidt, Tannin A.; Sullivan, David A.; Knop, Erich; Richards, Stephen M.; Knop, Nadja; Liu, Shaohui; Sahin, Afsun; Darabad, Raheleh Rahimi; Morrison, Sheila; Kam, Wendy R.; Sullivan, Benjamin D.
Importance Lubricin may be an important barrier to the development of corneal and conjunctival epitheliopathies that may occur in dry eye disease and contact lens wear. Objective To test the hypotheses that lubricin (ie, proteoglycan 4 [PRG4]), a boundary lubricant, is produced by ocular surface epithelia and acts to protect the cornea and conjunctiva against significant shear forces generated during an eyelid blink and that lubricin deficiency increases shear stress on the ocular surface and promotes corneal damage. Design, Setting, and Participants Human, porcine, and mouse tissues and cells were processed for molecular biological, immunohistochemical, and tribological studies, and wild-type and PRG4 knockout mice were evaluated for corneal damage. Results Our findings demonstrate that lubricin is transcribed and translated by corneal and conjunctival epithelial cells. Lubricin messenger RNA is also present in lacrimal and meibomian glands, as well as in a number of other tissues. Absence of lubricin in PRG4 knockout mice is associated with a significant increase in corneal fluorescein staining. Our studies also show that lubricin functions as an effective friction-lowering boundary lubricant at the human cornea-eyelid interface. This effect is specific and cannot be duplicated by the use of hyaluronate or bovine serum albumin solutions. Conclusions and Relevance Our results show that lubricin is transcribed, translated, and expressed by ocular surface epithelia. Moreover, our findings demonstrate that lubricin presence significantly reduces friction between the cornea and conjunctiva and that lubricin deficiency may play a role in promoting corneal damage. PMID:23599181
Full Text Available Angiogenesis is beneficial in the treatment of ischemic heart disease and peripheral artery disease. However, it facilitates inflammatory cell filtration and inflammation cascade that disrupt the immune and angiogenesis privilege of the avascular cornea, resulting in ocular surface diseases and even vision loss. Although great progress has been achieved, healing of severe ocular surface injury and immunosuppression of corneal transplantation are the most difficult and challenging step in the treatment of ocular surface disorders. Mesenchymal stem cells (MSCs, derived from various adult tissues, are able to differentiate into different cell types such as endothelial cells and fat cells. Although it is still under debate whether MSCs could give rise to functional corneal cells, recent results from different study groups showed that MSCs could improve corneal disease recovery through suppression of inflammation and modulation of immune cells. Thus, MSCs could become a promising tool for ocular surface disorders. In this review, we discussed how angiogenesis and inflammation are orchestrated in the pathogenesis of ocular surface disease. We overviewed and updated the knowledge of MSCs and then summarized the therapeutic potential of MSCs via control of angiogenesis, inflammation, and immune response in the treatment of ocular surface disease.
José Alvaro Pereira Gomes
Full Text Available Objetivo: A membrana amniótica tem se consolidado como útil adjuvante no tratamento de afecções da superfície ocular. Sua utilização baseia-se na capacidade de beneficiar o processo de epitelização, além de reduzir os processos inflamatório, angiogênico e cicatricial. O objetivo deste trabalho foi investigar a utilização da membrana amniótica como adjuvante no tratamento das ceratoconjuntivites cicatriciais. Métodos: A membrana amniótica foi captada a partir de parto cesárea e conservada em meio de preservação de córnea e glicerol 1:1 e conservada à -80ºC. Onze olhos de 10 pacientes portadores de ceratoconjuntivite cicatricial grave foram submetidos à cirurgia reconstrutiva da superfície ocular empregando membrana amniótica associada (8 casos ou não (3 casos a transplante de limbo e conjuntiva. Dos 10 pacientes, 3 tinham diagnóstico de síndrome de Stevens-Johnson (SSJ (4 olhos, 6 queimadura ocular por álcali (6 olhos e 1 trauma mecânico (1 olho. Resultados: O tempo médio de seguimento foi de 5,22 meses (variação entre 2 e 13 meses. Um caso de SSJ apresentou infecção pós-operatória e foi excluído da análise dos resultados. Dos outros 10 casos, obtivemos êxito na reconstrução da superfície ocular em 8 casos (80%. Insucesso foi observado em 2 casos de SSJ que apresentavam necrose de córnea no momento da cirurgia (20%. Em relação à acuidade visual, observamos que todos os pacientes apresentaram melhora ou manutenção da acuidade visual. Conclusões: O uso de membrana amniótica constitui uma opção alternativa de grande utilidade na reconstrução da superfície ocular dos casos graves de ceratoconjuntivites cicatriciais que não estejam apresentando necrose estromal. Estudos com maior casuística e tempo de seguimento são necessários para melhor avaliar esse procedimento.Purpose: Amniotic membrane has been consolidated as an useful adjunct in the treatment of ocular surface disorders. Its use is
Full Text Available To develop an effective ocular drug delivery carrier, we prepared two different charged gelatin nanoparticles (GPs and evaluated particle size, surface charge, and morphology. The in vitro biocompatibility of GPs was assessed using human corneal epithelium (HCE cells and in vivo safety by administering them as eye drops to New Zealand rabbits. The GPs prepared using type A gelatin were positively charged (GP(+, +33 mV; size, 180.6±45.7 nm. Water-soluble tetrazolium salt (WST-1 assay showed that both GPs were nontoxic to HCE cells. The fluorescence intensity of HCE cells cultured with cationic GPs conjugated with a fluorescent dye was higher than that of the anionic GP-treated HCE cells. In vivo examination showed no serious irritation to the rabbit eyes. Furthermore, corneal thickness and ocular pressure in the eyes of the treated rabbits were similar to those in the eyes of normal rabbits. Microscopic examination of corneal cryosections showed widely distributed fluorescent nanocarriers, from the anterior to the posterior part of the cornea of the GP(+ group, and higher fluorescence intensity in the GP(+ group was also observed. In conclusion, GPs as cationic colloidal carriers were efficiently adsorbed on the negatively charged cornea without irritating the eyes of the rabbits and can be retained in the cornea for a longer time. Thus, GPs(+ have a great potential as vehicles for ocular drug delivery.
Goto, Eiki; Dogru, Murat; Sato, Enrique Adan; Matsumoto, Yukihiro; Takano, Yoji; Tsubota, Kazuo
To measure the sparkle of the human eye evaluated by the intensity of corneal light reflection in normal subjects and dry eye patients to investigate whether ocular surface wetness has an impact on the sparkle of the eye. Prospective case-control study. We examined a consecutive series of eight dry eye patients with Sjögren syndrome (SS, 15 eyes), as well as eight normal subjects (16 eyes). The specular corneal surface light reflection was quantitatively measured with an ophthalmic slit-lamp microscope and image capturing system under fixed conditions of light source, incident angle, and detector sensitivity. The intensity of images from subjects' corneal light reflection was quantified with image analysis software along with the measurement of grade of self-reported brilliancy of the eye, corneal fluorescein staining score, tear film break-up time, and Schirmer test value. The intensity of corneal light reflection was also compared before and after dry eye treatment. The mean intensity of corneal light reflection was significantly lower in dry eye patients (125.0 ± 40.1) than normal subjects (167.6 ± 36.6, P=.004). Grade of self-reported brilliancy of the eye, corneal fluorescein staining scores, tear film break-up time, and Schirmer test values showed good correlation to the intensity of corneal light reflection. After punctal plug treatment, the intensity of corneal light reflection significantly increased from 125.0 ± 40.1 to 167.2 ± 45.0 (Plight reflection representing the sparkle of the eye was significantly more intense in normal subjects compared to dry eye patients, and was increased after punctal plug treatment. The intensity of corneal light reflection appeared to correlate well with tear film stability, volume, and ocular surface desiccation. We showed that tears contributed not only to ocular surface wetness but also to the extent of the light reflection from the eye. Copyright © 2011 Elsevier Inc. All rights reserved.
Full Text Available Gregory Katz1, Clark L Springs2, E Randy Craven3, Michela Montecchi-Palmer41Huron Ophthalmology, Ypsilanti, MI, USA; 2Indiana University Eye Care, Indianapolis, IN, USA; 3Specialty Eye Care, Denver, CO, USA; 4Alcon Research Ltd., Fort Worth, TX, USAPurpose: The preservative benzalkonium chloride (BAK may adversely affect ocular surface health. This study evaluated symptoms of ocular surface disease (OSD in patients previously treated with a BAK-preserved therapy to lower their intraocular pressure, who either continued that therapy or switched to a BAK-free therapy.Methods: Eligible adult patients with ocular hypertension or open-angle glaucoma that had been controlled with BAK-preserved latanoprost 0.005% monotherapy (Xalatan® for at least one month and had a score of ≥ 13 (0 = none, 100 = most severe on the Ocular Surface Disease Index (OSDI questionnaire were entered into this prospective, double-masked, randomized, active-controlled, multicenter trial. By random assignment, patients either continued with BAK-preserved latanoprost 0.005% or transitioned to BAK-free travoprost 0.004% (Travatan Z® ophthalmic solution. OSDI scores were assessed again after six and 12 weeks.Results: For the 678 evaluable patients, mean change in OSDI score from baseline to week 12 favored the travoprost 0.004% BAK-free group, but was not statistically different between groups (P = 0.10. When patients with mild OSD at baseline were assessed after 12 weeks, the mean OSDI score was significantly lower (P = 0.04 in the BAK-free travoprost 0.004% group (score = 11.6 ± 10.8 units than in the BAK-preserved latanoprost 0.005% group (score = 14.4 ± 11.9 units, and a significantly larger percentage (P < 0.01 improved to normal OSDI scores in the BAK-free travoprost 0.004% group (62.9% of group than in the BAK-preserved latanoprost 0.005% group (47.0% of group. Patients pretreated with BAK-preserved latanoprost 0.005% for >24 months were significantly more likely (P
Lopes, Joao F.; Hubatsch, Douglas A.; Amaris, Patricia
Background Prostaglandin analogs reduce intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension; however, these medications may affect the ocular surface and elicit ocular discomfort when preserved with benzalkonium chloride (BAK). Methods This was an open-label, single-arm study conducted in Latin America from February 2012 to May 2013. Patients with open-angle glaucoma or ocular hypertension who were intolerant of latanoprost 0.005?% were transitioned to recei...
Akpek, Esen Karamursel; Vittitow, Jason; Verhoeven, Rozemarijn S; Brubaker, Kurt; Amar, Thierry; Powell, Kendall D; Boyer, José L; Crean, Christopher
To investigate the ocular distribution of 1% azithromycin ophthalmic solution and the effect of polycarbophil-based mucoadhesive formulation on ocular tissue levels of azithromycin after single and multiple topical administrations in the rabbit eye. Rabbits were treated with either a single administration of 1% azithromycin solution with or without polycarbophil, or with multiple administrations of 1% azithromycin solution in polycarbophil. Drug concentrations were measured using LC/MS/MS. Conjunctiva, cornea, aqueous humor, and tear samples were analyzed over a period of 144 h after a single administration of azithromycin with or without polycarbophil. Eyelid, conjunctiva, cornea, aqueous humor, and tear samples were collected over a period of 288 h during and after multiple administrations of azithromycin. Azithromycin was rapidly absorbed and distributed in the ocular tissues, reaching within 5 min, concentrations of 10,539 microg/mL in tear film, 108 microg/g in conjunctiva, and 40 microg/g in the cornea. The drug demonstrated tissue-specific half-lives of 15, 63, and 67 h, respectively. Following multiple administrations, the drug gradually accumulated. The polycarbophil formulation increased the bioavailability of the drug, producing peak concentrations that were between 5- and 12-fold higher than those without polycarbophil. Azithromycin also distributed rapidly in the eyelids, reaching peak concentrations of 180 mug/g at the end of the 7-day treatment, and was eliminated with a half-life of 125 h. Six days after treatment was discontinued, eyelid levels of azithromycin were above 40 microg/g. Sustained and high concentrations were encountered with 7-day approved administration of 1% azithromycin formulation (AzaSite, Inspire Pharmaceuticals, Inc., Durham, NC) within all ocular surface tissues, particularly the lids. Many ocular surface disorders involving the tear film, eyelids, and adnexal structures are associated with chronic, low-grade bacterial
Chao, Cecilia; Richdale, Kathryn; Jalbert, Isabelle; Doung, Kim; Gokhale, Moneisha
Contact lens wear is one of the primary risk factors for the development of ocular surface inflammatory events. The purpose of this review is to examine and summarize existing knowledge on the mechanisms of contact lens related ocular surface inflammation and the evidence for the effectiveness of current objective methods to measure ocular surface inflammation. Contact lens wear is postulated to trigger an inflammatory response on the ocular surface due to mechanical, chemical, hypoxic stress, or by the introduction of microbes and their toxins. Apart from the traditional signs of inflammation, such as swelling, oedema, redness and heat, on the ocular surface, other methods to measure ocular surface inflammation in sub-clinical levels include tear inflammatory mediator concentrations, conjunctival cell morphology, and corneal epithelial dendritic cell density and morphology. Tear inflammatory mediator concentrations are up- or down-regulated during contact lens wear, with or without the presence of associated inflammatory events. There is higher conjunctival cell metaplasia observed with contact lens wear, but changes in goblet cell density are inconclusive. Dendritic cell density is seen to increase soon after initiating soft contact lens wear. The long term effects of contact lens wear on dendritic cell migration in the cornea and conjunctiva, including the lid wiper area, require further investigation. Currently patient factors, such as age, smoking, systemic diseases and genetic profile are being studied. A better understanding of these mechanisms may facilitate the development of new management options and strategies to minimize ocular surface inflammation related to contact lens wear. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
Full Text Available AIM: To investigate the effect and value of amniotic membrane patches and grafts for acute ocular surface burn at different degrees.METHODS: A retrospective analysis of 28 cases(28 eyesaffected by ocular chemical or thermal burn with different degree were included in our hospital from March 2007 to March 2012. Amniotic membrane patched was undergone in 13 eyes with fresh amnion that the patients corneal burns degree Ⅱ or Ⅲ with partial limbal buns at degree Ⅳ. Amniotic membrane grafts was performed in 15 eyes with fresh amnion that the patients all corneal burns at degree Ⅲ with the whole limbal necrosis without severe eyelid defect. The follow-up time ranged 6～24mo. The postoperative visual acuity, the condition of amniotic membrane transplant, renovation of cornea and complications were observed. RESULTS: Postoperative corrected visual acuity was improved in 20 eyes(71%, it was not changed in 5 eyes(18%, the visual acuity declined in 3 eyes(11%. The amniotic membrane survived in 23 eyes and the survival rate was up to 82%. The cornea of 4 eyes recovered to transparent, nebula emceed in 8 eyes eventually, corneal macula emerged in 10 eyes, 4 eyes ended up with leukoma, 2 eyes developed corneal melting after therapy, then received lamellar keratoplasty. Corneal surface become epithelization after amnion patches or grafts, but any of them have recurrent epithelial erosion, and become stable epithalization after repeat operation.CONCLUSION: Amniotic membrane patches and grafts is an effective method to deal with acute ocular surface burn.
Tighe, Brian J
Since the initial launch of silicone hydrogel lenses, there has been a considerable broadening in the range of available commercial material properties. The very mobile silicon-oxygen bonds convey distinctive surface and mechanical properties on silicone hydrogels, in which advantages of enhanced oxygen permeability, reduced protein deposition, and modest frictional interaction are balanced by increased lipid and elastic response. There are now some 15 silicone hydrogel material variants available to practitioners; arguably, the changes that have taken place have been strongly influenced by feedback based on clinical experience. Water content is one of the most influential properties, and the decade has seen a progressive rise from lotrafilcon-A (24%) to efrofilcon-A (74%). Moduli have decreased over the same period from 1.4 to 0.3 MPa, but not solely as a result of changes in water content. Surface properties do not correlate directly with water content, and ingenious approaches have been used to achieve desirable improvements (e.g., greater lubricity and lower contact angle hysteresis). This is demonstrated by comparing the hysteresis value of the earliest (lotrafilcon-A, >40°) and most recent (delefilcon-A, silicone hydrogels. Although wettability is important, it is not of itself a good predictor of ocular response because this involves a much wider range of physicochemical and biochemical factors. The interference of the lens with ocular dynamics is complex leading separately to tissue-material interactions involving anterior and posterior lens surfaces. The biochemical consequences of these interactions may hold the key to a greater understanding of ocular incompatibility and end of day discomfort.
Carracedo, Gonzalo; Wang, Zicheng; Serramito-Blanco, Maria; Martin-Gil, Alba; Carballo-Alvarez, Jesús; Pintor, Jesús
To evaluate the ocular surface temperature using an infrared thermography camera before and after wearing scleral lens in patients with keratoconus and correlate these results with the tear production and stability. A pilot, experimental, short-term study has been performed. Twenty-six patients with keratoconus (36.95±8.95 years) participated voluntarily in the study. The sample was divided into two groups: patients with intrastromal corneal ring (KC-ICRS group) and patients without ICRS (KC group). Schirmer test, tear breakup time (TBUT), and ocular surface temperature in the conjunctiva, limbus, and cornea were evaluated before and after wearing a scleral lens. The patients wore the scleral lenses from 6 to 9 hours with average of 7.59±0.73 hours. No significant changes in Schirmer test and TBUT were found for both groups. No temperature differences were found between the KC-ICRS and the KC groups for all zones evaluated. There was a slight, but statistically significant, increase in the inferior cornea, temporal limbus, and nasal conjunctival temperature for KC-ICRS group and temporal limbus temperature decreasing for the KC group after wearing scleral lens (Ptemperature was statistically higher than the central cornea for both groups before and after scleral lenses wearing (Pperipheral cornea was found. No statistically significant differences in the central corneal temperature were found between the groups after scleral lens wearing (P>0.05). Scleral contact lens seems not to modify the ocular surface temperature despite the presence of the tear film stagnation under the lens.
V. N. Trubilin
Full Text Available When acute inflammation in anterior eye segment of a forward piece of an eye was stopped, ophthalmologists face a problem of absence of acute inflammation signs and at the same time complaints to the remain discomfort feelings. It causes dissatisfaction from the treatment. The complaints are typically caused by disturbance of tears productions. No accidental that the new group of diseases was allocated — the diseases of the ocular surface. Ocular surface is a difficult biologic system, including epithelium of the conjunctiva, cornea and limb, as well as the area costal margin eyelid and meibomian gland ducts. Pathological processes in conjunctiva, cornea and eyelids are linked with tears production. Ophthalmologists prescribes tears substitutions, providing short-term relief to patients. However, in respect that the lipid component of the tear film plays the key role in the preservation of its stability, eyelids hygiene is the basis for the treatment of dry eye associated with ocular surface diseases. Eyelids hygiene provides normal functioning of glands, restores the metabolic processes in skin and ensures the formation of a complete tear film. Protection of eyelids, especially the marginal edge from aggressive environmental agents, infections and parasites and is the basis for the prevention and treatment of blepharitis and dry eye syndrome. The most common clinical situations and algorithms of their treatment and prevention of dysfunction of the meibomian glands; demodectic blepharitis; seborrheic blepharitis; staphylococcal blepharitis; allergic blepharitis; barley and chalazion are discussed in the article. The prevention keratoconjunctival xerosis (before and postoperative period, caused by contact lenses, computer vision syndrome, remission after acute conjunctiva and cornea inflammation is also presented. The first part of the article presents the treatment and prevention algorithms for dysfunction of the meibomian glands, as well as
Espana, Edgar M; Levine, Mark; Schoenfield, Lynn; Singh, Arun D
Ocular surface squamous cell neoplasia in an anophthalmic socket is an exceptionally rare occurrence. We report a 62-year-old white man who had his left eye enucleated at age 2 and developed an invasive squamous cell carcinoma 60 years later. He received multiple treatments, including excisional biopsy, topical mitomycin C chemotherapy, cryotherapy, and finally exenteration. We review the literature to evaluate the clinical characteristics, time of onset following enucleation, treatment, and outcome of previously reported cases. Our case emphasizes the importance of a thorough examination of the anophthalmic socket, including upper and lower lid eversion. Copyright © 2011 Elsevier Inc. All rights reserved.
Singh, Arti; Maurya, O P S; Jagannadhan, M V; Patel, Ashok
The purpose of this paper is to determine the active form of matrix metalloproteinases (MMP-2 and MMP-9) in corneal ulcer and ocular surface disorder patients. A total of 35 patients of corneal ulcer, 20 patients of ocular surface disorders and 10 control subjects were included in this study and estimation of active form of MMP-2 and MMP-9 was done by gelatin zymography. Tear samples were collected by capillary tube method. Both pro- and active forms of MMP-9 were detected in 24 out of 35 patients with corneal ulcer and 15 out of 20 patients with ocular surface disorders. None of the patients were showing MMP-2 activity. Neither MMP-2 nor MMP-9 was detected in the control group. Active forms of MMP-9 are present in tears of severe ulcerative and ocular surface disorder patients. Thus, proteinase inhibitors have been recommended for the treatment of corneal ulcer and ocular surface disorders to reduced the progression of stromal ulcer and to minimize corneal scarring.
Mujat, Mircea; Patel, Ankit H.; Maguluri, Gopi N.; Iftimia, Nicusor V.; Patel, Chirag; Agranat, Josh; Tomashevskaya, Olga; Bonte, Eugene; Ferguson, R. Daniel
The use of a Prosthetic Replacement of the Ocular Surface Environment (PROSE) device is a revolutionary treatment for military patients that have lost their eyelids due to 3rd degree facial burns and for civilians who suffer from a host of corneal diseases. However, custom manual fitting is often a protracted painful, inexact process that requires multiple fitting sessions. Training for new practitioners is a long process. Automated methods to measure the complete corneal and scleral topology would provide a valuable tool for both clinicians and PROSE device manufacturers and would help streamline the fitting process. PSI has developed an ocular anterior-segment profiler based on Optical Coherence Tomography (OCT), which provides a 3D measure of the surface of the sclera and cornea. This device will provide topography data that will be used to expedite and improve the fabrication process for PROSE devices. OCT has been used to image portions of the cornea and sclera and to measure surface topology for smaller contact lenses [1-3]. However, current state-of-the-art anterior eye OCT systems can only scan about 16 mm of the eye's anterior surface, which is not sufficient for covering the sclera around the cornea. In addition, there is no systematic method for scanning and aligning/stitching the full scleral/corneal surface and commercial segmentation software is not optimized for the PROSE application. Although preliminary, our results demonstrate the capability of PSI's approach to generate accurate surface plots over relatively large areas of the eye, which is not currently possible with any other existing platform. Testing the technology on human volunteers is currently underway at Boston Foundation for Sight.
Simmons, Ken T; Xiao, Yangyan; Pflugfelder, Stephen C; de Paiva, Cintia S
Toll-like receptor 4 (TLR4) alerts cells to the presence of bacteria by initiating an inflammatory response. We hypothesize that disruption of the ocular surface barrier in dry eye enhances TLR4 signaling. This study determined whether dry eye enhances expression of inflammatory mediators in response to topically applied TLR4 ligand. A single dose of lipopolysaccharide (LPS) or vehicle (endotoxin-free water) was applied to the cornea of nonstressed (NS) mice or mice subjected to 5 days of desiccating stress (DS). After 4 hours, corneal epithelium and conjunctiva were extracted to analyze expression of inflammatory mediators via PCR. Protein expression was confirmed by immunobead assay and immunostaining. Topically applied LPS increased expression of inflammatory mediators IL-1β, CXCL10, IL-12a, and IFN-γ in the conjunctiva, and IL-1β and CXCL10 in the cornea of NS mice compared to that in untreated controls. LPS in DS mice produced 3-fold increased expression of IL-1β in cornea and 2-fold increased expression in IL-12a in conjunctiva compared to that in LPS-treated control mice. LPS increased expression of inflammatory cytokines on the ocular surface. This expression was further increased in dry eye, which suggests that epithelial barrier disruption enhances exposure of LPS to TLR4+ cells and that the inflammatory response to endotoxin-producing commensal or pathogenic bacteria may be more severe in dry eye disease.
Westekemper, H; Anastassiou, G; Sauerwein, W; Chauvel, P; Bornfeld, N; Steuhl, K-P; Meller, D
In cases of large, diffuse or multilocular growth pattern of conjunctival melanoma, proton beam irradiation can serve as an alternative therapy to exenteration. In extended tumours, ocular surface problems can result after therapy. In this study we examined ocular surface integrity of ten patients who underwent proton beam radiation between 1996 and 2002. The patients were examined during their follow-up. Eight of the ten cases who underwent proton radiotherapy were recurrent tumours, which were previously treated with other adjuvant therapies. We performed a standard ophthalmological examination and detailed tear film diagnostics. The follow-up was 17-87 months (mean: 40.9+/-20.1). In six cases more than 50% of the upper and lower eyelids were included in the radiation field. All of these cases showed moderate to severe sicca symptoms. The impression cytology revealed squamous metaplasia of conjunctival cells in nine of ten cases. Squamous metaplasia of conjunctival epithelia indicates a radiogenic, persisting disturbance of differentiation of the conjunctival epithelial cells. The tear film instability correlates with the loss of mucin-secreting goblet cells and meibomian gland dysfunction.
Guilherme Goulart Quinto
Full Text Available Autologous serum has been used to treat dry eye syndrome for many years. It contains several growth factors, vitamins, fibronectin and other components that have been considered important for corneal and conjunctival integrity. Serum eye drops are usually prepared as an unpreserved blood solution. The serum is by nature well tolerated and its biochemical properties are somewhat similar to natural tears. Autologous serum eye drops have been reported to be effective for the treatment of severe dry eye-related ocular surface disorders (Sjögren's syndrome, and also other entities such as superior limbic keratoconjunctivitis, graft-versus-host disease, Stevens-Johnson syndrome, ocular cicatricial pemphigoid, recurrent or persistent corneal erosions, neurotrophic keratopathy, Mooren's ulcer, aniridic keratopathy, filtering blebs after trabeculectomy, and post-keratorefractive surgery. The purpose of this study is to review the recently published literature on ocular surface diseases treated with human autologous serum eye drops.O soro autólogo tem sido adotado como uma nova abordagem para tratar síndrome do olho seco porque contém vitaminas, alguns fatores de crecimento e fibronectina que são considerados importantes contribuintes para integridade corneana e conjuntival. Colírio de soro autólogo é produzido sem preservativo. O soro é não-alérgico e suas propriedades bioquímicas são similares à lágrima. O soro autólogo tópico tem sido relatado efetivo para o tratamento de olho seco grave relacionado a distúrbios da superfície ocular como na síndrome de Sjögren, ceratoconjuntivite límbica superior, doença do enxerto versus hospedeiro, síndrome de Stevens-Johnson, procedimentos cerato-refrativos, erosão corneana persistente ou recorrente, ceratopatia neurotrófica, úlcera de Mooren, ceratopatia associada à aniridia, e bolhas filtrantes após trabeculectomia. O objetivo do presente estudo é revisar a literatura recentemente
Fernández-Ferreiro, Anxo; Silva-Rodríguez, Jesús; Otero-Espinar, Francisco Javier; González-Barcia, Miguel; Lamas, María Jesús; Ruibal, Alvaro; Luaces-Rodríguez, Andrea; Vieites-Prado, Alba; Lema, Isabel; Herranz, Michel; Gómez-Lado, Noemí; Blanco-Mendez, José; Gil-Martínez, María; Pardo, María; Moscoso, Alexis; Cortes, Julia; Sánchez-Martínez, María; Pardo-Montero, Juan; Aguiar, Pablo
In last years, sensitive hydrogels have become a breakthrough in ophthalmic pharmaceutical technology aimed at developing new strategies to increase the residence time of active substances. In a previous paper, we qualitatively demonstrated the capacity of a new ion sensitive hydrogel to increase the residence time. Nevertheless, the clearance of the gel from the ocular surface was not quantifiable with the used methodology. The aim of the present work was to use a well-established approach based on scintigraphy to quantitatively estimate the residence time of the previously proposed hydrogel. The rat corneal residence time of a topic ophthalmic formulation containing gellan gum and kappa carragenan (0.82% w/v) labeled with 99m Tc-DTPA radiotracer was evaluated and compared with the residence of an aqueous solution. Ophthalmic safety studies such as eye irritation or passage through the cornea were also carried out. After 1.5h of contact, 77% of the hydrogel remained in the ocular surface, presenting kinetics of disappearance one-phase decay and a half time of 262min. We conclude that the novel ophthalmic hydrogel developed with kappa carrageenan and gellan gum remains for long periods of time on the corneal surface, presenting a drop that fits an exponential decay. Copyright © 2017 Elsevier B.V. All rights reserved.
Perlmann, Eduardo; da Silva, Enry Garcia; Guedes, Pedro Mancini; Barros, Paulo Sergio de Moraes
A 14-year-old spayed female domestic short-haired cat was presented for evaluation of a mass in the right eye. Ophthalmic examination revealed a blind right eye and presence of two distinct masses: a pink and a red-to-brown mass, the latter occupying most of the cornea and part of the conjunctiva. Exenteration was performed under general anesthesia, and the ocular tissues were processed routinely for histopathology. Upon microscopic examination, a malignant epithelial neoplasm and a benign vascular neoplasm were present in the cornea. The conjunctiva and the third eyelid were also affected. Upon immunohistochemistry, the epithelial tumor was positive for cytokeratin and negative for vimentin and the endothelial tumor was negative for cytokeratin and positive for vimentin. A diagnosis of squamous cell carcinoma (SCC) and hemangioma was made. The SCC was affecting the cornea, bulbar conjunctiva (lateral and inferior) and the base of the third eyelid, whereas the hemangioma was affecting the cornea and medial limbus. To the authors' knowledge, this is the first report of concomitant SCC and hemangioma affecting the ocular surface in a cat.
Flavia Pelinsari Lana
Full Text Available Purpose: Many reports have indicated an association between thyroid dieases and primary Sjögren’s syndrome (pSS. The aim of our study was to evaluate the outcomes of the tests used for dry eye diagnosis and salivary gland involvement in patients with autoimmune thyroiditis. Methods: Forty-two patients (group 1 with autoimmune thyroid disease and 30 controls (group 2 were selected. Tear film break up time, Schirmer I test, Schirmer II test, ocular staining with 1% rose Bengal and salivary gland cintilography were performed in both groups. Results: Regarding the ocular surface damage observed by Rose Bengal test there was no difference between groups (p=0.77. For tear film break up time the groups did not differ statistically (p=0.46. There was no statistical difference between groups 1 and control in scintigraphy of the salivary gland (p=0.99. A statistical difference between the patients with thyroid disease and the control group was seem only in the Schirmer II test (p=0.0009. Conclusions: No patients fulfilled all criteria for Sjögren’s syndrome. It is possible that it could be underestimated.
Mastropasqua, Rodolfo; Agnifili, Luca; Fasanella, Vincenzo; Nubile, Mario; Gnama, Agbeanda A; Falconio, Gennaro; Perri, Paolo; Di Staso, Silvio; Mariotti, Cesare
Ocular surface diseases (OSDs) represent a widely investigated field of research given their growing incidence and the negative impact on quality of life. During OSDs, cytokines generated by damaged epithelia trigger and deregulate the lymphoid cells composing the eye-associated lymphoid tissues, inducing an immune-mediated chronic inflammation that amplifies and propagates the disease during time. The conjunctiva-associated lymphoid tissue (CALT), given its particular position that permits immune cells covering the cornea, might play a crucial role in the development of OSDs. Despite the recognized inflammatory role of mucosa-associated lymphoid tissues in other stations taking contact with the external environment (gut or bronchus), CALT did not gain the deserved consideration. In the last years, the diffusion of the in vivo confocal microscopy (IVCM) stimulated the interest to CALT, especially in dry eye, ocular allergy, and glaucoma. Though the initial stimuli were different, IVCM documented similar changes, represented by increased lymphoid cells within the diffuse layer, follicles and interfollicular spaces. These findings, which need to be validated by immunohistology, support the CALT stimulation during OSDs. However, while an involvement of the CALT in OSDs is hypothesizable, the exact role of this structure in their pathogenesis remains unclear and warrants further investigations.
Ng, Alison; Evans, Katharine; North, Rachel V; Jones, Lyndon; Purslow, Christine
Despite the fact that cosmetic products undergo rigorous testing to ensure they are safe for human use, some users report mild discomfort following their application. The cutaneous changes, such as allergic dermatitis, are well reported, but the ocular changes associated with eye cosmetic use are less so. Some pigmented cosmetic products may accumulate within the lacrimal system and conjunctivae over many years of use, but immediate reports of eye discomfort after application are most common. Changes to the tear film and its stability may occur shortly after application, and contact lens wearers can also be affected by lens spoliation from cosmetic products. Additionally, creams used in the prevention of skin aging are often applied around the eyes, and retinoids present in these formulations can have negative effects on meibomian gland function and may be a contributing factor to dry eye disease. The aim of this review is to summarize current knowledge regarding the impact of cosmetic products on the eye, ocular surface, and tear film.
He, Jingliang; Yamane, Mio; Shibata, Shinsuke; Fukui, Masaki; Shimizu, Eisuke; Yano, Tetsuya; Mukai, Shin; Kawakami, Yutaka; Li, Shaowei; Tsubota, Kazuo; Ogawa, Yoko
To report the characteristics of the ocular surface in a previously established sclerodermatous chronic graft-versus-host disease (cGVHD) mouse model. The ocular surface features and tear film parameters of the mouse model were assessed by histopathology, immunohistochemistry, electron microscopy, quantitative polymerase chain reaction, and flow cytometry. The mice exhibited loss of body weight and decreased tear secretion (P < 0.001), mimicking the clinical features of patients with cGVHD. Ocular examination demonstrated significant corneal epithelial staining, conjunctival (P < 0.001), and eyelid (P = 0.015) fibrosis compared with the control mice. The density of both goblet cells (P = 0.043) and microvilli was lower (P < 0.001), and the microvilli were shorter (P = 0.007) in the conjunctiva of cGVHD mice than those of the controls. The immunohistochemical studies demonstrated greater expression of CD45, CD4, and CD8 cells in the conjunctiva and eyelid tissues compared with the controls (P < 0.05 for all). In addition, reduced Forkhead box P3 (Foxp3)+ cells were found in both the peripheral blood (P < 0.001) and conjunctiva (P = 0.042) of cGVHD mice compared with the controls. The constellation of these findings suggests that the sclerodermatous cGVHD mouse model well recapitulates ocular manifestations of cGVHD in humans. This model can be used to study the mechanisms involved in the pathogenesis and treatment of chronic ocular graft-versus-host disease.
Zhang, Lily; Mercado, Carolina; Galor, Anat; Holland, Edward J; Wang, Gaofeng; Karp, Carol L
Few studies have described ocular surface squamous neoplasia (OSSN) and its association with atopic diseases and there is no consensus on the course of OSSN in atopic patients. We thereby report three patients with atopy and OSSN. Retrospective case series. Three male patients with mean age of 73 presented with OSSN and history of atopy treated with immunosuppressant therapy. Their histories included atopic dermatitis and keratoconjunctivitis. All patients had treatment complicated by multiple surgeries, recurrences, or advanced disease. The patients initially received medical treatment with topical interferon-alpha-2b (IFNα2b). However, all the patients had recurrences and required modification of treatment including topical 5-fluorouracil (5-FU). We report on three patients with a history of atopy whose OSSN presentation and course was challenging. Overall, our cases responded better to topical 5-fluorouracil compared to topical interferon-alpha-2b, but recurrences were common. These patients may benefit from more aggressive and long-term treatment.
Zhang, Aizhong; Maki, Kara L; Salahura, Gheorghe; Kottaiyan, Ranjini; Yoon, Geunyoung; Hindman, Holly B; Aquavella, James V; Zavislan, James M
In this study, we explore the usage of ocular surface temperature (OST) decay patterns to distinguished between dry eye patients with aqueous deficient dry eye (ADDE) and meibomian gland dysfunction (MGD). The OST profiles of 20 dry eye subjects were measured by a long-wave infrared thermal camera in a standardized environment (24 °C, and relative humidity (RH) 40%). The subjects were instructed to blink every 5 s after 20 ∼ 25 min acclimation. Exponential decay curves were fit to the average temperature within a region of the central cornea. We find the MGD subjects have both a higher initial temperature (p model, referred to as the thermal impulse perturbation (TIP) model. We conclude that long-wave-infrared thermal imaging is a plausible tool in assisting with the classification of dry eye patient. Copyright © 2015 Elsevier Ltd. All rights reserved.
Shields, Carol L; Kancherla, Swarupa; Bianciotto, Carlos G; Lally, Sara E; Shields, Jerry A
To describe the clinical features and management of extensive ocular surface squamous neoplasia (OSSN) (squamous cell carcinoma) of the socket. Retrospective interventional case series. Interferon α 2b (IFNa2b) eye drops (1 million units/cc) 4 times daily and IFNa2b sublesional injection (5 million units/0.5cc to 8 million units/0.8 cc) were delivered for tumor control. Participants were 3 patients with ocular prosthesis who developed extensive socket OSSN. Tumor control was graded as complete regression, partial regression, or no regression. OSSN was detected in the socket at age 60, 43, and 20 years in patients who had worn ophthalmic prostheses for 54, 26, and 13 years, respectively. The patients had chronic discharge and irritation (n = 3) managed with intermittent topical corticosteroids (n = 2). There were no predisposing factors of cigarette exposure, radiation exposure, eczema, systemic immune suppression, or organ transplantation. The prosthesis fit well with nonirritative edges. At presentation, OSSN was subtle (n = 3), vascular (n = 3), and multifocal (n = 3), with largest lesions or confluence of lesions measuring 20, 25, and 20 mm, respectively. The tumors involved the tarsal (n = 3), bulbar (n = 2), and forniceal (n = 2) surfaces. All patients were treated with topical and injection IFNa2b, with complete regression achieved in 2 cases (at 1 months and 20 months) and partial regression in one case (at 9 months). All patients continue on chronic maintenance IFNa2b topically. There were no recurrences, and IFNa2b injection side effects of nausea and chills were minor, lasting 1 day. No patient required surgical removal of tumors from the socket and no patient required exenteration. Patients wearing ophthalmic prosthesis over a socket should be monitored for the development of OSSN. Combined topical and injection IFNa2b could represent a potentially effective therapy for this condition.
Lee, Hyo Seok; Cui, Lian; Li, Ying; Choi, Ji Suk; Choi, Joo-Hee; Li, Zhengri; Kim, Ga Eon; Choi, Won; Yoon, Kyung Chul
To investigate the influence of overexposure to light emitting diode (LED)-derived light with various wavelengths on mouse ocular surface. LEDs with various wavelengths were used to irradiate C57BL/6 mice at an energy dose of 50 J/cm2, twice a day, for 10 consecutive days. The red, green, and blue groups represented wavelengths of 630 nm, 525 nm, and 410 nm, respectively. The untouched group (UT) was not exposed to LED light and served as the untreated control. Tear volume, tear film break-up time (TBUT), and corneal fluorescein staining scores were measured on days 1, 3, 5, 7, and 10. Levels of interferon (IFN)-γ, interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α were measured in the cornea and conjunctiva using a multiplex immunobead assay at day 10. Levels of malondialdehyde (MDA) were measured with an enzyme-linked immunosorbent assay. Flow cytometry, 2'7'-dichlorofluorescein diacetate (DCF-DA) assay, histologic analysis, immunohistochemistry with 4-hydroxynonenal, and terminal deoxynucleotidyl transferase-mediated dUTP-nick end labeling (TUNEL) staining were also performed. TBUT of the blue group showed significant decreases at days 7 and 10, compared with the UT and red groups. Corneal fluorescein staining scores significantly increased in the blue group when compared with UT, red, and green groups at days 5, 7, and 10. A significant increase in the corneal levels of IL-1β and IL-6 was observed in the blue group, compared with the other groups. The blue group showed significantly increased reactive oxygen species production in the DCF-DA assay and increased inflammatory T cells in the flow cytometry. A significantly increased TUNEL positive cells was identified in the blue group. Overexposure to blue light with short wavelengths can induce oxidative damage and apoptosis to the cornea, which may manifest as increased ocular surface inflammation and resultant dry eye.
Gipson, Ilene K
Aging of the ocular surface and corneal tissues, major components of the visual system, causes major eye disease and results in substantial cost in medical and social terms. These diseases include the highly prevalent dry eye disease that affects the ocular surface and its glands, leading to tear film alterations, discomfort, and decreased vision. Studies show that 14.4% of the population in the United States older than 50 years have dry eye disease and demonstrate that it is particularly prevalent among women. Annual medical costs per patient with dry eye in the United States are estimated at $783 per year, with an overall medical cost adjusted to prevalence of $3.84 billion per year. Societal costs, which include loss of productivity, are estimated per patient at $11,302 per year, with overall costs adjusted to prevalence of $55.4 billion per year. Because there are few effective treatments for the disease, more research on its etiology and mechanisms is warranted and needed. Increased public education about risk factors for the disease is also required. Another major age-related eye disease of the cornea that leads to vision impairment and potentially blindness if left untreated is Fuchs' endothelial corneal dystrophy. This disease leads to loss of the endothelial cells on the internal side of the cornea that are responsible for keeping the cornea in the proper hydration state to ensure its transparency to light. The mechanism of cell loss is unknown, and the only treatment available to date is surgical transplantation of the cornea or inner part of the cornea. These medically costly procedures require donor corneas, eye banking, and medical follow-up, with accrued costs. Fuchs' endothelial corneal dystrophy is a major cause of corneal transplantation in the United States; therefore, research support is needed to determine the mechanism of this age-related disease, to develop medical, nonsurgical methods for treatment.
Full Text Available Pur po se: To investigate the effectiveness of amniotic membrane transplantation in cases with corneal thinning, desmatocele and refractive corneal ulcer. Ma te ri al and Met hod: Fifty-four eyes of 54 patients who were applied amniotic membrane transplantation for various ocular surface disease between January 2004 and February 2009 in Çukurova University Ophthalmology Department were included in the study. A complete ophthalmologic examination was performed. Corneal culture and corneal cytology samples were collected from the patients with the diagnosis of corneal ulcers. The patients were informed about the surgical procedure and the possible complications and informed consent was obtained. The amniotic membranes that were prepared under optimal conditions and protected in frozen forms were used in the operations. Follow-up examinations were done at postoperative 1st day, 1st week, 1st month, 3rd month, 6th month and then once in a year. Re sults: Of 54 patients, 26 (48.1% were men and 28 (51.8% were women. The mean age of patients was 52.53±19.75 (2-87 years. The cases were separated into 2 groups according to the etiology: group 1 - eyes with corneal ulcer (n:26 and group 2 - eyes with corneal stromal thinning, persistent epithelial defects and desmatocel (n:28. The transplantations were performed using cover technique in 17 eyes (31.4%, graft technique in 37 eyes (68.5% and graft technique with corneal patch in 2 eyes (3.7%. Partial penetrating keratoplasty was required in 38 of 54 eyes (70.3%. One eye was enucleated. Dis cus si on: The amniotic membrane transplantation has advantages like: it can be prepared easily and is cost-effective. It is a safe and effective procedure in ocular surface disease. (Turk J Ophthalmol 2012; 42: 177-82
Galor, Anat; Garg, Nisha; Nanji, Afshan; Joag, Madhura; Nuovo, Gerard; Palioura, Sotiria; Wang, Gaofeng; Karp, Carol L
To identify the frequency of human papilloma virus (HPV) in ocular surface squamous neoplasia (OSSN) and to evaluate differences in clinical features and treatment response of tumors with positive versus negative HPV results. Retrospective case series. Twenty-seven patients with OSSN. Ocular surface squamous neoplasia specimens were analyzed for the presence of HPV. Clinical features and response to interferon were determined retrospectively and linked to the presence (versus absence) of HPV. Clinical characteristics of OSSN by HPV status. Twenty-one of 27 tumors (78%) demonstrated positive HPV results. The HPV genotypes identified included HPV-16 in 10 tumors (48%), HPV-31 in 5 tumors, HPV-33 in 1 tumor, HPV-35 in 2 tumors, HPV-51 in 2 tumors, and a novel HPV in 3 tumors (total of 23 tumors because 1 tumor had 3 identified genotypes). Tumors found in the superior limbus were more likely to show positive HPV results (48% vs. 0%; P=0.06, Fisher exact test). Tumors with positive HPV-16 results were larger (68 vs. 34 mm2; P=0.08, Mann-Whitney U test) and were more likely to have papillomatous morphologic features (50% vs. 12%; P=0.07, Fisher exact test) compared with tumors showing negative results for HPV-16. Human papilloma virus status was not found to be associated with response to interferon therapy (P=1.0, Fisher exact test). Metrics found to be associated with a nonfavorable response to interferon were male gender and tumors located in the superior conjunctivae. The presence of HPV in OSSN seems to be more common in lesions located in the nonexposed, superior limbus. Human papilloma virus presence does not seem to be required for a favorable response to interferon therapy. Copyright © 2015 American Academy of Ophthalmology. All rights reserved.
Angelino Julio Cariello
Full Text Available PURPOSE: To evaluate the ocular surface toxicity of two nitric oxide donors in ex vivo and in vivo animal models: S-nitrosoglutathione (GSNO and S-nitroso-N-acetylcysteine (SNAC in a hydroxypropyl methylcellulose (HPMC matrix at final concentrations 1.0 and 10.0 mM. METHODS: Ex vivo GSNO and SNAC toxicities were clinically and histologically analyzed using freshly excised pig eyeballs. In vivo experiments were performed with 20 albino rabbits which were randomized into 4 groups (5 animals each: Groups 1 and 2 received instillations of 150 µL of aqueous HPMC solution containing GSNO 1.0 and 10.0 mM, respectively, in one of the eyes; Groups 3 and 4 received instillations of 150 µL of aqueous HPMC solution-containing SNAC 1.0 and 10.0 mM, respectively, in one of the eyes. The contralateral eyes in each group received aqueous HPMC as a control. All animals underwent clinical evaluation on a slit lamp and the eyes were scored according to a modified Draize eye test and were histologically analyzed. RESULTS: Pig eyeballs showed no signs of perforation, erosion, corneal opacity or other gross damage. These findings were confirmed by histological analysis. There was no difference between control and treated rabbit eyes according to the Draize eye test score in all groups (p>0.05. All formulations showed a mean score under 1 and were classified as "non-irritating". There was no evidence of tissue toxicity in the histological analysis in all animals. CONCLUSION: Aqueous HPMC solutions containing GSNO and SNAC at concentrations up to 10.0 mM do not induce ocular irritation.
Cariello, Angelino Julio; Souza, Gabriela Freitas Pereira de; Lowen, Márcia Serva; Oliveira, Marcelo Ganzarolli de; Höfling-Lima, Ana Luisa
To evaluate the ocular surface toxicity of two nitric oxide donors in ex vivo and in vivo animal models: S-nitrosoglutathione (GSNO) and S-nitroso-N-acetylcysteine (SNAC) in a hydroxypropyl methylcellulose (HPMC) matrix at final concentrations 1.0 and 10.0 mM. Ex vivo GSNO and SNAC toxicities were clinically and histologically analyzed using freshly excised pig eyeballs. In vivo experiments were performed with 20 albino rabbits which were randomized into 4 groups (5 animals each): Groups 1 and 2 received instillations of 150 µL of aqueous HPMC solution containing GSNO 1.0 and 10.0 mM, respectively, in one of the eyes; Groups 3 and 4 received instillations of 150 µL of aqueous HPMC solution-containing SNAC 1.0 and 10.0 mM, respectively, in one of the eyes. The contralateral eyes in each group received aqueous HPMC as a control. All animals underwent clinical evaluation on a slit lamp and the eyes were scored according to a modified Draize eye test and were histologically analyzed. Pig eyeballs showed no signs of perforation, erosion, corneal opacity or other gross damage. These findings were confirmed by histological analysis. There was no difference between control and treated rabbit eyes according to the Draize eye test score in all groups (p>0.05). All formulations showed a mean score under 1 and were classified as "non-irritating". There was no evidence of tissue toxicity in the histological analysis in all animals. Aqueous HPMC solutions containing GSNO and SNAC at concentrations up to 10.0 mM do not induce ocular irritation.
Onischenko, A L; Dimaksyan, M V; Kolbasko, A V; Zilina, N M
To evaluate ocular surface changes in patients with primary open-angle glaucoma (POAG) as well as the hypotensive effect of preservative-free betaxolol eye drops. A total of 22 patients (42 eyes) aged 55-83 with POAG stage I-II were examined. All of them were switched from betaxolol b.i.d. to its preservative-free analogue (Xonef BK). The baseline examination included visual acuity measurement, Morisky-Green test (questionnaire), Norn test, Schirmer's test, lissamine green staining, and ocular tonometry. The latter was repeated 2 and 4 weeks after the drug had been switched, while the whole complex--2 months after the beginning of the study. The total tear production in POAG patients under betaxolol therapy was 19.1 ± 10.6 mm. After the 2 months of preservative-free betaxolol use there were no statistically significant changes in Schirmer's test results (p = 0.248). Tear film break-up time (Norn test) improved from 7.8 ± 0.5 secto 9.8 ± 0.8 sec (p = 0.067) as well as the results of lissamine green staining (W = 90.0, p < 0.022). In the Morisky-Green Test betaxolol patients scored only 2.6 ± 0.05 points on average, thus showing non-compliance. After the 2 months of preservative-free betaxolol instillations the scores increased up to 3.1 ± 0.07 (p = 0.04). According to Dunnett's test, used for multiple comparisons, intraocular pressure did not change significantly in either of the study periods (baseline and follow-up measurements at weeks 2, 4, and 8 were taken into account). The study proves Xonef BK safe, effective, and appropriate in all types of glaucoma.
Full Text Available The aim of this work is to investigate changes in the ocular surface (OS and tear film (TF by means of questionnaire-based subjective symptoms, TF break-up time, Schirmer test, and TF analysis in women working with computers and to analyze the effects of the oral supplementation with antioxidants/omega 3 fatty acids (A/ω3 in the OS outcomes. Women aged 40–65 years (n=148 were recruited at the Administrative Offices of Valencia (Spain and distributed into two age groups, 40–52 years (AGE1; n=87 and 53–65 years (AGE2; n=61, and then subdivided according to being (or not computer users (CUG; NCUG during the workday. Homogeneous subgroups were randomly assigned (or not to the daily intake of three pills of A/ω3 for three months. At baseline and at the end of follow-up, personalized interviews and ocular examination were done. Reflex tear samples were collected from the inferior meniscus and processed for a multiplexed particle-based flow cytometry assay to measure proinflammatory molecules. Statistics were performed using the SPSS 15.0 program. The OS pathology was clinically evident in the AGE1-CUG (33% versus the AGE2-CUG (64% of women. Significantly higher interleukins-1β and -6 tear levels were found in the AGE1 versus the AGE2 women employees (P=0.006 and P=0.001, resp., as well as in the CUG versus the NCUG (P=0.001 and P=0.000, resp.. Supplementation with A/ω3 positively influenced the OS pathology as manifested by the amelioration of the clinical signs/symptoms related to computer uses. Strategies involving a safe environment and oral micronutrient supplements may be managed within eye-care standards in older women.
Ribelles, Alfredo; Galbis-Estrada, Carmen; Parras, Maria A; Vivar-Llopis, Bárbara; Marco-Ramírez, Carla; Diaz-Llopis, Manuel
The aim of this work is to investigate changes in the ocular surface (OS) and tear film (TF) by means of questionnaire-based subjective symptoms, TF break-up time, Schirmer test, and TF analysis in women working with computers and to analyze the effects of the oral supplementation with antioxidants/omega 3 fatty acids (A/ω3) in the OS outcomes. Women aged 40-65 years (n = 148) were recruited at the Administrative Offices of Valencia (Spain) and distributed into two age groups, 40-52 years (AGE1; n = 87) and 53-65 years (AGE2; n = 61), and then subdivided according to being (or not) computer users (CUG; NCUG) during the workday. Homogeneous subgroups were randomly assigned (or not) to the daily intake of three pills of A/ω3 for three months. At baseline and at the end of follow-up, personalized interviews and ocular examination were done. Reflex tear samples were collected from the inferior meniscus and processed for a multiplexed particle-based flow cytometry assay to measure proinflammatory molecules. Statistics were performed using the SPSS 15.0 program. The OS pathology was clinically evident in the AGE1-CUG (33%) versus the AGE2-CUG (64%) of women. Significantly higher interleukins-1β and -6 tear levels were found in the AGE1 versus the AGE2 women employees (P = 0.006 and P = 0.001, resp.), as well as in the CUG versus the NCUG (P = 0.001 and P = 0.000, resp.). Supplementation with A/ω3 positively influenced the OS pathology as manifested by the amelioration of the clinical signs/symptoms related to computer uses. Strategies involving a safe environment and oral micronutrient supplements may be managed within eye-care standards in older women.
Hayirci, Emre; Yagci, Ayse; Palamar, Melis; Basoglu, O K; Veral, Ali
To evaluate the effect of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea syndrome on the ocular surface. This is a prospective, sectional cohort study of 80 eyes of 40 patients diagnosed with obstructive sleep apnea syndrome. Routine ophthalmologic examination and ocular surface evaluation, including biomicroscopy, Schirmer 1 testing, tear break-up time measurement, ocular surface staining, and conjunctival impression cytology, were performed in both of each patient's eyes before and 4 months after starting CPAP therapy. After CPAP therapy, increases in squamous metaplasia (Nelson classification: t = 0.34, P = 0.014) and Schirmer 1 score (t = 3.20, P = 0.008), and decreases in tear break-up time (t = -1.38, P = 0.008) in the right eyes were statistically significant, as compared with the pretreatment values. Although these parameters changed in a similar fashion in the left eyes, differences between the pre-CPAP and post-CPAP values were not significant. The findings indicate that CPAP therapy increased ocular irritation, tear evaporation, and squamous metaplasia in the conjunctiva of the patients' right and left eyes. Although the parameters measured were similar in both eyes before CPAP therapy, these parameters changed significantly after CPAP therapy only in the right eyes. The observed differences between the right and left eyes require further investigation to determine the possible effects of sleeping position, CPAP mask displacement, and the other factors involved.
Ying Ting Chen
Full Text Available Keratinizing squamous metaplasia (SQM of the ocular surface is a blinding consequence of systemic autoimmune disease and there is no cure. Ocular SQM is traditionally viewed as an adaptive tissue response during chronic keratoconjunctivitis sicca (KCS that provokes pathological keratinization of the corneal epithelium and fibrosis of the corneal stroma. Recently, we established the autoimmune regulator-knockout (Aire KO mouse as a model of autoimmune KCS and identified an essential role for autoreactive CD4+ T cells in SQM pathogenesis. In subsequent studies, we noted the down-regulation of paired box gene 6 (Pax6 in both human patients with chronic KCS associated with Sjögren's syndrome and Aire KO mice. Pax6 encodes a pleiotropic transcription factor guiding eye morphogenesis during development. While the postnatal function of Pax6 is largely unknown, we hypothesized that its role in maintaining ocular surface homeostasis was disrupted in the inflamed eye and that loss of Pax6 played a functional role in the initiation and progression of SQM. Adoptive transfer of autoreactive T cells from Aire KO mice to immunodeficient recipients confirmed CD4+ T cells as the principal downstream effectors promoting Pax6 downregulation in Aire KO mice. CD4+ T cells required local signaling via Interleukin-1 receptor (IL-1R1 to provoke Pax6 loss, which prompted a switch from corneal-specific cytokeratin, CK12, to epidermal-specific CK10. The functional role of Pax6 loss in SQM pathogenesis was indicated by the reversal of SQM and restoration of ocular surface homeostasis following forced expression of Pax6 in corneal epithelial cells using adenovirus. Thus, tissue-restricted restoration of Pax6 prevented aberrant epidermal-lineage commitment suggesting adjuvant Pax6 gene therapy may represent a novel therapeutic approach to prevent SQM in patients with chronic inflammatory diseases of the ocular surface.
... Español Eye Health / Eye Health A-Z Ocular Hypertension Sections What Is Ocular Hypertension? Ocular Hypertension Causes ... Hypertension Diagnosis Ocular Hypertension Treatment What Is Ocular Hypertension? Leer en Español: ¿Qué es la hipertensión ocular? ...
Avetisov, S É; Safonova, T N; Novikov, I A; Pateiuk, L S; Griboedova, I G
As any mucous membrane the conjunctiva is characterized by a definite pH value which guarantees-physiological functioning of the ocular surface. The most commonly used method of assessment is potentiometric pH measurement with ion-specific glass microelectrodes. The results, however, can be affected by such factors, as conjunctival sac zoning, tissue acidity, epithelial trauma, and reflex tear secretion. Few data and hypotheses are available on mechanisms of maintaining the acid-base balance of the conjunctival sac (bicarbonate buffering system in particular). to study spatial variability of conjunctival tear fluid pH and possible mechanisms of its maintenance using original methods of acidity measurement and mineral content assessment. Tear pH was determined in 42 healthy participants (84 eyes) by means of litmus test strips and computer- aided colorimetry. Electron probe microanalysis in combination with energy dispersive spectrometry was performed in 8 healthy participants (8 eyes, 8 samples). In the group of 42 healthy participants (84 eyes) the pH value of conjunctival tear fluid varied from 6.30 to 7.23 with the average of 6.76 and pH mode 6.74. The pH value of conjunctival mucous discharge was measured in 25 healthy participants (28 eyes) and varied from 7.00 to 8.00 with the average of 7.26 and pH mode 7.30. The main mineral components of tear fluid are chlorine, sodium, potassium, and boron. Borate buffer is regarded as a mechanism of maintaining the acid-base balance of the ocular surface. The developed method of pH measurement ensuresreliable determination of conjunctival sac acidity in accordance with zoning and heterogeneity of its media as well as the complex structure of the tear film. In a healthy population, the acidity of tear significantly differs from that of conjunctival mucous discharge. Soluble chlorine, sodium, potassium, and boron compounds are the prevailing mineral components of tear fluid. Borate buffer appears to be the most stable of
Full Text Available Shweta Gupta Rathi, Anasua Ganguly Kapoor, Swathi Kaliki Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India Abstract: Ocular surface squamous neoplasia (OSSN refers to a spectrum of conjunctival and corneal epithelial tumors including dysplasia, carcinoma in situ, and invasive carcinoma. In this article, we discuss the current perspectives of OSSN associated with HIV infection, focusing mainly on the epidemiology, pathophysiology, clinical manifestations, diagnosis, and treatment of these tumors in patients with HIV. Upsurge in the incidence of OSSN with the HIV pandemic most severely affected sub-Saharan Africa, due to associated risk factors, such as human papilloma virus and solar ultraviolet exposure. OSSN has been reported as the first presenting sign of HIV/AIDS in 26%–86% cases, and seropositivity is noted in 38%–92% OSSN patients. Mean age at presentation of OSSN has dropped to the third to fourth decade in HIV-positive patients in developing countries. HIV-infected patients reveal large aggressive tumors, higher-grade malignancy, higher incidence of corneal, scleral, and orbital invasion, advanced-stage T4 tumors, higher need for extended enucleation/exenteration, and increased risk of tumor recurrence. Current management of OSSN in HIV-positive individuals is based on standard treatment guidelines described for OSSN in the general population, as there is little information available about various treatment modalities or their outcomes in patients with HIV. OSSN can occur at any time in the disease course of HIV/AIDS, and no significant trend has been discovered between CD4 count and grade of OSSN. Furthermore, the effect of highly active antiretroviral therapy on OSSN is controversial. The current recommendation is to conduct HIV screening in all cases presenting with OSSN to rule out undiagnosed HIV infection. Patient counseling is crucial, with emphasis on regular follow-up to address
Barabino, Stefano; De Servi, Barbara; Aragona, Salvatore; Manenti, Demetrio; Meloni, Marisa
So far tear substitutes have demonstrated a limited role in restoring ocular surface damage in dry eye syndrome (DES). The aim of this study was to assess the efficacy of a new ocular surface modulator in an in vitro model of human corneal epithelium (HCE) damaged by severe osmotic stress mirroring the features of dry eye conditions. A reconstructed HCE model challenged by the introduction of sorbitol in the culture medium for 16 h was used to induce an inflammatory pathway and to impair the tight junctions integrity determining a severe modification of the superficial layer ultrastructure. At the end of the overnight stress period in the treated HCE series, 30 μl of the ocular surface modulator (T-LysYal, Sildeha, Switzerland) and of hyaluronic acid (HA) in the control HCE series were applied for 24 h. The following parameters were quantified: scanning electron microscopy (SEM), trans-epithelial electrical resistance (TEER), immunofluorescence analysis of integrin β1 (ITG-β1), mRNA expression of Cyclin D-1 (CCND1), and ITG-β1. In the positive control after the osmotic stress the HCE surface damage was visible at the ultrastructural level with loss of cell-cell interconnections, intercellular matrix destruction, and TEER reduction. After 24 h of treatment with T-LysYal, HCE showed a significant improvement of the ultrastructural morphological organization and increased expression of ITG-β1 at the tissue level when compared to positive and control series. A significant increase of mRNA expression for ITG-β1 and CCND1 was shown in the HA-treated cells compared to T-LysYal. TEER measurement showed a significant reduction in all groups after 16 h without modifications after the treatment period. This study has shown the possibility of a new class of agents denominated ocular surface modulators to restore corneal cells damaged by dry eye conditions. Further in vivo studies are certainly necessary to confirm these results.
Full Text Available Recurrent extensive ocular surface squamous neoplasia (OSSN with orbital invasion can be successfully managed with external radiotherapy using electrons resulting in eye and vision salvage. We report a case of right eye recurrent OSSN in an immunocompetent adult Indian male, with extensive orbital involvement. The patient had two previous surgical excisions with recurrent disease. At this stage, conventionally exenteration is considered the treatment modality. However, he was treated with 5040 cGy radiotherapy (15eV electrons resulting in complete disease regression. At the end of 3 years follow-up, the patient was disease free, maintained a vision of 20/25, with mild dry eye, well-managed with topical lubricants. Extensive OSSN with orbital invasion does not always need exenteration. External beam electron radiotherapy provides a noninvasive cure with organ and vision salvage and should be considered in extensive OSSN not amenable to simple excision biopsies. Long-term studies to evaluate the effect of radiation on such eyes are suggested.
Holcombe, David J; Lee, Graham A
To evaluate topical interferon alfa-2b (IFN-alpha2b) for the treatment of recalcitrant ocular surface squamous neoplasia (OSSN). Prospective, noncomparative, interventional consecutive case series. Ten patients with recalcitrant OSSN were treated with topical IFN-alpha2b (1 million IU/ml) four times a day until clinical resolution of the lesion or until the lesion appeared nonresponsive-that is, treatment failure. Progress was assessed by clinical examination and photographic records, with a minimum follow-up of six months. Eight of 10 patients achieved clinical resolution from topical IFN-alpha2b treatment. One patient developed invasive squamous cell carcinoma and underwent exenteration. The other patient required further mitomycin C therapy to achieve clinical resolution. The mean duration to clinical resolution for the eight patients treated with IFN-alpha2b was 21.9 weeks (range six to 59 weeks). There have been no recurrences for any of the nine patients during follow-up (mean 55.0 weeks; range 26 to 84 weeks). Topical IFN-alpha2b is an important treatment modality for recalcitrant OSSN; it avoids the risks of further limbal stem cell destruction from other agents and surgical excision. If invasive disease is diagnosed at any stage, topical therapy is contraindicated, necessitating surgical excision.
Murthy, Ramesh; Gupta, Himika; Krishnatry, Rahul; Laskar, Siddhartha
Recurrent extensive ocular surface squamous neoplasia (OSSN) with orbital invasion can be successfully managed with external radiotherapy using electrons resulting in eye and vision salvage. We report a case of right eye recurrent OSSN in an immunocompetent adult Indian male, with extensive orbital involvement. The patient had two previous surgical excisions with recurrent disease. At this stage, conventionally exenteration is considered the treatment modality. However, he was treated with 5040 cGy radiotherapy (15eV electrons) resulting in complete disease regression. At the end of 3 years follow-up, the patient was disease free, maintained a vision of 20/25, with mild dry eye, well-managed with topical lubricants. Extensive OSSN with orbital invasion does not always need exenteration. External beam electron radiotherapy provides a noninvasive cure with organ and vision salvage and should be considered in extensive OSSN not amenable to simple excision biopsies. Long-term studies to evaluate the effect of radiation on such eyes are suggested.
Full Text Available Abstract Background Ocular surface squamous neoplasia (OSSN is a rare cancer that has increased in incidence with the HIV pandemic in Africa. The underlying cause of this cancer in HIV-infected patients from Botswana is not well defined. Results Tissues were obtained from 28 OSSN and 8 pterygia patients. The tissues analyzed from OSSN patients were 83% positive for EBV, 75% were HPV positive, 70% were KSHV positive, 75% were HSV-1/2 positive, and 61% were CMV positive by PCR. Tissues from pterygium patients were 88% positive for EBV, 75% were HPV positive, 50% were KSHV positive, and 60% were CMV positive. None of the patients were JC or BK positive. In situ hybridization and immunohistochemistry analyses further identified HPV, EBV, and KSHV in a subset of the tissue samples. Conclusion We identified the known oncogenic viruses HPV, KSHV, and EBV in OSSN and pterygia tissues. The presence of these tumor viruses in OSSN suggests that they may contribute to the development of this malignancy in the HIV population. Further studies are necessary to characterize the molecular mechanisms associated with viral antigens and their potential role in the development of OSSN.
Full Text Available Borneol is a compound widely used in ophthalmic preparations in China. Little is known about its exact role in treating eye diseases. Here we report that transient receptor potential melastatin 8 (TRPM8 channel is a pharmacological target of borneol and mediates its therapeutic effect in the eyes. Ca2+ measurement and electrophysiological recordings revealed that borneol activated TRPM8 channel in a temperature- and dose-dependent manner, which was similar to but less effective than the action of menthol, an established TRPM8 agonist. Borneol significantly increased tear production in guinea pigs without evoking nociceptive responses at 25°C, but failed to induce tear secretion at 35°C. In contrast, menthol evoked tearing response at both 25 and 35°C. TRPM8 channel blockers N-(3-Aminopropyl-2-[(3-methylphenylmethoxy]-N-(2-thienylmethylbenzamide hydrochloride (AMTB and N-(4-tert-butylphenyl-4-(3-chloropyridin-2-ylpiperazine-1-carboxamide (BCTC abolished borneol- and menthol-induced tear secretion. Borneol at micromolar concentrations did not affect the viability of human corneal epithelial cells. We conclude that borneol can activate the cold-sensing TRPM8 channel and modestly increase ocular surface wetness, which suggests it is an active compound in ophthalmic preparations and particularly useful in treating dry eye syndrome.
Banaee, Touka; Pourreza, Hamidreza; Doosti, Hassan; Abrishami, Mojtaba; Ehsaei, Asieh; Basiry, Mohsen; Pourreza, Reza
To compare the distribution of different sized vessels using digital photographs of the ocular surface of diabetic and normal individuals. In this cross-sectional study, red-free conjunctival photographs of diabetic and normal individuals, aged 30-60 years, were taken under defined conditions and analyzed using a Radon transform-based algorithm for vascular segmentation. The image areas occupied by vessels (AOV) of different diameters were calculated. The main outcome measure was the distribution curve of mean AOV of different sized vessels. Secondary outcome measures included total AOV and standard deviation (SD) of AOV of different sized vessels. Two hundred and sixty-eight diabetic patients and 297 normal (control) individuals were included, differing in age (45.50 ± 5.19 vs. 40.38 ± 6.19 years, P distribution curves of mean AOV differed between patients and controls (smaller AOV for larger vessels in patients; P distribution curve of vessels compared to controls. Presence of diabetes mellitus is associated with contraction of larger vessels in the conjunctiva. Smaller vessels dilate with diabetic retinopathy. These findings may be useful in the photographic screening of diabetes mellitus and retinopathy.
Full Text Available AIM:To observe the effect of different concentrations of sodium hyaluronate on ocular surface change of dry eye. METHODS: New Zealand rabbits with dry eye was prepared and treated with 0.1% and 0.3% sodium hyaluronate drops fluid respectively, which were regarded as low concentration treatment group(group Band high concentration treatment group(group Crespectively. However, the rabbits treated with saline were regarded as control group(group A. And then, corneal fluorescein staining, Schirmer test, conjunctival goblet cells, mucin expression and histological changes were observed.RESULTS: On D7 and D14 after treatment, corneal fluorescein staining scores were lower in group B and group C than that in group A(PP PCONCLUSION: The sodium hyaluronate can improve ocular surface damage of dry eye in New Zealand rabbits. The high concentration of sodium hyaluronate has better effect than low concentration.
Han, Ji Yun; Kang, Boram; Eom, Youngsub; Kim, Hyo Myung; Song, Jong Suk
To compare the effect of exposure to particulate matter on the ocular surface of normal and experimental dry eye (EDE) rat models. Titanium dioxide (TiO2) nanoparticles were used as the particulate matter. Rats were divided into 4 groups: normal control group, TiO2 challenge group of the normal model, EDE control group, and TiO2 challenge group of the EDE model. After 24 hours, corneal clarity was compared and tear samples were collected for quantification of lactate dehydrogenase, MUC5AC, and tumor necrosis factor-α concentrations. The periorbital tissues were used to evaluate the inflammatory cell infiltration and detect apoptotic cells. The corneal clarity score was greater in the EDE model than in the normal model. The score increased after TiO2 challenge in each group compared with each control group (normal control vs. TiO2 challenge group, 0.0 ± 0.0 vs. 0.8 ± 0.6, P = 0.024; EDE control vs. TiO2 challenge group, 2.2 ± 0.6 vs. 3.8 ± 0.4, P = 0.026). The tear lactate dehydrogenase level and inflammatory cell infiltration on the ocular surface were higher in the EDE model than in the normal model. These measurements increased significantly in both normal and EDE models after TiO2 challenge. The tumor necrosis factor-α levels and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling-positive cells were also higher in the EDE model than in the normal model. TiO2 nanoparticle exposure on the ocular surface had a more prominent effect in the EDE model than it did in the normal model. The ocular surface of dry eyes seems to be more vulnerable to fine dust of air pollution than that of normal eyes.
Guilherme Goulart Quinto
Full Text Available O líquido amniótico banha o feto durante a vida intra-uterina e está em contato permanente com a superfície ocular durante este importante período do desenvolvimento. Ele contém uma série de fatores de crescimento que podem ter diversos efeitos sobre o processo cicatricial. Estes fatores aceleram a recuperação da sensibilidade corneana e regeneração nervosa após procedimentos cerato-refrativos, além de controlar a formação de cicatriz e o equilíbrio da superfície ocular após sua aplicação tópica. Centenas de diferentes proteínas têm sido identificadas no líquido amniótico humano e o papel de cada uma continua desconhecido. Os resultados obtidos até o momento sobre a aplicação de líquido amniótico em doenças de superfície ocular sugerem uma terapia promissora. Pesquisas estão sendo realizadas para identificar os efeitos dos fatores específicos do líquido amniótico sobre a inflamação ocular. O objetivo desta revisão é relatar as propriedades e utilizações atuais do líquido amniótico, bem como apresentar os recentes estudos relacionados ao uso deste líquido e doenças da superfície ocular.Amniotic fluid bathes the fetus during intrauterine life and is in permanent contact with the fetal ocular surface in this important period of development. It contains a series of growth factors that may have multiple effects on the wound healing process. These factors are thought to accelerate the recovery of corneal sensitivity and nerve regeneration after keratorefractive procedures, and also may control scar formation and balance the ocular surface after topical application. Hundreds of different proteins have been identified in the human amniotic fluid, and the role of each still not quite understood. The outcomes obtained so far with amniotic fluid application to ocular surface diseases suggest a promising therapy. Research is underway to identify the effects of specific factors of the amniotic fluid in ocular
Jones, Allan; Hodges, Ben; McClelland, James; Hardison, Amber; Moffett, Kevan
Linkages between ecology and hydrology in terrestrial surface water often invoke a discussion of lentic (reservoir) vs. lotic (riverine) system behaviors. However, the literature shows a wide range of thresholds separating lentic/lotic regimes and little agreement on a quantitative, repeatable classification metric that can be broadly and reliably applied across a range of systems hosting various flow regimes and suspended/benthic taxa. We propose an integrated Residence Time (iTR) metric as part of a new Freshwater Continuum Classification (FCC) to address this issue. The iTR is computed as the transit time of a water parcel across a system given observed temporal variations in discharge and volume, which creates a temporally-varying metric applicable across a defined system length. This approach avoids problems associated with instantaneous residence times or average residence times that can lead to misleading characterizations in seasonally- or episodically-dynamic systems. The iTR can be directly related to critical flow thresholds and timescales of ecology (e.g., zooplankton growth). The FCC approach considers lentic and lotic to be opposing end-members of a classification continuum and also defines intermediate regimes that blur the line between the two ends of the spectrum due to more complex hydrological system dynamics. We also discover the potential for "oscillic" behavior, where a system switches between lentic and lotic classifications either episodically or regularly (e.g., seasonally). Oscillic behavior is difficult to diagnose with prior lentic/lotic classification schemes, but can be readily identified using iTR. The FCC approach was used to analyze 15 tidally-influenced river segments along the Texas (USA) coast of the Gulf of Mexico. The results agreed with lentic/lotic designations using prior approaches, but also identified more nuanced intermediate and oscillic regimes. Within this set of systems, the oscillic nature of some of the river
Mônica de Cássia Alves
Full Text Available Diabetes mellitus and its clinical association with dry eye and ocular surface are becoming a frequent and sometimes complicate problem in Ophthalmology. Epidemiological data show that an increase in the number of patients with this association is expected following the trend to rise of the disease. The present work reviews the clinical and functional aspects of this problem. The observations indicate that metabolic, neuropathic and vascular tissue damages lead to an inflammatory process and functional degeneration. The physiopathological mechanism include hyperglycemia, advanced glycated end product accumulation, oxidative stress and inflammation mediated by NF-κB signaling pathways. Potential treatments enlightened by those findings would include antioxidant, anti-inflammatory, secretagogues and/or anabolic agents that would mimic insulin effects.O diabetes mellitus e sua associação clínica com olho seco e doença da superfície ocular estão se tornando um problema freqüente e muitas vezes complicado em oftalmologia. Os dados epidemiológicos mostram que o número de casos deve crescer acompanhando a tendência de aumento da incidência da doença. Esse trabalho revê seus aspectos clínicos e funcionais. As observações indicam que as lesões metabólicas, neuropáticas e vasculares levam a um processo inflamatório e degeneração funcional. Os mecanismos fisiopatológicos incluem hiperglicemia, acúmulo de produtos finais de glicosilação avançada, estresse oxidativo e inflamação mediada pelas vias de sinalização do NF-kB. Os tratamentos potenciais sugeridos por essas observações incluiriam antioxidantes, antiinflamatórios, secretagogos e/ou agentes anabólicos com efeitos miméticos ao da insulina.
Full Text Available AIM: To study the changes of ocular surface in cataract patients with Meibomian gland dysfunction(MGDwho treated with Meibomian gland massage before surgery. METHODS: Totally 90 patients(93 eyeswith cataract and MGD were randomly divided into two groups. Patients in experimental group were treated with hot compress and Meibomian gland massage every day before surgery, while the patients in the control group were not taken. Two groups of patients received phacoemulsification combined with intraocular lens implantation. Lid margin abnormalities, secretion characteristics, Schimer I test(SⅠtand tear film break-up time(BUTwere recorded and compared between two groups using slit lamp microscope inspection preoperatively and postoperatively 1wk. RESULTS: In the control group, the postoperative score of eyelid margin and Meibomian gland secretion was increased significantly than preoperative, while the value of BUT and SⅠt was down significantly. Compared with control group, the postoperative score of eyelid margin shape and Meibomian gland secretion in the experimental group was decreased significantly, while the value of BUT and SIT improved significantly(PCONCLUSION: Phacoemulsification can aggravate the Meibomian gland dysfunction and have some extent of effects on the ocular surface. Meibomian gland massage before surgery can significantly improve the function of Meibomian gland and the state of ocular surface in patients with MDG.
Zubkov, V. S.
We present a mathematical model describing the spatial distribution of tear film osmolarity across the ocular surface of a human eye during one blink cycle, incorporating detailed fluid and solute dynamics. Based on the lubrication approximation, our model comprises three coupled equations tracking the depth of the aqueous layer of the tear film, the concentration of the polar lipid, and the concentration of physiological salts contained in the aqueous layer. Diffusive boundary layers in the salt concentration occur at the thinnest regions of the tear film, the black lines. Thus, despite large Peclet numbers, diffusion ameliorates osmolarity around the black lines, but nonetheless is insufficient to eliminate the build-up of solute in these regions. More generally, a heterogeneous distribution of solute concentration is predicted across the ocular surface, indicating that measurements of lower meniscus osmolarity are not globally representative, especially in the presence of dry eye. Vertical saccadic eyelid motion can reduce osmolarity at the lower black line, raising the prospect that select eyeball motions more generally can assist in alleviating tear film hyperosmolarity. Finally, our results indicate that measured evaporative rates will induce excessive hyperosmolarity at the black lines, even for the healthy eye. This suggests that further evaporative retardation at the black lines, for instance due to the cellular glycocalyx at the ocular surface or increasing concentrations of mucus, will be important for controlling hyperosmolarity as the black line thins. © 2012 Society for Mathematical Biology.
Thygesen, John; Aaen, Kim; Theodorsen, F.
ophthalmology, open-angle glaucoma, ocular hypertension, glaucoma therapy, latanoprost, timolol, Rose-Bengal test, break-up time, Schirmer-1-test, conjunctival impression cytology......ophthalmology, open-angle glaucoma, ocular hypertension, glaucoma therapy, latanoprost, timolol, Rose-Bengal test, break-up time, Schirmer-1-test, conjunctival impression cytology...
Meel, Rachna; Dhiman, Rebika; Vanathi, Murugesan; Pushker, Neelam; Tandon, Radhika; Devi, Saranya
The aim is to study the clinicodemographic profile and treatment outcome of ocular surface squamous neoplasia (OSSN). This was a retrospective observational study of 57 eyes (56 cases) with clinically diagnosed OSSN, presenting in our center over the past year. The median age of presentation was 55 years with male:female ratio being 4.5:1. Systemic predisposing conditions were xeroderma pigmentosa (1) postkidney transplant immunosuppression (1), and human immunodeficiency virus infection (1). Patients with predisposing conditions had a younger median age of onset (33 years). The majority of tumors were nodular (61.4%), gelatinous (61.4%), and had limbal involvement (96%). On ultrasound biomicroscopy (UBM), mean tumor height was 2.93 ± 1.02 mm, and intraocular extension was evident in seven eyes. OSSN with intraocular extension had a mean tumor height of 4.3 ± 1.32 mm. Nodal metastasis was seen in one case at presentation. As per American Joint Committee for Cancer Classification seventh edition staging-two cases were T1, one was T2, 46 were T3 and eight were T4. Treatment advised included conservative therapy for 39; wide local excision (4 mm margin clearance) with cryotherapy for seven; enucleation in four; and exenteration in four eyes. Overall, complete regression was achieved in 88% of cases during a mean follow-up of 13.5 ± 4.6 months. Recurrence was seen in three cases, which were treated with exenteration, radical neck dissection, and palliative chemo-radiotherapy, respectively. Although associated with old age, earlier onset of OSSN is seen in patients with systemic predisposing conditions. Thicker tumors in the setting of a previous surgery or immunocompromised status should be considered high-risk features for intraocular extension and should be evaluated on UBM.
Rathi, Shweta Gupta; Ganguly Kapoor, Anasua; Kaliki, Swathi
Ocular surface squamous neoplasia (OSSN) refers to a spectrum of conjunctival and corneal epithelial tumors including dysplasia, carcinoma in situ, and invasive carcinoma. In this article, we discuss the current perspectives of OSSN associated with HIV infection, focusing mainly on the epidemiology, pathophysiology, clinical manifestations, diagnosis, and treatment of these tumors in patients with HIV. Upsurge in the incidence of OSSN with the HIV pandemic most severely affected sub-Saharan Africa, due to associated risk factors, such as human papilloma virus and solar ultraviolet exposure. OSSN has been reported as the first presenting sign of HIV/AIDS in 26%-86% cases, and seropositivity is noted in 38%-92% OSSN patients. Mean age at presentation of OSSN has dropped to the third to fourth decade in HIV-positive patients in developing countries. HIV-infected patients reveal large aggressive tumors, higher-grade malignancy, higher incidence of corneal, scleral, and orbital invasion, advanced-stage T4 tumors, higher need for extended enucleation/exenteration, and increased risk of tumor recurrence. Current management of OSSN in HIV-positive individuals is based on standard treatment guidelines described for OSSN in the general population, as there is little information available about various treatment modalities or their outcomes in patients with HIV. OSSN can occur at any time in the disease course of HIV/AIDS, and no significant trend has been discovered between CD4 count and grade of OSSN. Furthermore, the effect of highly active antiretroviral therapy on OSSN is controversial. The current recommendation is to conduct HIV screening in all cases presenting with OSSN to rule out undiagnosed HIV infection. Patient counseling is crucial, with emphasis on regular follow-up to address high recurrence rates and early presentation to an ophthalmologist for of any symptoms in the unaffected eye. Effective evidence-based interventions are needed to allow early diagnosis
Kaliki, Swathi; Freitag, Suzanne K; Chodosh, James
To describe clinical presentation and histopathological features of a nodulo-ulcerative variant of ocular surface squamous neoplasia (OSSN). Retrospective study. Six patients were identified with a nodulo-ulcerative variant of OSSN. Mean age at presentation was 56 years. One patient was immunosuppressed because of human immunodeficiency virus infection. The initial misdiagnosis was necrotizing scleritis/sclerokeratitis (n = 4), intraepithelial neoplasia (n = 1), and chalazion (n = 1). The mean delay in diagnosis as OSSN was 6 months. The lesion involved bulbar conjunctiva in 5 patients and tarsal conjunctiva in 1 patient. The mean maximum tumor dimension was 16 mm, and the mean area of conjunctivoscleral/conjunctivotarsal necrosis was 8 mm. The primary treatment for nodulo-ulcerative OSSN included excisional biopsy (n = 2), plaque radiotherapy (n = 1), and orbital exenteration (n = 3). Tumor recurrence was noted in two patients necessitating orbital exenteration. At last follow-up, globe salvage could be achieved in only 1 case. Histopathology showed invasive conjunctival squamous cell carcinoma in all cases with lesions being well-differentiated (n = 4), moderately differentiated (n = 1), and with mucoepidermoid differentiation (n = 1). Underlying scleral/tarsal tumor infiltration was evident in all 6 (100%) cases. Intraocular tumor extension was evident in 3 cases infiltrating the iris (n = 2), ciliary body (n = 3), and choroid (n = 3). Orbital tumor extension was evident in 2 cases because of tumor recurrence. No metastasis or death was recorded at a mean follow-up of 26 months. The nodulo-ulcerative variant of OSSN is rare and is most often misdiagnosed as necrotizing scleritis/sclerokeratitis causing a delay in the diagnosis. It is an aggressive lesion with increased occurrence of intraocular or orbital tumor extension.
Full Text Available Purpose: The aim is to study the clinicodemographic profile and treatment outcome of ocular surface squamous neoplasia (OSSN. Methods: This was a retrospective observational study of 57 eyes (56 cases with clinically diagnosed OSSN, presenting in our center over the past year. Results: The median age of presentation was 55 years with male:female ratio being 4.5:1. Systemic predisposing conditions were xeroderma pigmentosa (1 postkidney transplant immunosuppression (1, and human immunodeficiency virus infection (1. Patients with predisposing conditions had a younger median age of onset (33 years. The majority of tumors were nodular (61.4%, gelatinous (61.4%, and had limbal involvement (96%. On ultrasound biomicroscopy (UBM, mean tumor height was 2.93 ± 1.02 mm, and intraocular extension was evident in seven eyes. OSSN with intraocular extension had a mean tumor height of 4.3 ± 1.32 mm. Nodal metastasis was seen in one case at presentation. As per American Joint Committee for Cancer Classification seventh edition staging-two cases were T1, one was T2, 46 were T3 and eight were T4. Treatment advised included conservative therapy for 39; wide local excision (4 mm margin clearance with cryotherapy for seven; enucleation in four; and exenteration in four eyes. Overall, complete regression was achieved in 88% of cases during a mean follow-up of 13.5 ± 4.6 months. Recurrence was seen in three cases, which were treated with exenteration, radical neck dissection, and palliative chemo-radiotherapy, respectively. Conclusion: Although associated with old age, earlier onset of OSSN is seen in patients with systemic predisposing conditions. Thicker tumors in the setting of a previous surgery or immunocompromised status should be considered high-risk features for intraocular extension and should be evaluated on UBM.
Full Text Available William B Trattler,1 Parag A Majmudar,2 Eric D Donnenfeld,3 Marguerite B McDonald,4 Karl G Stonecipher,5 Damien F Goldberg6 On behalf of the PHACO Study Group 1Center for Excellence in Eye Care, Miami, FL, USA; 2Chicago Cornea Consultants, Chicago, IL, USA; 3Ophthalmic Consultants of Long Island, Garden City, NY, USA; 4Ophthalmic Consultants of Long Island, Lynbrook, NY, USA; 5University North Carolina School of Medicine, Chapel Hill, NC, USA; 6Wolstan & Goldberg Eye Associates, Torrance, CA, USA Purpose: To determine the incidence and severity of dry eye as determined by the International Task Force (ITF scale in patients being screened for cataract surgery.Patients and methods: This was a prospective, multi-center, observational study of 136 patients, at least 55 years of age, who were scheduled to undergo cataract surgery. The primary outcome measure was the incidence of dry eye as evaluated by grade on the ITF scale and secondary outcome measures include tear break-up time (TBUT, ocular surface disease index score, corneal staining with fluorescein, conjunctival staining with lissamine green, and a patient questionnaire to evaluate symptoms of dry eye.Results: Mean patient age was 70.7 years. A total of 73.5% of patients were Caucasian and 50% were female. Almost 60% had never complained of a foreign body sensation; only 13% complained of a foreign body sensation half or most of the time. The majority of patients (62.9% had a TBUT ≤5 seconds, 77% of eyes had positive corneal staining and 50% of the eyes had positive central corneal staining. Eighteen percent had Schirmer’s score with anesthesia ≤5 mm.Conclusion: The incidence of dry eye in patients scheduled to undergo cataract surgery in a real-world setting is higher than anticipated. Keywords: cataract surgery screening, dry eye, International Task Force scale, observational study
Li, Yingli; Inoue, Tomoyuki; Takamatsu, Fumihiko; Maeda, Naoyuki; Ohashi, Yuichi; Nishida, Kohji
Cultured human corneal limbal stem/progenitor cells are usually established and maintained on feeder layers. However, animal feeder cells are associated with viral infection, pathogen transmission, and xenogenic contamination. All feeder cells also can be mixed easily into cell-sheet production, causing self-contamination. We developed a line of labeled, immortalized, eliminable human dermal fibroblast cells to eliminate these problems. The enhanced green fluorescent protein gene, human-derived telomerase reverse transcriptase gene, and herpes simplex virus thymidine kinase gene were transfected into human dermal fibroblast cells to establish labeled, immortalized, eliminable feeder cells. Established eliminable dermal fibroblasts (TERT+TK-D) were treated with mitomycin, cocultured with human limbal stem/progenitor cells to regenerate epithelium sheets, and compared with 3T3 feeder cells. Established TERT+TK-D feeder cells maintained immortalization, visualization, and eliminable characteristics during 6 months of continuous passages. The colony-forming efficiency of limbal stem/progenitor cells was similar in the TERT+TK-D group (11.77 ± 0.21%) and the 3T3 group (12.8 ± 1.61%) (P = 0.332). All cell sheets were well stratified into 4 to 5 layers. The TERT+TK-D group colonies and epithelial cell sheets showed weaker staining of corneal epithelium differentiation marker K3 than the 3T3 group and quantitative analysis of mRNA transcripts. Moreover, PCR analysis against the long terminal repeat sequence of the lentiviral vector integrated into the genetically modified feeder cells showed no contamination of ganciclovir-treated regeneration epithelial sheets. Genetically modified, labeled, immortalized, eliminable human dermal feeder cells are promising substitutes for 3T3 feeder cells for xenogeny-free ocular surface regeneration.
Gichuhi, Stephen; Macharia, Ephantus; Kabiru, Joy; Zindamoyen, Alain M'bongo; Rono, Hillary; Ollando, Ernest; Wachira, Joseph; Munene, Rhoda; Onyuma, Timothy; Jaoko, Walter G; Sagoo, Mandeep S; Weiss, Helen A; Burton, Matthew J
To determine modifiable risk factors of ocular surface squamous neoplasia (OSSN) in Kenya using disease-free controls. Adults with conjunctival lesions were recruited at four eye care centres in Kenya and underwent excision biopsy. An equal number of controls having surgery for conditions not affecting the conjunctiva and unrelated to ultraviolet light were group-matched to cases by age group, sex and eye care centre. Associations of risk factors with OSSN were evaluated using multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). Continuous variables were compared using the t-test or the Wilcoxon-Mann-Whitney U-test depending on their distribution. A total of 131 cases and 131 controls were recruited. About two-thirds of participants were female, and the mean age of cases and controls was 42.1 years and 43.3 years, respectively. Risk factors for OSSN were HIV infection without antiretroviral therapy (ART) use (OR = 48.42; 95% CI: 7.73-303.31) and with ART use (OR = 19.16; 95% CI: 6.60-55.57), longer duration of exposure to the sun in the main occupation (6.9 h/day vs. 4.6 h/day, OR = 1.24; 95% CI: 1.10-1.40) and a history of allergic conjunctivitis (OR = 74.61; 95% CI: 8.08-688.91). Wearing hats was protective (OR = 0.22; 95% CI: 0.07-0.63). Measures to prevent and control HIV, reduce sun exposure such as wearing hats and control allergic conjunctivitis are recommended. © 2016 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.
Ngo, William; Srinivasan, Sruthi; Keech, Adam; Keir, Nancy; Jones, Lyndon
To compare the difference in Ocular Surface Disease Index © (OSDI) scores when participants were given the OSDI to complete on their own (self-guided, SG), versus under the guidance of the examiner (examiner-guided, EG). 100 participants enrolled in this prospective two-visit study (fifty under-45 years old, 38F/12M; and fifty 45 years-and-older, 42F/8M). Participants who scored ≥1 on the Subjective Evaluation of Symptoms of Dryness (SESoD) were included in this study. Participants completed the OSDI SG during the first visit. Participants returned the next day and repeated the OSDI, but with EG (with standardized instructions). Participants were under deception and believed that they were comparing the OSDI to the SESoD. The mean OSDI score of the SG and EG administration was 32.0±17.3 and 33.8±19.6 respectively (p>0.05) with 95% limits of agreement between -20.6 and +24.2. The correlation between SG and EG administration was Spearman's r=0.81, p0.05) for both the under-45 group, and 45-and-older group. The 95% limits of agreement for the under-45 group were smaller than the 45-and-older group (under-45: [-15.5, +13.1,], 45-and-older: [-23.3, +32.2]). A significant difference was found between 8 of the 12 questions items (all p≤0.01). However, the mean difference for each was <0.6 and was not considered to be clinically significant. There was no clinically significant difference in OSDI score between SG and EG administration, however having instructions provided with EG administration affected variability of scores in the older group more than the younger group. Copyright © 2016 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.
Contreras Ruiz, L; Mir, F A; Turpie, B; Masli, S
Sjögren's syndrome is the second most common rheumatic disease in which autoimmune response targets exocrine glands (salivary and lacrimal glands) result in clinical symptoms of dry mouth and dry eye. Inflammation of the lacrimal gland induces tear abnormalities that contribute to the inflammation of the ocular surface, which includes ocular mucosa. Thrombospondin-1 (TSP-1) plays a critical regulatory role in the ocular mucosa and as such TSP-1 -/- mice develop spontaneously chronic ocular surface inflammation associated with Sjögren's syndrome. The autoimmune pathology is also accompanied by a peripheral imbalance in regulatory (T reg ) and inflammatory Th17 effectors. In this study, we demonstrate an in-vitro effect of a CD47-binding TSP-derived peptide in the induction of transforming growth factor (TGF)-β1-secreting forkhead box protein 2 (Foxp3 + ) T regs from activated CD4 + CD25 - T cells and the inhibition of pathogenic T helper type 17 (Th17)-promoting interleukin (IL)-23 derived from antigen-presenting cells. The in-vivo administration of this peptide promotes Foxp3 + T reg induction and inhibition of Th17 development. Consistent with these results, topical administration of CD47-binding TSP peptide, both before and after the onset of the disease, attenuates clinical symptoms of SS-associated dry eye in TSP-1 -/- mice. Augmented expression of Foxp3 detected in the draining lymph nodes of TSP peptide -treated mice compared to those treated with control peptide suggests the ability of TSP peptide to restore peripheral immune imbalance. Thus, our results suggest that TSP-derived peptide attenuates Sjögren's syndrome-associated dry eye and autoimmune inflammation by preventing Th17 development while promoting the induction of T regs . Collectively, our data identify TSP-derived peptide as a novel therapeutic option to treat autoimmune diseases. © 2017 British Society for Immunology.
Tomić, Martina; Kaštelan, Snježana; Soldo, Kata Metež; Salopek-Rabatić, Jasminka
Primary open-angle glaucoma (POAG), a chronic, degenerative optic neuropathy, requires persistent decrease of intraocular pressure so as to prevent visual impairment and blindness. However, long-term use of topical ocular medications may affect ocular surface health. Purpose of this study was to evaluate the influence of BAK-preserved prostaglandin analog treatment on the ocular surface health in patients with newly diagnosed POAG. 40 newly diagnosed POAG patients were included in this prospective study. Intraocular pressure (IOP), tear break-up time (TBUT), and ocular surface disease index (OSDI) were assessed at baseline and 3-month after starting treatment with BAK-preserved travoprost 0.004%. IOP decreased in all patients from baseline to 3-month final visit (23.80 ± 1.73 mmHg versus 16.78 ± 1.27 mmHg; P preserved travoprost 0.004% is an effective medication in newly diagnosed POAG patients, but its long-term use may negatively influence ocular surface health by disrupting the tear film stability. Further studies are needed to better understand the clinical effects of different preservative types and concentrations on the ocular surface.
V. N. Trubilin
problem of modern ophthalmology.Part 1 — Trubilin VN, Poluninа EG, Kurenkov VV, Kapkova SG, Markova EY, Therapeutic eyelids hygiene in the algorithms of prevention and treatment of ocular surface diseases. Ophthalmology in Russia. 2016;13(2:122–127 doi: 10.18008/1816–5095– 2016–2–122–127
Full Text Available Robert Sambursky Coastal Eye Institute, Cornea and Comprehensive Ophthalmology, Bradenton, FL, USA Background: The presence of clinically significant inflammation has been confirmed in the tears of 40%–65% of patients with symptoms of dry eye. Ocular surface inflammation may lead to tear film instability, epithelial cell irregularities, and permeability, resulting in chronic symptomatic pain and fluctuating vision as well as negative surgical outcomes.Patients and methods: A retrospective single center medical chart review of 100 patients was conducted. All patients were tested with the InflammaDry test to determine if patients exhibited elevated levels of matrix metalloproteinase 9 (MMP-9. InflammaDry-positive patients were started on a combination of cyclosporine 0.05% twice daily, 2,000–4,000 mg oral omega-3 fatty acids, and frequent artificial tear replacement. InflammaDry-negative patients were started on 2,000–4,000 mg of oral omega-3 fatty acids and frequent artificial tear replacement. Each patient was retested at ~90 days. A symptom questionnaire was performed at the initial visit and at 90 days.Results: 60% of the patients with dry eye symptoms tested positive for elevated MMP-9 at the initial visit. 78% of all patients returned for follow-up at ~90 days including 80% (48/60 of the previously InflammaDry-positive patients and 75% (30/40 of the previously InflammaDry-negative patients. A follow-up symptom questionnaire reported at least 75% symptomatic improvement in 65% (31/48 of the originally InflammaDry-positive patients and in 70% (21/30 of the initially InflammaDry-negative patients. Symptomatic improvement of at least 50% was reported in 85% (41/48 of previously InflammaDry-positive patients and 86% (26/30 of previously InflammaDry-negative patients. Following treatment, 54% (26/48 of previously InflammaDry-positive patients converted to a negative InflammaDry result.Conclusion: Identifying which symptomatic dry eye
Dursch, Thomas J; Li, Wing; Taraz, Baseem; Lin, Meng C; Radke, Clayton J
A corneal heat-transfer model is presented to quantify simultaneous measurements of fluorescein tear-breakup area (TBA) and ocular-surface temperature (OST). By accounting for disruption of the tear-film lipid layer (TFLL), we report evaporation rates through lipid-covered tear. The modified heat-transfer model provides new insights into evaporative dry eye. A quantitative analysis is presented to assess human aqueous tear evaporation rate (TER) through intact TFLLs from simultaneous in vivo measurement of time-dependent infrared OST and fluorescein TBA. We interpret simultaneous OST and TBA measurements using an extended heat-transfer model. We hypothesize that TBAs are ineffectively insulated by the TFLL and therefore exhibit higher TER than does that for a well-insulting TFLL-covered tear. As time proceeds, TBAs increase in number and size, thereby increasing the cornea area-averaged TER and decreasing OST. Tear-breakup areas were assessed from image analysis of fluorescein tear-film-breakup video recordings and are included in the heat-transfer description of OST. Model-predicted OSTs agree well with clinical experiments. Percent reductions in TER of lipid-covered tear range from 50 to 95% of that for pure water, in good agreement with literature. The physical picture of noninsulating or ruptured TFLL spots followed by enhanced evaporation from underlying cooler tear-film ruptures is consistent with the evaporative-driven mechanism for local tear rupture. A quantitative analysis is presented of in vivo TER from simultaneous clinical measurement of transient OST and TBA. The new heat-transfer model accounts for increased TER through expanding TBAs. Tear evaporation rate varies strongly across the cornea because lipid is effectively missing over tear-rupture troughs. The result is local faster evaporation compared with nonruptured, thick lipid-covered tear. Evaporative-driven tear-film ruptures deepen to a thickness where fluorescein quenching commences and local
Rahmatnejad, Kamran; Rapuano, Christopher J; Ichhpujani, Parul; Wizov, Sheryl S; Moster, Marlene R; Hark, Lisa A; Katz, L Jay
To assess ocular surface changes in participants using latanoprost with benzalkonium chloride (Xalatan) and travoprost with SofZia (Travatan Z). In this prospective, open-label, nonrandomized cohort study, participants were classified into two groups: group 1 (n=28) naive to glaucoma therapy, group 2 (n=27) on previous Xalatan monotherapy in both eyes. Both groups started (or continued) Xalatan in the right eye and Travatan Z in the left eye. Baseline, 1-, and 2-month measurements of tear breakup time (TBUT), corneal staining score, conjunctival staining score, conjunctival hyperemia score, tear production, and intraocular pressure were obtained. The Ocular Surface Disease Index questionnaire measured participants' comfort and dryness symptoms. Medication preference was recorded. Data were collected from 55 participants. Tear breakup time at baseline and 1-month follow-up in group 1 was significantly longer than that of group 2 (P=0.005). At 2 months, there was no significant difference in TBUT between the two groups (P=0.779). Tear production in group 1 at all three time points was significantly higher than group 2 (P<0.05). Conjunctival staining score at 2 months in group 1 was significantly higher than group 2 (P=0.031). There was no significant difference in other parameters between the groups at any other time point. No significant difference in any parameter was found between Xalatan and Travatan Z (intragroup comparison). Significant differences in ocular surface characteristics were detected between groups, but no significant difference was detected between participants treated with Xalatan and Travatan Z.
Holáň, Vladimír; Trošan, Peter; Čejka, Čestmír; Javorková, Eliška; Zajícová, Alena; Heřmánková, Barbora; Chudíčková, Milada; Čejková, Jitka
Roč. 4, č. 9 (2015), s. 1052-1063 ISSN 2157-6564 R&D Projects: GA ČR(CZ) GA14-12580S; GA MZd NT14102; GA MŠk(CZ) LO1309; GA MŠk(CZ) ED1.1.00/02.0109 Institutional support: RVO:68378041 Keywords : limbal stem cells * mesenchymal stem cells * alkali-injured ocular surface * corneal regeneration * stem cell-based therapy Subject RIV: FF - HEENT, Dentistry Impact factor: 4.247, year: 2015
Agarwal, Rohit; Chawla, Bhavna; Asif, Mohamed Ibrahime; Pujari, Amar
Xeroderma pigmentosum (XP) is an autosomal recessive disorder associated with multiple oculocutaneous manifestations.We discuss a unique case of XP having bilateral ocular surface squamous neoplasia (OSSN) and periocular basal cell carcinoma. In the right eye, a large OSSN mass involving the ocular surface extensively along with intraocular invasion was noted, whereas in the left eye, the tumour mass was involving the limbus, and extending up to three clock hours. Because of extensive disease in the right eye, orbital exenteration was performed, and for the left eye, a wide excision of the mass with triple freeze thaw cryo application to the margins followed by amniotic membrane grafting was done. Basal cell carcinoma was noted around the medial canthus on both sides. The right-sided basal cell carcinoma was treated by wide excision followed by a forehead rotation flap and the left-sided lesion was managed with topical 5% imiquimod cream. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
T.R. Jackson; R. Haggerty; S.V. Apte; A. Coleman; K.J. Drost
Surface transient storage (STS) has functional significance in stream ecosystems because it increases solute interaction with sediments. After volume, mean residence time is the most important metric of STS, but it is unclear how this can be measured accurately or related to other timescales and field-measureable parameters. We studied mean residence time of lateral...
Hamada, Samer; Moore, Tara C B; Moore, Jonathan E; Al-Dreihi, Madonna G; Anbari, Anas; Shah, Sunil
To assess the effect of cyclosporine-A (CsA) 0.05% ophthalmic emulsion on corneal sensation and ocular surface problems following cataract surgery. Prospective, randomized, double masked clinical trial. Consecutive case series of patients attending for bilateral cataract surgery. Subject's eyes were randomized to receive either topical CsA or carboxymethylcellulose 0.5% (CMC) eye drops twice daily for one month following routine cataract surgery. Subjective and objective assessments were performed pre-operatively, one week, and one month after surgery. Primary safety parameters included best spectacle-corrected visual acuity and incidence of adverse events. Objective assessments included tests of tear film (osmolarity, tear break-up time, and Schirmer's type-I test), ocular surface staining, corneal sensitivity and a subjective assessment: ocular surface disease index (OSDI) questionnaire. 30 subjects (60 eyes) were recruited. At one month following cataract surgery, osmolarity, ocular surface staining, TBUT, Schirmer's results showed a greater improvement after CsA drops compared to CMC and this was statistically significant for all measures (psensation measurements were reduced after one week and one month. Eyes receiving CsA had higher recovery of corneal sensation at both time points post operatively and this was statistically significant at one month. OSDI questionnaire results did not show a statistically significant difference between the two eyes. CsA is effective and safe in the management of ocular surface problems after cataract surgery and allows faster recovery of corneal sensation. This recovery of sensation may be relevant to the improvement in ocular surface problems in all patients. Copyright © 2015 Elsevier Ltd. All rights reserved.
Montanaro, Jacqueline; Inic-Kanada, Aleksandra; Ladurner, Angela; Stein, Elisabeth; Belij, Sandra; Bintner, Nora; Schlacher, Simone; Schuerer, Nadine; Mayr, Ulrike Beate; Lubitz, Werner; Leisch, Nikolaus; Barisani-Asenbauer, Talin
To target chronic inflammatory ocular surface diseases, a drug delivery platform is needed that is safe, possesses immunomodulatory properties, and can be used either for drug delivery, or as a foreign antigen carrier. A new therapeutic approach that we have previously proposed uses nonliving bacterial ghosts (BGs) as a carrier-delivery system which can be engineered to carry foreign antigens and/or be loaded with therapeutic drugs. The parent strain chosen for development of our BG delivery system is the probiotic Escherichia coli strain Nissle 1917 (EcN), whose intrinsic properties trigger the innate immune system with the flagella and fimbriae used to attach and stimulate epithelial cells. In previous studies, we have shown that EcN BGs are safe for the ocular surface route, but evidence that EcN BGs retain flagella and fimbriae after transformation, has never been visually confirmed. In this study, we used different visualization techniques to determine whether flagella and fimbriae are retained on EcN BGs engineered either for drug delivery or as a foreign antigen carrier. We have also shown by immunoelectron microscopy that EcN retains two foreign antigens after processing to become EcN BGs. Furthermore, we demonstrated that BGs derived from EcN and expressing a foreign antigen attachment to conjunctival epithelial cells in vitro without causing reduced cell viability. These results are an important step in constructing a delivery system based on a nonliving probiotic that is suitable for use in ocular surface diseases pairing immunomodulation and targeted delivery.
Full Text Available BACKGROUND Glaucoma is one of the leading causes of blindness worldwide. Majority of these patients need lifelong medical therapy in the form of topical medications. Most of these medications contain preservatives, which have deleterious effects on eyes of patients causing Ocular Surface Disorder (OSD. When left undiagnosed, OSD can lead to noncompliance further deteriorating the situation and causing progression of glaucoma. Dry eye symptoms in glaucoma patients under topical medications can be ascertained with a simple 12-query OSDI (ocular surface disease index questionnaire. But, it needs to be assessed whether this can be relied on to establish a clinical diagnosis. The aim of the study is to correlate subjective OSDI scores with objective clinical findings in glaucoma patients using topical medications. MATERIALS AND METHODS 110 patients of primary open-angle glaucoma on antiglaucoma medications for >3 months underwent OSDI scoring and three clinical tests, Tear Film Break-Up Time (TBUT, Schirmer-1 Test and Lissamine-Green (LG staining of ocular surface. A clinical diagnosis of dry eye was considered if either eye showed TBUT <10 seconds or on Schirmer-1 test <10 mm or positive LG staining. Statistical analysis was done to know the correlation between OSDI scores and clinical diagnosis. Setting and Design- Prospective, single visit, comparative study carried in a tertiary care hospital. RESULTS 44 patients (40% had OSDI scores ≥13 indicating dry eye disease. 54 patients (49.1% had TBUT <10 seconds, 41 patients (37.27% had Schirmer-1 test <10 mm and 18 patients (16.36% had positive Lissamine-Green staining. So, dry eye was diagnosed in 54 patients (49.1%. We found that OSDI scores have a sensitivity of 81.48% and specificity of 100% in diagnosing dry eye. On Chi-square test, OSDI scores and diagnosis of dry eye have statistically significant correlation (p value <0.0001. CONCLUSION In our study, OSDI scores significantly correlates with
Yusimik Toledo González
Full Text Available La toxoplasmosis ocular es una enfermedad producida por el parásito toxoplasma gondii. Es la causa más frecuente de uveítis posterior, es una enfermedad de distribución universal, al menos 500 millones de personas están infectadas en todo el mundo, ocasionando disminución de la visión y ceguera en muchas de ellas. Por tal motivo, realizamos una revisión actualizada sobre, la situación actual a nivel mundial, la historia de la enfermedad, la prevención, formas clínicas y el control de la toxoplasmosis. Se tratan otros aspectos de interés como el modo de transmisión, los hospederos (definitivos e intermediarios y las manifestaciones clínicas más notables.The ocular toxoplasmosis is an illness caused by Toxoplasma gondii parasite. It is the most frequent cause in posterior uveitis, and it spreads worldwide since at least 500 million people are infected in the entire world, causing decrease of vision and blindness in many of them. This is the reason why we made a literature review, the current situation worldwide, the history, the prevention, the clinical forms and the control of toxoplasmosis. Other interesting aspects were the channel of transmission, the hosts (intermediary and final and the most remarkable clinical manifestations.
Full Text Available Jacqueline Montanaro,1 Aleksandra Inic-Kanada,1 Angela Ladurner,1 Elisabeth Stein,1 Sandra Belij,1 Nora Bintner,1 Simone Schlacher,1 Nadine Schuerer,1 Ulrike Beate Mayr,2 Werner Lubitz,2 Nikolaus Leisch,3 Talin Barisani-Asenbauer11Laura Bassi Centres of Expertise, OCUVAC – Centre of Ocular Inflammation and Infection, Centre for Pathophysiology, Infectiology, and Immunology, Medical University of Vienna, Vienna, Austria; 2BIRD-C GmbH & Co KG, Kritzendorf, Austria; 3Department of Ecogenomics and Systems Biology, University of Vienna, Vienna, AustriaAbstract: To target chronic inflammatory ocular surface diseases, a drug delivery platform is needed that is safe, possesses immunomodulatory properties, and can be used either for drug delivery, or as a foreign antigen carrier. A new therapeutic approach that we have previously proposed uses nonliving bacterial ghosts (BGs as a carrier-delivery system which can be engineered to carry foreign antigens and/or be loaded with therapeutic drugs. The parent strain chosen for development of our BG delivery system is the probiotic Escherichia coli strain Nissle 1917 (EcN, whose intrinsic properties trigger the innate immune system with the flagella and fimbriae used to attach and stimulate epithelial cells. In previous studies, we have shown that EcN BGs are safe for the ocular surface route, but evidence that EcN BGs retain flagella and fimbriae after transformation, has never been visually confirmed. In this study, we used different visualization techniques to determine whether flagella and fimbriae are retained on EcN BGs engineered either for drug delivery or as a foreign antigen carrier. We have also shown by immunoelectron microscopy that EcN retains two foreign antigens after processing to become EcN BGs. Furthermore, we demonstrated that BGs derived from EcN and expressing a foreign antigen attachment to conjunctival epithelial cells in vitro without causing reduced cell viability. These results
Hassani, R Tahiri Joutei; Brasnu, E; Amar, N; Gheck, L; Labbé, A; Sterkers, M; Baudouin, C
Ocular surface squamous neoplasia (OSSN) is the most common conjunctival and limbic malignant tumor that could resemble a pterygium in the early phase of the disease. We report the case of a woman who presented with a limbic tumor of the left eye that was mistakenly diagnosed as a pterygium. An in vivo confocal microscopy examination using the HRTII Rostock Cornea Module and a surgical biopsy were performed. The in vivo confocal microscopy findings and the slit lamp examination showed characteristics that strongly supported the diagnosis of OSSN, and the histological examination of both biopsy and surgical exeresis (exenteration) confirmed the diagnosis of epidermoid carcinoma. This case report underlines the value of in vivo confocal microscopy in the diagnosis of OSSN, particularly epidermoid carcinoma. This device could be helpful for the early differential diagnosis with pterygium.
Kaliki, Swathi; Kamal, Saurabh; Fatima, Saba
To study the importance of routine human immunodeficiency virus (HIV) screening in patients with ocular surface squamous neoplasia (OSSN) and describe their clinical features and management. Retrospective study. Of 228 cases of OSSN screened for HIV by enzyme-linked immunosorbent assay, 86 (38%) patients were HIV positive. Of these 86 patients, 60 (70%) were unaware of their HIV-positive status prior to HIV screening. These 60 (26%) patients with newly detected HIV-positive status were included in this study. Ocular surface squamous neoplasia was the sole presenting feature of HIV infection in these patients. Mean age at presentation was 41 years. Bilateral involvement occurred in 9 (15%) cases. The mean tumor basal diameter was 11 mm. Orbital involvement was noted in 6 (9%) cases, and intraocular tumor extension occurred in 1 (1%) case. Based on American Joint Committee Classification, T2 (n = 35, 51%) was most common. The primary treatment for OSSN included excision biopsy (n = 52, 75%), topical chemotherapy with Mitomycin-C (n = 5, 7%), extended enucleation (n = 4, 6%), and orbital exenteration (n = 8, 12%). Tumor recurrence occurred in 23% cases during a mean follow-up period of 9 months. On histopathology, invasive squamous cell carcinoma was more common (n = 38, 55%). OSSN was the presenting sign of underlying HIV infection in 26% cases, and 70% were unaware of their HIV-positive status prior to HIV screening. In this study, T2 tumor was most common, and 26% cases required extended enucleation/orbital exenteration to achieve complete tumor resection.
DeLoss, Karen S; Fatteh, Nadeem H; Hood, Christopher T
To compare the ocular characteristics and visual outcomes of eyes with corneal ectasia that were fitted with the Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) scleral device to those that underwent keratoplasty. Retrospective, comparative case series. We reviewed the charts of consecutive patients with corneal ectasia that were evaluated for PROSE or underwent keratoplasty at our institution. Clinical data, topographic indices, and corneal thickness were reviewed, and eyes were stratified according to the Amsler-Krumeich classification for severity of ectasia. Only the more severe eye of each patient was included in the study. We compared visual acuity before and after PROSE fitting or keratoplasty. For PROSE evaluations, achievement of satisfactory fit and continued wear at 1 year of follow-up were recorded. From 2010 to 2012, 36 patients underwent PROSE evaluation for corneal ectasia while 37 patients underwent keratoplasty for the same indication. All eyes were successfully fitted with the PROSE device. Eyes in the keratoplasty group had more severe ectasia than eyes in the PROSE group (P = .038). Visual acuity was achieved more rapidly in the PROSE cohort compared to keratoplasty, and mean visual acuity was significantly better for all eyes (P ectasia (P ectasia achieved 20/25 visual acuity after PROSE than after keratoplasty (P = .003). At 1 year follow-up in the PROSE cohort, Snellen acuity was 20/28 (P = .108 vs keratoplasty), improving to 20/25 with over-refraction (P = .006 vs keratoplasty). Eyes with advanced corneal ectasia can be successfully fitted with the PROSE device, and the visual acuity outcome for stage 4 ectasia was better and more rapid compared to keratoplasty. The acuity remained excellent with 1 year of follow-up. PROSE evaluation should be considered in patients with advanced corneal ectasia before proceeding to keratoplasty, especially if the ectasia is deemed stable. Copyright © 2014 Elsevier Inc. All rights reserved.
Full Text Available Karl G Stonecipher,1,2 Gail L Torkildsen,3 George W Ousler III,4 Scot Morris,5 Linda Villanueva,6 David A Hollander6 1Department of Ophthalmology, University of North Carolina, Chapel Hill, 2TLC Laser Eye Centers, Greensboro, NC, 3Andover Eye Associates, 4Ora, Inc., Andover, MA, 5Eye Consultants of Colorado, Conifer, CO, 6Allergan plc, Irvine, CA, USA Objective: The aim of this study was to evaluate the effects of cyclosporine ophthalmic emulsion 0.05% on ocular surface staining and visual performance in patients with dry eye.Methods: This was a single-center, 6-month, open-label, Phase IV study. Patients with bilateral dry eye disease and a symptom score of ≥2 on the Ocular Discomfort and 4-Symptom Questionnaire, an Ocular Surface Disease Index score of >12, at least one eye with Schirmer’s score <10 mm/5 minutes, and central corneal staining graded as ≥2 on the Ora Calibra™ Corneal and Conjunctival Staining Scale were enrolled. Cyclosporine ophthalmic emulsion 0.05% (Restasis® was instilled twice daily in each eye. The primary efficacy endpoints were ocular surface staining and visual function at 6 months. Secondary outcome measures included Schirmer’s test, tear film breakup time, symptoms, and adverse events.Results: A total of 40 patients with the mean age of 59.4 years (range, 40–78 years were enrolled; 35 (87.5% were female and 37 (92.5% completed the study. At 6 months, inferior corneal, central corneal, total corneal, and total ocular surface fluorescein staining were significantly improved from baseline in both eyes (P<0.001. Patient responses on the Ocular Surface Disease Index showed significant improvement in blurred vision and visual function related to reading, driving at night, working with a computer or bank machine, and watching television (P≤0.041. At 6 months, 35.1% of patients achieved ≥5 mm improvement and 18.9% achieved ≥10 mm improvement in the average eye Schirmer score. Mean tear film breakup
Ana Carolina Cabreira Vieira
Full Text Available Rosacea is a prevalent chronic cutaneous disorder with variable presentation and severity. Although considered a skin disease, rosacea may evolve the eyes in 58-72% of the patients, causing eyelid and ocular surface inflammation. About one third of the patients develop potentially sight-threatening corneal involvement. Untreated rosacea may cause varying degrees of ocular morbidity. The importance of early diagnosis and adequate treatment cannot be overemphasized. There is not yet a diagnostic test for rosacea. The diagnosis of ocular rosacea relies on observation of clinical features, which can be challenging in up to 90% of patients in whom accompanying roseatic skin changes may be subtle or inexistent. In this review, we describe the pathophysiologic mechanisms proposed in the literature, clinical features, diagnosis and management of ocular rosacea, as well as discuss the need for a diagnostic test for the disease.
Ophthalmologist (NOG) that protective polycarbonate glasses be worn while lighting and watching of fire-works is also advocated (7). Banger-related ocular injuries result in significant ocular morbidity and unilateral visual loss. Public education regarding proper use of bangers along with strict legislation regulating their use ...
Lopes, Joao F; Hubatsch, Douglas A; Amaris, Patricia
Prostaglandin analogs reduce intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension; however, these medications may affect the ocular surface and elicit ocular discomfort when preserved with benzalkonium chloride (BAK). This was an open-label, single-arm study conducted in Latin America from February 2012 to May 2013. Patients with open-angle glaucoma or ocular hypertension who were intolerant of latanoprost 0.005 % were transitioned to receive once-daily BAK-free travoprost 0.004 % containing polyquaternium-1 (Travatan® preserved with POLYQUAD® [PQ], Alcon Laboratories, Inc; Fort Worth, TX) for 12 weeks. Mean change in IOP from baseline (primary efficacy endpoint) and the percentage of patients who achieved a target IOP of ≤18 mmHg were evaluated at all on-therapy visits. Ocular hyperemia, patient preference, and self-projected adherence were assessed at week 12. Adverse events (AEs) were monitored throughout the study. All enrolled patients were included in the analysis (n = 191); the majority of patients (90.6 %, n = 173/191) completed the study. Mean (SD) patient age was 67.5 (11.3) years, and mean baseline IOP was 14.8 mmHg. Mean IOP was reduced by 0.94 mmHg at week 6 and by 1.09 mmHg at week 12 (P glaucoma or ocular hypertension who were intolerant of latanoprost. BAK-free travoprost 0.004 % is a viable alternative for patients who require switching their IOP-lowering medications because of tolerability issues. ClinicalTrials.gov identifier, NCT01510145.
Full Text Available Hideto Sagara,1,2 Tomohiro Iida,2,3 Kimimori Saito,4 Hiroki Noji,2 Masashi Ogasawara,2 Hiroshi Oyamada21The Marui Eye Clinic, Fukushima, 2Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, 3Tokyo Women's Medical University, Tokyo, 4Matuki Eye Clinic, Fukushima, JapanBackground: Sodium hyaluronate and autologous serum eye drops are used to treat ocular surface disease (OSD and are reported to prevent and treat late-onset bleb leaks following trabeculectomy with mitomycin C. In this study, we evaluated the efficacy of a combination of sodium hyaluronate and autologous serum eye drops and treatment for obstructive meibomian gland dysfunction as a therapy for late-onset bleb leaks after trabeculectomy with mitomycin C.Methods: This was a retrospective, interventional, nonsimultaneous study of 12 subjects (12 eyes of mean age of 64.3 ± 18.3 years with OSD and apparent late-onset bleb leaks following trabeculectomy with mitomycin C between 1998 and 2008. We compared patients diagnosed with leakages before July 2005, who had been treated with separate eye drop solutions containing 0.1% sodium hyaluronate, 50% autologous serum, and 0.3% ofloxacin (sodium hyaluronate and autologous serum group, n = 7, with patients diagnosed from August 2005 to December 2008, who were treated with a combination of eye drops (0.1% sodium hyaluronate, 50% autologous serum, and 0.08% levofloxacin hydrate and eyelid massage and warm compresses for obstructive meibomian gland dysfunction (combination eye drop group, n = 5.Results: Leakage was resolved in one patient (14.3% in the separately treated sodium hyaluronate and autologous serum eye drop group and in five patients (100% in the combination eye drop group (P = 0.015. The period after resolution of leakage with conservative treatment was 23 months in the one eye in the sodium hyaluronate and autologous serum group and 36–61 (mean 52.4 ± 10.1 months in the five eyes in the
Full Text Available Robert J Nutt,1 John L Clements,2 William H Dean3 1Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK; 2Boa Vista Eye Clinic, Benguela, Angola; 3Bristol Eye Hospital, Bristol, UK Background: Ocular surface squamous neoplasia (OSSN is becoming increasingly prevalent and aggressive in Sub-Saharan Africa. It is a phenomenon linked with human immunodeficiency virus (HIV infection, although association rates in Angola are currently unknown. A topical treatment that is effective in HIV-positive and HIV-negative individuals may be preferable to surgery in some contexts. We aimed to estimate the proportion of OSSN associated with HIV in Angola and to report on the success of topical 5-fluorouracil as a primary treatment in HIV-positive and HIV-negative patients.Methods: Photographs of OSSNs taken at presentation and following treatment with 5-fluorouracil in patients presenting to Boa Vista Eye Clinic, Angola, between October 2011 and July 2013 were grouped into HIV-positive and HIV-negative groups and analyzed to compare presenting features and treatment response. Eighty-one OSSNs were analyzed for clinical features and 24 met the inclusion criteria for analysis of treatment response.Results: Eighty-two patients presented with OSSN between October 2011 and July 2013. Twenty-one (26% were HIV-positive and typically had OSSNs that exhibited more pathological features than those in HIV-negative patients. Twenty-four (29% patients met the inclusion criteria for analysis of treatment response; of these, 26 (91% OSSNs in both groups displayed at least partial resolution after one treatment course. In the HIV-positive group, five of eight patients displayed complete resolution, two showed partial resolution, and one failed. In the HIV-negative group, five of 16 showed complete resolution, ten of 16 had partial resolution, and one failed.Conclusion: Individuals presenting with OSSN in Angola are more likely to have HIV infection compared
Gelen Welch Ruiz
Full Text Available Se realizó un estudio descriptivo de tipo retrospectivo longitudinal cuyo universo estuvo constituido por 72 ojos de 72 pacientes con traumatismos oculares mecánicos que fueron hospitalizados en el Hospital Militar Central “Dr. Carlos J. Finlay” desde enero de 1999 hasta enero de 2005. Para el análisis estadístico de la información se utilizó el programa automatizado SPSS versión 11.5 en el cual también se conformó la base de datos y se realizaron los cálculos de acuerdo con el tipo de variable analizada. Se utilizaron medidas de resumen, tendencia central y asociación estadística con un nivel de significación de p A retrospective longitudinal and descriptive study was carried out in 72 eyes from 72 patients with mechanical occular traumas, who had been hospitalized in “Dr. Carlos J. Finlay” Military Hospital from December 1999 to January 2005. For the statistical data analysis, an automated program (SPSS 11.5 version was used to create the database and estimations were made according to the variable types. Summary measures, central tendency measures and statistical association with significance level equal to p < 0.05 were employed. Males prevailed (95.8%, the average age was 30.26 years with a minimum rate of 17 years and maximum rate of 82 years. The most frequent mechanisms of trauma were aggressions (23. 6% and injures from secondary projectiles (13.9%. The anterior segment traumas were more frequent (61, 1% than posterior segment traumas (6.94%. Both segments of the eyeball were affected in 39, 1% of eyes which evinced the worst visual acuity. The most common associated injures were hyphema (54, 2% and vitreous hemorrhage (16.6%. Closed trauma (contusions were more common and most of the eyes had better final visual acuity (45, 2% with vision range of 0.6-1.0 and 26.2% with vision range of 0.59-0.1. On the other hand, eyes affected by open trauma (simple wound, contusion-wound, wound with intraocular foreign body and
Macedo-de-Araújo, Rute J; van der Worp, Eef; González-Méijome, José M
To report the on-eye breakage of a mini-scleral contact lens in a healthy cornea after being hit by a speeding object, without causing any severe corneal damage. A 24-year-old Caucasian male involved in a clinical study reported the in situ breakage of a mini-scleral contact lens during motorbike maintenance. The patient reported eye redness and irritation that significantly decreased after all the pieces of the lens were recovered from the eye. Ocular examinations within 48 h showed absence of corneal damage other than superficial punctate keratitis inferiorly and no fragments of the lens were found in the conjunctival sac. The patient was wearing a 15.2 mm mini-scleral lens in a high Dk material. The evolution of rigid materials towards higher Dk values has resulted in a decreased hardness and modulus values, so these materials are more elastic when subjected to mechanical stress, which could be a beneficial aspect in absorbing the energy of an impact before breaking in pieces. This case report shows that ScCL could have a protective effect to the corneal surface from the direct impact of a high-speed object. Mechanical material properties, wide supporting area and post-lens tear volume acted as protective factors helping to absorb and distribute the kinetic energy of the impacting object. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
Full Text Available Proper availability of drug on to corneal surface is a challenging task. However, due to ocular physiological barriers, conventional eye drops display poor ocular bioavailability of drugs (< 1%. To improve precorneal residence time and ocular penetration, earlier our group developed and evaluated in situ gel and nanoparticles for ocular delivery. In interest to evaluate the combined effect of in situ gel and nanoparticles on ocular retention, we combined them. We are the first to term this combination as "nanoparticle laden in situ gel", that is, poly lactic co glycolic acid nanoparticle incorporated in chitosan in situ gel for sparfloxacin ophthalmic delivery. The formulation was tested for various physicochemical properties. It showed gelation pH near pH 7.2. The observation of acquired gamma camera images showed good retention over the entire precorneal area for sparfloxacin nanoparticle laden in situ gel (SNG as compared to marketed formulation. SNG formulation cleared at a very slow rate and remained at corneal surface for longer duration as no radioactivity was observed in systemic circulation. The developed formulation was found to be better in combination and can go up to the clinical evaluation and application.
Full Text Available Five cases of ocular rosacea (one male and four females are reported in this paper. Two of the patients were with keratoconjunctivitis sicca, one with conjunctivitis chronica and blepharitis, one with conjunctivitis chronica and meibomitis, and one with reccurent corneal erosions with meibomitis and chordeloum. In four patients ocular symptoms preceded the occurence of skin lesions. The treatment with oral tetracyclines significantly improved the state of ocular rosacea in four patients, while in one case the changes of the anterior eye segment progressed in more severe state of ulcerative keratitis. It is considered that in almost 20% of the patients with rosacea ocular lesions may precede the skin changes, representing a diagnostic problem. Thus, in those cases multidisciplinary approach is suggested. Such approach is particularly important because of the decrease of morbidity and the prevention of the onset of the eye complications such as drastic worsening of visual acuity, i.e., the blindness.
Galor, Anat; Small, Leslie; Feuer, William; Levitt, Roy C; Sarantopoulos, Konstantinos D; Yosipovitch, Gil
To evaluate associations between sensations of ocular itch and dry eye (DE) symptoms, including ocular pain, and DE signs. A cross-sectional study of 324 patients seen in the Miami Veterans Affairs eye clinic was performed. The evaluation consisted of questionnaires regarding ocular itch, DE symptoms, descriptors of neuropathic-like ocular pain (NOP), and evoked pain sensitivity testing on the forehead and forearm, followed by a comprehensive ocular surface examination including corneal mechanical sensitivity testing. Analyses were performed to examine for differences between those with and without subjective complaints of ocular itch. The mean age was 62 years with 92% being male. Symptoms of DE and NOP were more frequent in patients with moderate-severe ocular itch compared to those with no or mild ocular itch symptoms. With the exception of ocular surface inflammation (abnormal matrix metalloproteinase 9 testing) which was less common in those with moderate-severe ocular itch symptoms, DE signs were not related to ocular itch. Individuals with moderate-severe ocular itch also demonstrated greater sensitivity to evoked pain on the forearm and had higher non-ocular pain, depression, and post-traumatic stress disorders scores, compared to those with no or mild itch symptoms. Subjects with moderate-severe ocular itch symptoms have more severe symptoms of DE, NOP, non-ocular pain and demonstrate abnormal somatosensory testing in the form of increased sensitivity to evoked pain at a site remote from the eye, consistent with generalized hypersensitivity.
Lin, Zhirong; Zhou, Yueping; Wang, Yuqian; Zhou, Tong; Li, Jie; Luo, Pingping; He, Hui; Wu, Huping; Liu, Zuguo
To investigate the effects and possible mechanisms of serine protease inhibitor A3K (SERPINA3K) on the formation of ocular surface squamous metaplasia in a mouse dry eye model induced by topical benzalkonium chloride (BAC). The eye drops containing SERPINA3K were topically administered during the induction of BAC-induced dry eye. The clinical indications of dry eye were evaluated on day (D)16, including tear break-up time (BUT), tear volume, corneal fluorescein staining, and inflammatory index. Global specimens were collected on D16 and the following examinations were performed: histologic investigation, immunostaining of cytokeratin 10 (K10), p63 and Ki67 in the cornea, and Western blot analysis of tumor necrosis factor-α (TNF-α). Serine protease inhibitor A3K suppressed the formation of BAC-induced dry eye, presenting with longer BUTs, lower corneal fluorescein staining scores, and inflammatory index, while no significant changes in tear volume. It also reduced the severity of abnormal differentiation and proliferation on ocular surface with lower expressions of K10, p63, and Ki67, and retained the number of goblet cells in the conjunctival fornix. Serine protease inhibitor A3K significantly decreased the levels of TNF-α in the cornea. Topical application of SERPINA3K ameliorated the severity of ocular surface squamous metaplasia and suppressed the formation of BAC-induced dry eye. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.
Ru, Yusha; Huang, Yue; Liu, Huijuan; Du, Juan; Meng, Zhu; Dou, Zexia; Liu, Xun; Wei, Rui Hua; Zhang, Yan; Zhao, Shaozhen
Dry eye is a highly prevalent, chronic, and multifactorial disease that compromises quality of life and generates socioeconomic burdens. The pathogenic factors of dry eye disease (DED) include tear secretion abnormalities, tear film instability, and ocular surface inflammation. An effective intervention targeting the pathogenic factors is needed to control this disease. Here we applied α-Melanocyte-stimulating hormone (α-MSH) twice a day to the ocular surface of a scopolamine-induced dry eye rat model. The results showed that α-MSH at different doses ameliorated tear secretion, tear film stability, and corneal integrity, and corrected overexpression of proinflammatory factors, TNF-α, IL-1β, and IFN-γ, in ocular surface of the dry eye rats. Moreover, α-MSH, at 10(-4) μg/μl, maintained corneal morphology, inhibited apoptosis, and restored the number and size of conjunctival goblet cells in the dry eye rats. Mechanistically, α-MSH activated both PKA-CREB and MEK-Erk pathways in the dry eye corneas and conjunctivas; pharmacological blockade of either pathway abolished α-MSH's protective effects, suggesting that both pathways are necessary for α-MSH's protection under dry eye condition. The peliotropic protective functions and explicit signaling mechanism of α-MSH warrant translation of the α-MSH-containing eye drop into a novel and effective intervention to DED.
Gandhi, Niral B.; Su, Zhitao; Zhang, Xiaobo; Volpe, Eugene A.; Pelegrino, Flavia S. A.; Rahman, Salman A.; Li, De-Quan; Pflugfelder, Stephen C.; de Paiva, Cintia S.
TSP-1 is a physiologic activator of TGF-β, a critical induction factor for Th17-mediated immunity. The purpose of this study was to investigate the role of TSP-1 in the induction of the Th17 ocular surface response to DS. TSP-1KO and WT mice were subjected to DS5 and DS10), and parameters of ocular surface disease, including corneal barrier function, conjunctival CD4+ T cell infiltration, and GC density, were evaluated. TSP-1KO mice subjected to DS had less corneal barrier disruption, reduced loss of PAS+ GC, and decreased CD4+ T cell infiltration in the conjunctiva. In contrast to WT, TSP-1KO mice failed to up-regulate MMP-3 and MMP-9 mRNA transcripts in the cornea and IL-17A mRNA transcripts in the conjunctiva. RAG-1KO recipients of adoptively transferred CD4+ T cells isolated from TSP-1KO mice subjected to DS5 showed milder dry-eye phenotype and less conjunctival inflammation than recipients of CD4+ T cells from DS5 WT control. Reconstitution of TSP-1KO mice with WT DCs prior to DS reversed the resistance of the TSP-1KO to DS-induced immunopathology. In conclusion, DC-derived TSP-1 is critical for generating the Th17 ocular surface response to DS. PMID:23983225
Patterson, Colin J.; Shiri, Samira; Bird, James C.
Liquid drops can bounce when they impact non-wetting surfaces. Recently, studies have demonstrated that the time that the bouncing drop contacts a superhydrophobic surface can be reduced by incorporating ridged macrotextures on the surface. Yet the existing models aimed at explaining this phenomenon offer incompatible predictions of the contact time when a drop impacts multiple intersecting macrotextures, or spokes. Furthermore, it is unclear whether the effects of the macrotexture on the drop hydrodynamics extend to non-wetting surfaces in which direct contact is avoided by a thin vapor layer. Here we demonstrate that the phenomenon observed for macrotextured, superhydrophobic surfaces extends to macrotextured, wettable surfaces above the Leidenfrost temperature. We show that the number of droplets and overall residence time both depend on the number of intersecting spokes. Finally, we compare and contrast our results with mechanistic models to rationalize various elements of the phenomenon.
Colter, Jourdan; Wirostko, Barbara; Coats, Brittany
Hyaluronic acid-based polymer films are emerging as drug-delivery vehicles for local and continuous drug administration to the eye. The highly lubricating hyaluronic acid increases comfort, but displaces films from the eye, reducing drug exposure and efficacy. Previous studies have shown that careful control of the surface interaction of the film with the eye is critical for improved retention. In this study, the frictional interaction of a carboxymethylated, hyaluronic acid-based polymer (CMHA-S) with and without methylcellulose was quantified against ovine and human sclera at three axial loads (0.3, 0.5, and 0.7 N) and four sliding velocities (0.3, 1.0, 10, and 30 mm/s). Static coefficients of friction significantly increased with rate (P Friction became more rate-dependent when methylcellulose was added to CMHA-S. Kinetic coefficient of friction was not affected by rate, and averaged 0.15 ± 0.1. Methylcellulose increased CMHA-S static and kinetic friction by 60% and 80%, respectively, but was also prone to wear during testing. These data suggest that methylcellulose can be used to create a friction differential on the film, but a potentially increased degradation rate with the methylcellulose must be considered in the design.
Tahiri Joutei Hassani, Rachid; Liang, Hong; El Sanharawi, Mohamed; Brasnu, Emmanuelle; Kallel, Sofiene; Labbé, Antoine; Baudouin, Christophe
To explore the potential of spectral-domain optical coherence tomography (SD-OCT) using the en-face technology for the imaging of ocular surface diseases and to correlate the findings with in vivo confocal microscopy (IVCM) images. 113 eyes of 75 subjects with various ocular surface diseases were investigated with the RTVue(®) anterior-segment en face OCT. En face OCT images were compared to B-scan OCT and IVCM images. Patients with corneal dystrophies, corneal deposits, keratitis, pterygium, conjunctivochalasis, or ocular surface squamous neoplasia and patients who underwent lamellar corneal surgeries were included. En-face OCT images showed ocular surface tissue changes that were not discernible using conventional B-scan OCT. Nevertheless, there was a good correlation with IVCM analysis. Compared with IVCM, the major advantages of en-face OCT included easy operation and rapid image acquisition, with minimal operator experience required. In addition, the non-contact method avoided patient discomfort and external pressure on the globe, which was especially useful in patients with corneal dystrophies, ulcers, or corneal abscesses. Although the resolution of en-face OCT was lower than that of IVCM, it allowed useful overall visualization of corneal lesions due to the larger areas analyzed. En-face SD-OCT is a novel, valuable tool to assess a wide variety of ocular surface diseases. It can provide additional information and new insight into different ocular surface conditions with no corneal contact. Copyright © 2014 Elsevier Inc. All rights reserved.
Kamal, Saurabh; Kaliki, Swathi; Mishra, Dilip K; Batra, Jyoti; Naik, Milind N
To describe and compare the clinical presentation, treatment outcomes, and histopathologic features of ocular surface squamous neoplasia (OSSN) based on human immunodeficiency virus (HIV) status. Case-control study. A total of 200 patients with OSSN, of whom 83 (41%) had positive results for HIV and were classified as cases and 117 (59%) had negative results for HIV and were classified as controls. Enzyme-linked immunosorbent assay for HIV, conjuntival excision biopsy, extended enucleation, orbital exenteration. Clinical features, treatment outcomes, and histopathologic characteristics. The mean age at presentation of OSSN in both cases and controls was 40 years (median, 40 years; range, 13-65 years) and in controls was 40 years (median, 38 years; range, 15-80 years). On comparison of cases versus controls with OSSN, HIV-positive individuals had larger (12 vs. 8 mm; P exenteration (27% vs. 11%; P Ocular surface squamous neoplasia in HIV-positive individuals is aggressive with larger and thicker tumors and with higher incidence of corneal, scleral, and orbital invasion. These patients are associated with poor ocular prognosis with higher need for extended enucleation, exenteration, or both. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Anders Woerman; Lars Marklund; Xu Shulan; Bjoern Dverstorp
The safety analysis of the final repository of spent nuclear fuel will include large-scale migration behaviour of radionuclides that accidentally leak from the repository in deep bedrock. Physically based models of radionuclides release-processes would typically take into account the flow and transport in the hydrosphere as well as spreading through ecosystems to individual humans. This study addresses the coupling between discharge pattern in the landscape and factors controlling the residence times or radionuclides in the biosphere on land. The overall residence time on land is crucial because it controls the maximum exposure of radioactivity to individual humans. Numerical analysis indicate that variation in topography and quaternary deposits affect the discharge pattern in the landscape for radionuclides that escapes the waste repository in deep bedrock. Those analyses are based on extensive geographical data covering surface topography, stream network characteristics and geological structure on the continental scale of Scandinavia. Results on the discharge pattern in three typical Swedish landscapes are used as a basis for comparative analyses of the residence time distribution in surface hydrological systems for radionuclides that escape the waste repository. The groundwater flow analyses show that pathways of deep groundwater predominantly lead to the stream network, but to some extent also to lakes, wetlands and root uptake. The proportion varies slightly with altitude in the watershed as well as between different watersheds. The residence times in the stream network was based on convoluting the residence times for single discharge points over the entire stream network according to the technique of and data on stream distance distribution. The retardation due to uptake in the hyporheic zone was accounted for using the methods of and estimated sorption properties for Cs-137. The residence time for radionuclides in the hydrological systems of the continent
Full Text Available Background. Ocular toxoplasmosis is one of the important causes of severe visual loss in young otherwise healthy people. Diagnosis is clinical, supported by laboratory tests. Current evidence about the timing of toxoplasma infection leading to ocular disease suggests, that recurrent toxoplasmic retinochoroiditis is the result of prenatal (congenital or remote, postnatal (acquired infection. The timing of infection is rarely exactly known, and retinitis is not only a late manifestation of congenital disease as previously believed. The purpose is to review recent observations regarding ocular toxoplasmosis, and to review our experiences in the treatment of our patients with this illness.Methods. A review of the medical literature about ocular toxoplasmosis, especially regarding pathogenesis, therapy and prevention of the disease.Results. Epidemiological data for toxoplasmosis are various in different parts of the world. The highest rate is in Brasil. In Slovenia the rate is similar like in France or in the Netherlands (at age 40 there is 60% population seropositive. Toxoplasmosis screening in pregnant women is partly performed since 1991 and systematically since 1995 in Slovenia. No retinochorioditis was found in newborns so far. In the pathogenesis there are some several potential sources and routes of infections, that were previously unrecognized. Ocular involvement in cases of acquired infection appears to be more common than believed before. Classical therapy for ocular toxoplasmosis is still most commonly used. In prevention the education of pregnant women, and correct treatment of infected patients is recommended.Conclusions. The time of infection with Toxoplasma gondii and consequential retinochoroiditis is rarely confirmed. Patients with acquired infection after birth are probably more numerous than with congenital disease. As potentially treatable and preventable cause of visual loss these facts must be considered in primary and secondary
The 1990 Clean Air Act Amendments direct the U.S. Environmental Protection Agency to evaluate and modify, as required, existing dispersion models for the prediction of dispersion of dust from surface coal mines. The application of mathematical air pollution dispersion models to the dispersion of dust from surface coal mines requires knowledge of not only the amount of dust generated in the mine, but the fraction of that generated that actually escapes from the mine. The escape fraction can be related to the residence time that released material will remain, on average, within the mine. The concentration in the mine was found to follow an exponential decay function from which an exponential decay time constant (or residence time) was computed for each case. A semi-empirical formula was found that related the residence time to the mine geometry and wind direction quite well. This formula can be used to estimate escape fraction in determining the source strength for the application of mathematical dispersion models.
Sigrid Mueller-Schotte OD, MSc
Full Text Available Intra-ocular straylight can cause decreased visual functioning, and it may cause diminished vision-related quality of life (VRQOL. This cross-sectional population-based study investigates the association between straylight and VRQOL in middle-aged and elderly individuals. Multivariable linear regression analyses were used to assess the association between straylight modeled continuously and cutoff at the recommended fitness-to-drive value, straylight ≥ 1.4 log(s, and VRQOL. The study showed that participants with normal straylight values, straylight ≤ 1.4 log(s, rated their VRQOL slightly better than those with high straylight values (straylight ≥ 1.4 log(s. Furthermore, multivariable regression analysis revealed a borderline statistical significant association ( p = .06 between intra-ocular straylight and self-reported VRQOL in middle-aged and elderly individuals. The association between straylight and self-reported VRQOL was not influenced by the status of the intra-ocular lens (natural vs. artificial intra-ocular lens after cataract extraction or the number of (instrumental activities of daily living that were reported as difficult for the elderly individuals.
Gichuhi, Stephen; Macharia, Ephantus; Kabiru, Joy; Zindamoyen, Alain M'bongo; Rono, Hilary; Ollando, Ernest; Wanyonyi, Leonard; Wachira, Joseph; Munene, Rhoda; Onyuma, Timothy; Jaoko, Walter G; Sagoo, Mandeep S; Weiss, Helen A; Burton, Matthew J
Clinical features are unreliable for distinguishing ocular surface squamous neoplasia (OSSN) from benign conjunctival lesions. To evaluate the adverse effects, accuracy, and interobserver variation of toluidine blue 0.05% vital staining in distinguishing OSSN, confirmed by histopathology, from other conjunctival lesions. Cross-sectional study in Kenya from July 2012 through July 2014 of 419 adults with suspicious conjunctival lesions. Pregnant and breastfeeding women were excluded. Comprehensive ophthalmic slitlamp examination was conducted. Vital staining with toluidine blue 0.05% aqueous solution was performed before surgery. Initial safety testing was conducted on large tumors scheduled for exenteration looking for corneal toxicity on histology before testing smaller tumors. We asked about pain or discomfort after staining and evaluated the cornea at the slitlamp for epithelial defects. Lesions were photographed before and after staining. Diagnosis was confirmed by histopathology. Six examiners assessed photographs from a subset of 100 consecutive participants for staining and made a diagnosis of OSSN vs non-OSSN. Staining was compared with histopathology to estimate sensitivity, specificity, and predictive values. Adverse effects were enumerated. Interobserver agreement was estimated using the κ statistic. A total of 143 of 419 participants (34%) had OSSN by histopathology. The median age of all participants was 37 years (interquartile range, 32-45 years) and 278 (66%) were female. A total of 322 of the 419 participants had positive staining while 2 of 419 were equivocal. There was no histological evidence of corneal toxicity. Mild discomfort was reported by 88 (21%) and mild superficial punctate keratopathy seen in 7 (1.7%). For detecting OSSN, toluidine blue had a sensitivity of 92% (95% CI, 87%-96%), specificity of 31% (95% CI, 25%-36%), positive predictive value of 41% (95% CI, 35%-46%), and negative predictive value of 88% (95% CI, 80%-94%). Interobserver
Full Text Available Pur po se: To evaluate the 1-year follow-up results of cultivated limbal epithelial cell (CLEC transplantation in unilateral limbal stem cell deficiency (LSCD. Ma te ri al and Met hod: One-year follow-up results of five unilateral LSCD patients who had undergone CLEC transplantation were evaluated. Parameters for this evaluation were: fluorescein staining of ocular surface, corneal vascularization and status of epithelium with slit lamp, and visual acuity. 1.5-mm limbal biopsy was performed from the superior limbus of the healthy eyes, broke into two equal pieces, expanded on human amniotic membrane (hAM and inserts for 14 days until getting 20 mm in size. CLECs on hAMs were used directly, and cells on inserts were usedafter detachment procedure. The symblepharon and pannus tissues were removed, superficial keratectomy was performed. CLEC on hAMs were transplanted with the epithelial side up onto the bare corneal stroma, sutured to the conjunctiva with 10-0 nylon sutures. Free CLEC layer from insert was placed on hAM as a second layer, additional hAM was used as a protective layer all over other tissues. Re sults: Median age was 44.4 years (14-71. The etiology was chemical burn in all patients. Median duration of symptoms was 10 years (2-18, median follow-up period was 12.6 (12-12.5 months. Preoperative best corrected visual acuities (BCVA were light perception in three patients, counting fingers at 50 cm in one patient and 3/10 in one patient. Visions were improved in all patients. Postoperative BCVA 12 months after the surgery were between counting fingers at 3 meters to 6/10. There was a temporary hemorrhage between the two layers of hAMs in one patient at the early postoperative period. Peripheral corneal vascularization has occurred in three patients, in patient corneal vascularization has reached to the paracentral area. Dis cus si on: CLEC transplantation is an efficient treatment option for unilateral LSCD in mid-long term. (Turk J
Joshi, Rajesh Subhash; Somani, Abhishek Arun Kumar
Ocular problems are common in mentally retarded children. Due to population growth these problems are increasing. Prevalence rate is variable from region to region. Data on ocular problems in mentally retarded school children is lacking in this region. The aim of the present study was to identify the ocular disorders in children with mental retardation attending special schools in a district and to study their relationship with the degree of retardation. A total of 241 mentally retarded school children in the age group of 6-16 years attending special schools for the mentally retarded children in a district in central India were examined by a team of ophthalmologist, psychiatrist, and a resident in ophthalmology department of a medical college. Complete ocular examination was done. Ocular problems were identified and categorized according to the intelligent quotient. One hundred and twenty four children (51.45%) had ocular problems. Strabismus (10.37%) and refractive error (20.75%) were the common ocular problems seen in this study. An association was found between the severity of mental retardation and ocular problems (P<0.005). However, no association was seen between the severity of mental retardation and strabismus and refractive error. A high prevalence of ocular problems was seen in mentally retarded school children. Children with mental retardation should undergo annual ophthalmological check up. Early detection and correction of ocular problems will prevent visual impairment in future.
Marina Soares Viegas Moura Rezende
Full Text Available Após uma injúria corneana, é fundamental a eliminação dos miofibroblastos a fim de garantir sua transparência. Os miofibroblastos corneanos apresentam um receptor para o fator ativador de plaquetas em sua superfície. O concentrado de plaquetas é uma das mais ricas fontes de fatores de crescimento essenciais, causando redução do sangramento, da inflamação, da escarificação, do tempo de cicatrização, acelerando assim o fechamento das úlceras.Relatamos um caso de úlcera trófica corneana não responsiva aos tratamentos convencionais e que apresentou melhora clínica significativa com colírio de concentrado de plaquetas autólogo.In order to assure corneal transparency after injury the effective removal of myofibroblasts is fundamental. The corneal myofibroblasts display platelet activator factor receptor on its surface. The platelet concentrate is one of the richest sources of essential growth factors, reducing bleeding, inflammation, scaring time, thus speeding up the closing of the ulcers. We report a case which provides evidence of clinical improvement with concentrate platelet eyedrops on a non responsive trophic corneal disease.
Full Text Available Models of benzalkonium chloride (BAC-induced ocular disruption have been created and are widely used in various animals. This study aimed to compare the effects of BAC on the ocular surfaces of C57BL/6 and BALB/c mice. C57BL/6 and BALB/c mice were treated separately with BAC eye-drops at different concentrations. Eyes were evaluated by scoring epithelial disruption, corneal opacity and neovascularization in vivo, and by histological assays with hematoxylin/eosin (H/E and periodic acid-Schiff stainings and by determining the expression of inflammatory factors in vitro on Days 7 and 14. The in vivo corneal epithelial disruption, corneal edema/opacity and neovascularization, which were in accordance with the results of the H/E staining and peaked at Day 7, were observed in a dose-dependent manner in the BAC-treated mice, with more severe signs in the C57BL/6 mice than the BALB/c mice. The loss of conjunctival goblet cells in the conjunctivas and the increasing expression of monocyte chemoattractant protein 1 (MCP-1, growth-regulated protein alpha (GROa and macrophage inflammatory protein-1 alpha (MIP-1a in the corneas were found in a dose-dependent manner in both strains of mice. Topical application of BAC can dramatically disrupt the ocular surfaces of C57BL/6 and BALB/c mice, and the disruptions were much more severe in the C57BL/6 mice that received high doses of BAC.
Detection of Acanthamoeba on the ocular surface in a Spanish population using the Schirmer strip test: pathogenic potential, molecular classification and evaluation of the sensitivity to chlorhexidine and voriconazole of the isolated Acanthamoeba strains.
Rocha-Cabrera, Pedro; Reyes-Batlle, María; Martín-Navarro, Carmen María; Dorta-Gorrín, Alexis; López-Arencibia, Atteneri; Sifaoui, Ines; Martínez-Carretero, Enrique; Piñero, José E; Martín-Barrera, Fernando; Valladares, Basilio; Lorenzo-Morales, Jacob
Pathogenic strains of Acanthamoeba are causative agents of a sight-threatening infection of the cornea known as Acanthamoeba keratitis, which is often associated with the misuse of contact lenses. However, there is still a question remaining to be answered, which is whether these micro-organisms are present on the ocular surface of healthy individuals. Therefore, the aim of this study was to determine the presence of Acanthamoeba on the ocular surface in healthy patients and also in those with other ocular surface infections. Sterile Schirmer test strips were used to collect samples from a group of patients who attended an ophthalmology consultation at the Hospital del Norte, Icod de los Vinos, Tenerife, Canary Islands. Most of the patients (46 individuals, 79.31 %) presented ocular surface pathologies such as blepharitis or conjunctivitis; the rest did not present any pathology. None of the patients included in the study wore contact lenses. The collected samples were cultured in 2 % non-nutrient agar plates and positive plates were then cultured in axenic conditions for further analyses. Molecular analysis classified all isolated strains as belonging to Acanthamoeba genotype tbl4, and osmotolerance and thermotolerance assays revealed that all strains were potentially pathogenic. Furthermore, all strains were assayed for sensitivity against voriconazole and chlorhexidine. Assays showed that both drugs were active against the tested strains. In conclusion, the Schirmer strip test is proposed as an effective tool for the detection of Acanthamoeba on the ocular surface.
Kudela, Pavol; Koller, Verena Juliana; Mayr, Ulrike Beate; Nepp, Johannes; Lubitz, Werner; Barisani-Asenbauer, Talin
The purpose of the presented investigation was to examine the efficiency of the novel carrier system Bacterial Ghosts (BGs), which are empty bacterial cell envelopes of Gram-negative bacteria to target human conjunctival epithelial cells, as well as to test the endocytic capacity of conjunctival cells after co-incubation with BGs generated from different bacterial species, and to foreclose potential cytotoxic effects caused by BGs. The efficiency of conjunctival cells to internalize BGs was investigated using the Chang conjunctival epithelial cell line and primary human conjunctiva-derived epithelial cells (HCDECs) as in vitro model. A high capacity of HCDECs to functionally internalize BGs was detected with the level of internalization depending on the type of species used for BGs generation. Detailed analysis showed no cytotoxic effect of BGs on HCDECs independently of the used bacterial species. Moreover, co-incubation with BGs did not enhance expression of both MHC class I and class II molecules by HCDECs, but increased expression of ICAM-1. The high rates of BG's internalization by HCDECs with no BG-mediated cytotoxic impact designate this carrier system to be a promising candidate for an ocular surface drug delivery system. BGs could be useful for future therapeutic ocular surface applications and eye-specific disease vaccine development including DNA transfer. Copyright © 2011 Elsevier B.V. All rights reserved.
Gurumurthy, Srividya; Iyer, Geetha; Srinivasan, Bhaskar; Agarwal, Shweta; Angayarkanni, Narayanasamy
To study the tear cytokine and the conjunctival and oral mucosal marker profile in chronic ocular Stevens-Johnson syndrome (SJS) and their alteration following mucous membrane grafting (MMG) for lid margin keratinisation (LMK). In a 1-year prospective study, SJS cases (n=25) and age-matched/sex-matched healthy controls (n=25) were recruited. Tear specimen (Schirmer's strip), conjunctival and oral mucosal imprints were collected from controls and SJS cases pre-MMG and post-MMG (at first follow-up, n=17). Tear cytokines were profiled using 27-bioplex array. Transforming growth factor-beta (TGF-β)-mediated extracellular matrix changes in conjunctival and oral mucosal cells were analysed by gene expression studies. 30 RESULTS: Tear cytokine profiling of chronic SJS cases at pre-MMG stage revealed significant upregulation of cytokines granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin (IL)-8, IL-1β, monocyte chemoattractant protein-1, IL-15, IL-2, IL-17A and basic fibroblast growth factor (bFGF) with downregulation of IP-10 (interferon gamma-induced protein 10), tumour necrosis factor-α, interferon-γ, IL-10, vascular endothelial growth factor, regulated upon activation normal T-cell expressed and secreted (RANTES), IL-7, IL-12p70 and IL-13, with maximal increase in GM-CSF and maximal downregulation of IP-10, respectively. Of these, IL-2, IL-15, bFGF and IL-17A showed significant correlation with disease severity, pre-MMG. Conjunctival cells pre-MMG showed increase in TGF-β1, TGF-βRII, connective tissue growth factor and collagen-III gene expression by 10, 67, 173 and 184 folds, respectively, which dropped to 1.3, 11, 13.5 and 19 folds correspondingly, post-MMG. However, their expressions in oral mucosa were negligible. A proinflammatory, profibrotic, antiapoptotic ocular surface milieu characterises chronic ocular SJS. IP-10, an antifibrotic cytokine was noted to be maximally downregulated, unlike in other forms of chronic dry eye disease. The
Regmi, Suresh C; Samsom, Michael L; Heynen, Miriam L; Jay, Gregory D; Sullivan, Benjamin D; Srinivasan, Sruthi; Caffery, Barbara; Jones, Lyndon; Schmidt, Tannin A
Sjögren's syndrome (SS) is an autoimmune disease affecting the lacrimal and salivary glands with hallmark clinical symptoms of dry eye and dry mouth. Recently, markedly increased cathepsin S (CTSS) activity has been observed in the tears of SS patients. Proteoglycan 4 (PRG4), also known as lubricin, is an effective boundary lubricant that is naturally present on the ocular surface. While PRG4 is susceptible to proteolytic digestion, the potential effect of CTSS on PRG4 remains unknown. The objective of this study was to assess the ability of CTSS to enzymatically degrade purified PRG4, and PRG4 naturally present in human tears, and alter ocular surface boundary lubricating properties. To assess the potential time course and dose-dependency of PRG4 digestion by CTSS, full-length recombinant human PRG4 (rhPRG4) was incubated at 37 °C with or without CTSS in an enzymatic digestion buffer. Digestion of PRG4 by CTSS was also examined within normal human tear samples, both with and without supplementation by rhPRG4. Finally, digestion of endogenous PRG4 by CTSS, and the effect of a CTSS inhibitor, was examined in SS tears on Schirmer strips. Digestion products were separated on 3-8% SDS-PAGE and visualized by protein staining and western blotting. The boundary lubricating ability of rhPRG4 samples was assessed using an in vitro human eyelid-cornea friction test. Finally, SDS-PAGE protein stain bands resulting from rhPRG4 digestion were submitted for tandem mass spectrometry analysis to confirm their identity as PRG4 and identify non-tryptic cleavage sites. CTSS digested rhPRG4 in a time and dose dependent manner. CTSS digestion of rhPRG4 at 1% (where % is the mass ratio of CTSS to rhPRG4) resulted in a time dependent decrease in the full-length, ∼460 kDa, monomeric rhPRG4 band, and an appearance of lower MW fragments. After 20 h, no full-length rhPRG4 was observed. Furthermore, with an increased relative enzyme concentration of 3%, no protein bands were observed
Francisco Infante Barrera
Full Text Available La evolución etiológica de la medicina la podemos dividir en dos grandes períodos: período de la sífilis y período de la tuberculosis. El período de la sífilis, gracias a las armas de combate de que hoy disponemos, ocupa un lugar secundario. El período de la tuberculosis y que no es sino el paralelo de la vida moderna, ocupa en vigencia el primer lugar. Es el período presente. Hasta hace poco tiempo el médico en general, iniciaba la exploración de su paciente con un interrogatorio, una inspección, un tacto y una serología con una obsesión sifilítica. En la época actual el médico y en especial el oftalmólogo debe tener una obsesión tuberculosa en la investigación etiológica. Cuántas veces en una afección ocular que de una manera lenta pero progresiva produce profundas alteraciones oculares, lleva el sello soterrado de una tuberculosis? Cuántos enfermos de una constitución en apariencia envidiable hacen precisamente por un exceso de sus defensas una alergia tuberculosa? Tan traicionera como la sífilis es la tuberculosis. La sífilis quema sus etapas y estalla con una hemorragia cerebral, una locura, una parálisis general, una ataxia locomotriz progresiva, una goma o una meningitis sifilítica. La tuberculosis hace su presentación con una afección ocular, una goma, una granulia, una artritis, una osteítis, o una meningitis óptico-quiasmática. Siendo esto así, es necesario, en la mayoría de las afecciones oculares, tratar de identificarla por los medios de diagnóstico de que hoy disponemos.
Ochs, Rachel F; Horn, Susan D; van Rijswijk, Lia; Pietsch, Catherine; Smout, Randall J
To provide empirical evidence comparing pressure ulcer healing rates between different support surfaces, data were analyzed from eligible residents with pressure ulcers (N = 664) enrolled in the National Pressure Ulcer Long-Term Care Study, a retrospective pressure ulcer prevention and treatment study. Support surfaces were categorized as: Group 1 (static overlays and replacement mattresses), Group 2 (low-air-loss beds, alternating pressure, and powered/non-powered overlays/mattresses), and Group 3 (air-fluidized beds). Calculation of healing rates, using the largest ulcer from each resident, found mean healing rates greatest for air-fluidized therapy (Group 3) (mean = 5.2 cm(2)/week) versus Group 1 (mean =1.5 cm(2)/week) and Group 2 (mean = 1.8 cm(2)/week) surfaces (P = 0.007). Healing rates also were assessed using 7- to 10-day "episodes"; each ulcer generated separate episode(s) that included all ulcers when residents had multiple ulcers. Mean healing rates were significantly greater for Stage III/IV ulcers on Group 3 surfaces (mean = 3.1 cm(2)/week) versus Group 1 (mean = 0.6 cm(2)/week) and Group 2 (mean = 0.7 cm(2)/week) surfaces (Group 2 versus Group 3: P = 0.0211). This finding persisted for ulcers with comparable initial baseline areas (20 cm(2) to 75 cm(2)) on Group 2 and Group 3 surfaces; healing improved on Group 3 surfaces (+2.3 cm(2)/week) versus Group 2 surfaces (-2.1 cm(2)/week, P = 0.0399). Residents on Group 3 (6 out of 82; 7.3%) and Group 1 (47 out of 461; 10.2%) surfaces had fewer hospitalizations and emergency room visits than those on Group 2 surfaces (23 out of 121; 19.0%, P = 0.01) despite significantly greater illness in residents on Group 2 and 3 versus Group 1 surfaces (P is less than 0.0001). Despite limitations inherent in retrospective studies, ulcers on Group 3 surfaces versus Groups 1 and Group 2 surfaces had statistically significant faster healing rates (particularly for Stage III/IV ulcers) with significantly fewer
Gnyawali, Subodh; Shrestha, Gauri Shankar; Khanal, Safal; Dennis, Talisa; Spencer, John C
High altitude, often characterized by settings over 2400m, can be detrimental to the human body and pose a significant risk to ocular health. Reports concerning various ocular morbidities occurring as a consequence of high altitude are limited in the current literature. This study was aimed at evaluating the ocular health of porters working at high altitudesof Himalayas in Nepal. A mobile eye clinic was set up in Ghat and patient data were collected from its out- patient unit by a team of seven optometrists which was run for five days. Ghat is a small village in north-eastern Nepal, located at 2860 m altitude. Travellers walking through the trekking route were invited to get their eyes checked at the clinic. Comprehensive ocular examinations were performed, including visual acuities, objective and subjective refraction, anterior and posterior segment evaluations, and intraocular pressure measurements; blood pressure and blood glucose levels were also measured as required. Ocular therapeutics, prescription glasses, sunglasses and ocular health referrals were provided free of cost as necessary. A total of 1890 people visited the eye clinic, among which 57.4% (n=1084) were porters. Almost half of the porters had an ocular morbidity. Correctable refractive error was most prevalent, with other ocular health-related complications, including dry eye disease, infectious disorders, glaucoma and cataract. Proper provision of regular and effective eye care services should be made more available for those residing at these high altitudes in Nepal. © NEPjOPH.
Stein, Elisabeth; Inic-Kanada, Aleksandra; Belij, Sandra; Montanaro, Jacqueline; Bintner, Nora; Schlacher, Simone; Mayr, Ulrike Beate; Lubitz, Werner; Stojanovic, Marijana; Najdenski, Hristo; Barisani-Asenbauer, Talin
For the successful topical administration of drugs or vaccines to treat ocular surface diseases, efficient and well-tolerated delivery systems/carriers for conjunctival delivery are crucial in the development of new treatment strategies. The present study investigated the efficiency of internalization of bacterial ghosts (BGs) produced from probiotic Escherichia coli Nissle 1917 (EcN) by human conjunctival epithelial (HCjE) cell line, the EcN BGs cytotoxicity for HCjE cells, and in vivo uptake of EcN BGs by conjunctival guinea pig epithelial cells. The uptake of EcN BGs by HCjE cells was analyzed by laser scanning microscopy and flow cytometry. Immunohistochemistry was used to localize the EcN BGs in the guinea pig conjunctival tissue. Cytotoxicity of EcN BGs on HCjE cells was evaluated by measurement of LDH. Laser scanning microscopy and flow cytometry revealed that EcN BGs internalization by HCjE cells was time- and dose dependent. No cytotoxic effect on HCjE cells was observed after EcN BGs inoculation for 30 and 120 minutes, as well as 24 hours. In addition, the uptake of EcN BGs was detected in the conjunctival cells after in vivo administration of EcN BGs into the eye of the guinea pig. The findings that EcN BGs are nontoxic and effectively internalized in vitro by human and in vivo by guinea pig conjunctival cells comprise an important contribution to the future use of BGs as a system for conjunctival delivery of drugs and vaccines, either to treat or prevent ocular surface diseases.
... targeted in other autoimmune conditions, such as autoimmune thyroid disease. How is ocular myasthenia gravis treated? People with ocular MG and their caregivers should balance the severity of the symptoms with the risks and benefits of treatment. People ...
Oude Lashof, A.M.L.; Rothova, A.; Sobel, J.D.; Ruhnke, M.; Pappas, P.G.; Viscoli, C.; Schlamm, H.T.; Oborska, I.T.; Rex, J.H.; Kullberg, B.J.
BACKGROUND: Ocular candidiasis is a major complication of candidemia. The incidence, risk factors, and outcome of eye involvement during candidemia are largely unknown. We prospectively studied the ocular manifestations of candidemia in a large, worldwide, randomized multicenter trial that compared
Full Text Available Masahiko Ayaki,1 Atsuo Iwasawa,2 Yoshimi Niwano31Department of Ophthalmology, International University of Health and Welfare, Mita Hospital, Tokyo, 2Department of Bioengineering, Graduate School of Bioscience and Biotechnology, Tokyo Institute of Technology, Yokohama, 3Laboratory for Redox Regulation, Tohoku University Graduate School of Dentistry, Sendai, JapanPurpose: Anti-inflammatory eyedrops are often used in the treatment of corneal epithelial disorders. In the present study, we evaluated the cytotoxicity of six anti-inflammatory eyedrops in four ocular surface cell lines.Methods: The cytotoxicity of six commercially available anti-inflammatory ophthalmic solutions (ie, diclofenac, bromfenac, pranoprofen, betamethasone, and fluoromethorone was assessed in three corneal cell lines and one conjunctival cell line. Cell viability was determined by the 3-(4,5-dimethyl-2 thiazoyl-2,5-diphenyl-2H-tetrazolium bromide and neutral red assays after exposing the cells to 10, 30, and 60 minutes of onefold, twofold, and tenfold dilutions of the drugs. Cytotoxicity was compared using the cell viability score (CVS, an integrated cytotoxic parameter that takes various factors into account, such as dilution by tear fluid or concentration by evaporation, drug exposure time, and ocular surface cell type.Results: Based on the CVS scores, the order of the anti-inflammatory eyedrops tested from least to most cytotoxic, with the active ingredient %CVS50, and %CVS40/80 for each solution given in parentheses, was as follows: Rinderon® (betamethasone, 100%, 100% >0.02% Flumethoron® (fluoromethorone, 68%, 22% = 0.1% Flumethoron® (fluoromethorone, 76%, 22% >Bronuck® (0.1% bromfenac, 53%, −8% = Diclod® (0.1% diclofenac, 44%, −15% = Niflan® (pranoprofen, 50%, −19%. Rinderon® exhibited the least toxicity of all the anti-inflammatory eyedrops tested. Eyedrops containing non-steroidal anti-inflammatory drugs exhibited greater cytotoxicity than those containing
Murillo, Juan C; Galor, Anat; Wu, Michael C; Kye, Natasha K; Wong, James; Ahmed, Ibrahim O; Joag, Madhura; Shalabi, Nabeel; Lahners, William; Dubovy, Sander; Karp, Carol L
The aim of this paper was to describe 2 cases of ocular surface squamous neoplasia (OSSN) of the conjunctiva with intracorneal and intraocular extension following intraocular surgery. We conducted a clinical pathological retrospective case series. Case 1 underwent cataract surgery in the setting of an unnoticed adjacent OSSN. An excisional biopsy with cryotherapy and intraoperative mitomycin C was subsequently performed, confirming OSSN. The patient had two recurrences treated topically with resolution. While the conjunctiva remained clear, a corneal haze emanating from the cataract incision site was noted. Penetrating keratoplasty (PK) for this haze revealed midstromal infiltrative carcinoma. Case 2 had a history of herpes simplex keratitis that ultimately required corneal grafts. Fifteen years later, he developed an OSSN treated with excisional biopsy and had clear margins. Eight months later, he presented with a recurrence of his OSSN and was treated briefly with topical interferon for 4 weeks; however, he developed an infectious keratitis with a corneal perforation requiring another PK. Four months after PK, low-grade inflammation was noted. Cytology of the anterior chamber aspirate revealed neoplastic squamous cells. Another PK was then performed. Pathology confirmed extensive intraocular neoplasia. Limited exenteration was performed. Patients with a history of OSSN may be at increased risk of neoplastic intraocular extension following intraocular surgery.
Kaliki, Swathi; Singh, Swati; Gowrishankar, Swarnalata; Reddy, Vijay Anand P
To discuss the association between ocular surface squamous neoplasia (OSSN) and Papillon-Lefèvre syndrome (PLS) and present the long-term outcome in a patient with these diseases. Case report. A 14-year-old boy presented with a raised pigmented mass lesion at the limbus in the right eye, which was clinically suggestive of OSSN. He also had palmoplantar hyperkeratosis and periodontosis suggestive of PLS. Excision biopsy of the lesion confirmed the diagnosis of OSSN. He was free of tumor recurrence for 2 years and was lost to follow-up thereafter. Seven years later, the patient presented with diffuse tumor recurrence with orbital extension in the right eye, regional lymph node metastasis, and ipsilateral parotid gland infiltration. The patient underwent exenteration of the right orbital contents, right parotidectomy, and radical neck dissection followed by concomitant external beam radiotherapy and systemic chemotherapy. Eleven years from initial presentation, the patient was detected to have OSSN in the contralateral eye and was managed by wide excision biopsy and adjuvant cryotherapy. One year after detection of OSSN in the left eye, the patient was found to have systemic metastases to the lungs and brain. The patient died of the disease within 3 months of detection of systemic metastasis. OSSN in PLS is associated with poor prognosis.
Lafosse, Edouard; Romín, Daniel Monsálvez; Esteve-Taboada, José-Juan; Wolffsohn, James S; Talens-Estarelles, Cristian; García-Lázaro, Santiago
To assess and compare the effect of the corneo-scleral lenses (C-ScL) and scleral lenses (ScL) on tear film parameters and central corneal thickness (CCT) in healthy presbyopic subjects. Thirty subjects wore two contact lenses (CLs), randomly assigned, of neutral power, but of different diameters, 12.7mm (C-ScL) and 18mm (ScL) and being equal in the others parameters: material (HS100) and centre thickness (0.29mm). At baseline, 20min after insertion and at 8h, the tear meniscus area (TMA) and CCT was measured (with optical coherence tomography) as well as tear osmolarity. TMA revealed statistical differences for both lenses at 20min (plenses at 20min (p=0.002), and also at 8h (p=0.001), being lower for the C-ScL. Osmolarity did not reveal statistical differences at 20min (p=0.29), while it was statistically different at 8h (p=0.03), being lower for the C-ScL. C-ScL lead to a lesser reduction in the TMA and a lower induced hypoxic stress than the ScL. Osmolarity levels remained within normal values across the day with no clinical difference between lenses. Both designs can represent a good optical platform for correcting presbyopia as well as protecting the ocular surface by vaulting the cornea. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
Full Text Available BACKGROUND: Stevens-Johnson syndrome (SJS is an acute inflammatory vesiculobullous reaction of the skin and mucosa, often including the ocular surface, and toxic epidermal necrolysis (TEN occurs with its progression. Although SJS/TEN is thought to be initiated by certain types of medication coupled with possible infection. In the present study we examined the multiplicative interaction(s between HLA-A*0206 and 7 Toll-like receptor 3 (TLR3 Single-nucleotide polymorphisms (SNPs in patients with SJS/TEN. PRINCIPAL FINDINGS: We analyzed the genotypes for HLA-A and 7 TLR3 SNPs in 110 Japanese SJS/TEN patients with severe ocular complications and 206 healthy volunteers to examine the interactions between the two loci. We found that HLA-A*0206 exhibited a high odds ratio for SJS/TEN (carrier frequency: OR = 5.1; gene frequency: OR = 4.0 and that there was a strong association with TLR3 rs.5743312T/T SNP (OR = 7.4, TLR3 rs.3775296T/T SNP (OR = 5.8, TLR3 rs.6822014G/G SNP (OR = 4.8, TLR3 rs.3775290A/A SNP (OR = 2.9, TLR3 rs.7668666A/A SNP (OR = 2.7, TLR3 rs.4861699G/G SNP (OR = 2.3, and TLR3 rs.11732384G/G SNP (OR = 1.9. There was strong linkage disequilibrium (LD between rs.3775296 and rs.5743312 and between rs.7668666 and rs.3775290. The results of interaction analysis showed that the pair, HLA-A*0206 and TLR3 SNP rs3775296T/T, which exhibited strong LD with TLR3 rs.5743312, exerted more than additive effects (OR = 47.7. The other pairs, HLA-A*0206 and TLR3 rs.3775290A/A SNP (OR = 11.4 which was in strong LD with TLR3 rs7668666A/A SNP, and TLR3 rs4861699G/G SNP (OR = 7.6 revealed additive effects. Moreover, the combination HLA-A*0206 and TLR3 rs3775296T/T was stronger than the TLR3 rs6822014G/G and TLR3 rs3775290A/A pair, which reflected the interactions within the TLR3 gene alone. SIGNIFICANCE: By interaction analysis, HLA-A*0206 and TLR3 SNP rs3775296T/T, which were in strong LD with TLR3 SNP rs5743312T/T, manifested more than additive effects that
M K Shrestha
Full Text Available INTRODUCTION: The study assesses the spectrum of ocular morbidity and predictors of morbidity in children living in orphanages in the Kathmandu Valley. METHODS: A descriptive, cross-sectional survey was performed at 12 orphanages over a period of three months. The survey included a questionnaire and a complete eye examination, which included measurement of refraction, ocular deviation, and a fundus exam. Prevalence of ocular morbidity was calculated. Factors associated with ocular morbidity were examined using logistic regression. RESULTS: A total of 660 children were included in the study (median age nine years [range 0.25-15]; 53% male. The prevalence of ocular morbiditywas 17.9% (118. Of those with ocular morbidity, 88.1% (104 had similar ocular problems bilaterally. The most common type of morbidity was refractive error, found in 70.3% (83 of those with ocular morbidity (12.6% overall. CONCLUSIONS: Refractive errors, which are largely correctable, are the greatest source of morbidity. In order to reduce childhood blindness, children living in orphanages are an appropriate group to target for future ocular screening in Nepal. Keywords: children, Nepal, ocular morbidity, ocular screening, orphanage
Knop, Nadja; Korb, Donald R; Blackie, Caroline A; Knop, Erich
The conjunctival side of the upper and lower inner eyelid borders, termed the lid wiper, has a thickened epithelial lip for apposition to the globe, assumed to distribute the preocular tear film. The human lid wiper structure and its goblet cells are investigated. Conjunctival whole mounts, including lid margins from 17 eyes of human body donors, were investigated by routine histology and semithin plastic sections, using histology, histochemistry, and immunohistochemistry. In routine histology, the conjunctival lid wiper epithelium regularly showed goblet cells, single and in clusters, at the luminal surface and also deep within the epithelium without apparent surface contact. Semithin sections revealed that the deep goblet cells were often connected to cryptal epithelial infoldings that opened to the surface, hence making their mucins available at the surface. The goblet cells produced mucins of neutral (periodic acid-Schiff) and acidic (Alcian blue) type and stained positive for the gel-forming mucin MUC5AC. Surprisingly, MUC5AC-negative goblet cells were also observed in the lid wiper. Contrary to conventional assumptions, the lid wiper is part of the conjunctiva. It contains previously undescribed goblet cell crypts deep in the epithelium, suitable as an internal lubrication system for reduction of friction between the lid margin and the globe. This provides the first evidence of the morphological basis for the hydrodynamic type of lubrication and a more conclusive understanding of lid-margin lubrication and tear film distribution. It is another strong indication that the lid wiper is that area in apposition with the globe for distributing the thin preocular tear film during the blink.
24-Hour Efficacy and Ocular Surface Health with Preservative-Free Tafluprost Alone and in Conjunction with Preservative-Free Dorzolamide/Timolol Fixed Combination in Open-Angle Glaucoma Patients Insufficiently Controlled with Preserved Latanoprost Monotherapy.
Konstas, Anastasios-Georgios; Boboridis, Konstadinos G; Kapis, Paraskevas; Marinopoulos, Konstantinos; Voudouragkaki, Irini C; Panayiotou, Dimitrios; Mikropoulos, Dimitrios G; Pagkalidou, Eirini; Haidich, Anna-Bettina; Katsanos, Andreas; Quaranta, Luciano
The aim of the present study was to evaluate the 24-h efficacy, tolerability, and ocular surface health with preservative-free (PF) tafluprost and a PF triple drug regimen comprising tafluprost and dorzolamide/timolol fixed combination (DTFC) in open-angle glaucoma patients who were insufficiently controlled with preserved branded or generic latanoprost monotherapy and who exhibited signs or symptoms of ocular surface disease (OSD). Prospective, observer-masked, crossover, comparison. Eligible consecutive open-angle glaucoma patients were randomized to either PF tafluprost or the triple PF regimen for 3 months. They were then crossed over to the opposite therapy for another 3 months. At the end of the latanoprost run-in period and after each PF treatment period, patients underwent habitual 24-h intraocular pressure (IOP) monitoring with Goldmann tonometry in the sitting position (at 10:00, 14:00, 18:00, and 22:00) and Perkins tonometry in the supine position (at 02:00 and 06:00). Tolerability and selected ocular surface parameters were evaluated at baseline and the end of each treatment period. Forty-three open-angle glaucoma patients completed the trial. Mean 24-h IOP on preserved latanoprost was 22.2 ± 3.9 mmHg. Compared with latanoprost monotherapy, PF tafluprost obtained a greater reduction in mean, peak, and fluctuation of 24-h IOP including the 02:00 and 06:00 time points (P preserved latanoprost baseline (all P preserved latanoprost. The combination of PF tafluprost and PF dorzolamide/timolol fixed combination was statistically and clinically more efficacious than both monotherapies and demonstrated similar ocular surface characteristics to preserved latanoprost monotherapy. ClinicalTrials.gov (NCT02802137). Santen.
Yam, Jason C S; Kwok, Alvin K H
The objective of this study is to review the association between ultraviolet (UV) light and ocular diseases. The data are sourced from the literature search of Medline up to Nov 2012, and the extracted data from original articles, review papers, and book chapters were reviewed. There is a strong evidence that ultraviolet radiation (UVR) exposure is associated with the formation of eyelid malignancies [basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)], photokeratitis, climatic droplet keratopathy (CDK), pterygium, and cortical cataract. However, the evidence of the association between UV exposure and development of pinguecula, nuclear and posterior subcapsular cataract, ocular surface squamous neoplasia (OSSN), and ocular melanoma remained limited. There is insufficient evidence to determine whether age-related macular degeneration (AMD) is related to UV exposure. It is now suggested that AMD is probably related to visible radiation especially blue light, rather than UV exposure. From the results, it was concluded that eyelid malignancies (BCC and SCC), photokeratitis, CDK, pterygium, and cortical cataract are strongly associated with UVR exposure. Evidence of the association between UV exposure and development of pinguecula, nuclear and posterior subcapsular cataract, OSSN, and ocular melanoma remained limited. There is insufficient evidence to determine whether AMD is related to UV exposure. Simple behaviural changes, appropriate clothing, wearing hats, and UV blocking spectacles, sunglasses or contact lens are effective measures for UV protection.
Amparo, Francisco; Schaumberg, Debra A; Dana, Reza
The aim of this study was to compare patient-reported symptoms of dry eye disease (DED) as assessed by the Ocular Surface Disease Index (OSDI), a 12-item symptom frequency-based questionnaire, and the Symptom Assessment iN Dry Eye (SANDE), a 2-item frequency- and severity-based visual analog scale. Clinic-based evaluation of a diagnostic test. A total of 114 patients with DED. Patients were administered the OSDI and SANDE questionnaires at baseline and follow-up visits to evaluate DED-related symptoms. The correlations between both questionnaires' scores were evaluated using the Spearman coefficient, and their clinical differences were assessed using Bland-Altman analysis. Baseline and follow-up visit OSDI and SANDE dry eye symptom scores. At the baseline visit, the OSDI and SANDE questionnaire scores were significantly correlated (R = 0.64; P < 0.001). Moreover, a significant correlation was found between changes in the OSDI and SANDE scores from baseline to follow-up visits (R = 0.47; P < 0.001). A Bland-Altman analysis, after score normalization, revealed a difference (bias) of less than 2 centesimal units between the scores of the 2 questionnaires. Data collected from the SANDE questionnaire showed a significant correlation and negligible score differences with those from the OSDI, suggesting that the SANDE visual analog scale-based questionnaire has the potential to provide clinicians with a short, quick, and reliable measure for DED symptoms. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Ohba, Takashi; Hasegawa, Arifumi; Kohayagawa, Yoshitaka; Kondo, Hisayoshi; Suzuki, Gen
Body surface contamination levels should be correlated with inhaled actual thyroid doses during evacuation following the Fukushima Daiichi nuclear power plant (FDNPP) accident. Evacuees and residents were screened for body surface contamination using a Geiger-Mueller survey meter. The authors obtained 7,539 individual screening data sheets as well as gamma-spectrometry data from measurements made on clothing of two subjects by using a germanium spectrometer. Body surface contamination levels were analyzed in four residential groups during two different periods: 12-14 and 15-17 March 2011. Contamination levels during 12-14 March in the Tomioka/Okuma/Futaba/Naraha group were very low, indicating that residents evacuated before the radioactive plume reached their towns on 12 March. In contrast, levels in the Namie and Minamisoma groups were higher than those in the other groups in both periods, indicating that these residents were exposed to plumes twice on 12 and 15-16 March. The plume on 12 March was enriched with short-lived radionuclides: averaged proportions of radioactivity (relative to I) from Te, I, and Cs measured in clothing from two subjects were 2.3, 1.1, and 0.1, respectively, after correction for physical decay by 12:00 on 12 March. These proportions are similar to those (relative to I) from Te and Cs in dust sampled by a high-volume air sampler in the zone 20 km from the FDNPP on 12 March: 1.9 and 0.1, respectively. These data indicate that the relative contribution to inhaled thyroid dose of short-lived radionuclides in radioactive plumes released on 12 March could be as much as 37.5% in 1-y-old children.
Achados oculares em crianças de zero a seis anos de idade, residentes na cidade de São Caetano do Sul, SP Ocular findings in children between 0 and 6 years of age, residing in the city of São Caetano do Sul, SP
Sandra Maria Canelas Beer
Full Text Available OBJETIVO: Determinar a prevalência de erros refrativos, estrabismo, ambliopia e anisometropia nas crianças pertencentes à população em estudo, utilizando dois métodos de rastreamento (triagem na escola e triagem durante o dia da vacinação contra a poliomielite. MÉTODOS: Foram examinadas 2.640 crianças, residentes da cidade de São Caetano do Sul, entre zero e seis anos de idade, divididas em duas amostras (A e B. A amostra A consistiu de 476 crianças que foram examinadas por dez oftalmologistas e onze técnicos oftálmicos, durante o Dia Nacional de Vacinação (20 de junho de 1998 contra a Poliomielite. A amostra B consistiu de 2.164 crianças que freqüentavam escolas municipais, entre quatro e seis anos de idade e foram examinadas por dois oftalmologistas durante o ano de 1998. RESULTADOS: Na amostra A, a prevalência de estrabismo foi de 3,36% e de anisometropia foi de 1,26%. O principal tipo de erro refrativo encontrado foi a hipermetropia PURPOSE: To establish the prevalence of refractive errors, strabismus, amblyopia and anisometropia, among children in a population, using two methods of screening (at school and at the National Polio Vaccination Day. METHODS: We examined 2,640 children, between 0 and 6 years of age. The children, residents of the city São Caetano do Sul, were divided into two groups (A and B. Group A: 476 children, with an age range of a few months to 6 years, had their eyes examined by 10 ophthalmologists and 11 ophthalmology technicians, during the National Polio Vaccination Day (June 20,1998. Group B: 2,164 children attending municipal schools (EMEIs and EMIs, between 4 and 6 years of age, who had their eyes examined by two ophthalmologists during the year of 1998. RESULTS: In group A, the prevalence of strabismus was 3.36% and that of anisometropia was 1.26%. The most common type of refractive error was hypermetropia £ 2D and 14.11% required optical prescription. In group B, the prevalence of strabismus
De Miguel, Maria P; Alio, Jorge L; Arnalich-Montiel, Francisco; Fuentes-Julian, Sherezade; de Benito-Llopis, Laura; Amparo, Francisco; Bataille, Laurent
In addition to being a protective shield, the cornea represents two thirds of the eye's refractive power. Corneal pathology can affect one or all of the corneal layers, producing corneal opacity. Although full corneal thickness keratoplasty has been the standard procedure, the ideal strategy would be to replace only the damaged layer. Current difficulties in corneal transplantation, mainly immune rejection and shortage of organ supply, place more emphasis on the development of artificial corneas. Bioengineered corneas range from prosthetic devices that solely address the replacement of the corneal function, to tissue-engineered hydrogels that allow regeneration of the tissue. Recently, major advances in the biology of corneal stem cells have been achieved. However, the therapeutic use of these stem cell types has the disadvantage of needing an intact stem cell compartment, which is usually damaged. In addition, long ex vivo culture is needed to generate enough cell numbers for transplantation. In the near future, combination of advanced biomaterials with cells from abundant outer sources will allow advances in the field. For the former, magnetically aligned collagen is one of the most promising ones. For the latter, different cell types will be optimal: 1) for epithelial replacement: oral mucosal epithelium, ear epidermis, or bone marrow- mesenchymal stem cells, 2) for stromal regeneration: adipose-derived stem cells and 3) for endothelial replacement, the possibility of in vitro directed differentiation of adipose-derived stem cells towards endothelial cells provides an exciting new approach.
Vijay K Jain
Full Text Available Ninety psoriasis patients without arthropathy were subjected to complete ocular e tion, to determine, the incidence of eye symptoms. Various ocular lesions observed included,trachoma 32.(35.5%, squamous blephritis 18 (20% and cataract 7 (7.7%.
Petersen, E.; Kijlstra, A.; Stanford, M.
Retinal infection with Toxoplasma gondii is the most important cause of posterior uveitis, whereby prevalence and incidence of ocular symptoms after infection depend on socio-economic factors and the circulating parasite genotypes. Ocular toxoplasmosis is more common in South America, Central
Wörman, Anders; Marklund, Lars; Xu, Shulan; Dverstorp, Björn
The multiple scales of landscape topography produce a wide distribution of groundwater circulation cells that control the hydro-geological environments surrounding geological repositories for nuclear waste. The largest circulation cells tend to discharge water into major river reaches, large freshwater systems or the nearby Baltic Sea. We investigated numerically the release of radionuclides from repositories placed in bedrock with depths between 100 to 2000 meters in a Swedish coastal area and found that leakage from the deeper positions emerges primarily in the major aquatic systems. In effect, radionuclides from the deeper repositories are more rapidly transported towards the Sea by the stream system compared to leakage from more shallow repositories. The release from the shallower repositories is significantly retained in the initial stage of the transport in the (superficial) landscape because the discharge occurs in or near low-order streams with high retention characteristics. This retention and residence time for radioactivity in the landscape control radiological doses to biota and can, thus, be expected to constitute an essential part of an associated risk evaluation.
Wang, Liqiang; Huang, Yifei; Du, Gaiping; Dong, Ying; Guo, Huiling; Wang, Dajiang; Yu, Jifeng; Wang, Qun; Chen, Bing; Hou, Lulu
The aim of this study was to evaluate the clinical outcomes of the implantation of MICOF keratoprosthesis (Kpro) in patients with alkaline, acid and thermal ocular burns. This is a retrospective, non-competitive, interventional case series. Ninety eyes of 90 patients with ocular burns underwent MICOF KPro surgery at the Chinese People's Liberation Army General Hospital between April 2000 and December 2012. Preoperative and postoperative findings were recorded. Retention of the prostheses and the treatment for postoperative complications were investigated. The mean age of patients was 40.26±12.18 years (range: 8-64 years), and the mean duration after ocular trauma was 4.8±6.2 years (range: 1.5-12 years). The mean follow-up period was 58.22±36.28 months (range: 1-145 months). Eighty patients were followed for ≥1 year and 73 eyes (81.11%) achieved the best-corrected visual acuity of 20/200 or better and 39 eyes (43.33%) achieved best-corrected visual acuity of ≥20/40. The common complications were glaucoma, corneal melt and conjunctiva overgrowth, and the incidences of these complications were 59.99%, 40% and 31.11%, respectively. One patient experienced KPro extrusion, and two patients exhibited leakage from the area of the implant. Seven with endophthalmitis eyes had final visual acuities of light perception. There was no significant difference in the effectiveness of the implants among the different causes of injuries, including acid, alkali and thermal burns. MICOF Kpro is an effective alternative for patients with ocular burn with corneal blindness. Glaucoma and endophthalmitis were identified as significant risk factors for visual loss. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Membrana amniótica na reconstrução da superfície ocular após exérese de carcinoma de células escamosas da conjuntiva Amniotic membrane for ocular surface reconstruction after conjunctival squamous cell carcinoma resection
Paulo Roberto de Carvalho-Rêgo
Full Text Available OBJETIVO: Investigar a utilização da membrana amniótica humana na reconstrução da superfície ocular após exérese de carcinoma de células escamosas da conjuntiva. MÉTODOS: A membrana amniótica foi captada a partir de parto cesárea, conservada em meio de preservação de córnea e glicerol 1:1 e armazenada a -80º C. Os critérios de inclusão foram: pacientes portadores de lesão proliferativa conjuntival com características de carcinoma de células escamosas (lesão esbranquiçada plana ou elevada com aspecto em "carne de peixe", envolvendo conjuntiva, limbo e córnea. Oito olhos de 8 pacientes portadores de "carcinoma de células escamosas" da conjuntiva foram submetidos a cirurgia de exérese do tumor conjuntival, associado a transplante de membrana amniótica. Destes, 3 foram submetidos a epiteliectomia total da córnea e a transplante de limbo do olho contralateral. RESULTADOS: O tempo médio de seguimento foi de 17,8 meses (variação entre 10 e 35 meses. Cinco pacientes (71,4% obtiveram sucesso com o tratamento cirúrgico, com adequada reconstrução da área conjuntival retirada. Dois pacientes (28,6% obtiveram sucesso parcial, com presença de alterações cicatriciais leves (simbléfaro pequeno ou pequena fibrose. Um paciente foi excluído porque apresentou recidiva agressiva do tumor, com invasão intraocular, necessitando ser submetido a exenteração. CONCLUSÃO: O uso de membrana amniótica humana pode constituir uma importante opção para a reconstrução da superfície ocular após remoção de carcinoma de células escamosas.PURPOSE: This study was designed to evaluate the use of human amniotic membrane for ocular surface reconstruction after conjunctival squamous cell carcinoma resection. METHODS: Amniotic membrane was obtained at the time of cesarean section and was preserved at -80ºC in glycerol and cornea culture media at a ratio of 1:1. The inclusion criteria were patients presenting proliferating lesions
Frise, Anton E; Pagès, Guilhem; Shtein, Michael; Pri Bar, Ilan; Regev, Oren; Furó, István
The binding of block copolymer Pluronic F-127 in aqueous dispersions of single- (SWCNT) and multiwalled (MWCNT) carbon nanotubes has been studied by pulsed-field-gradient (PFG) (1)H NMR spectroscopy. We show that a major fraction of polymers exist as a free species while a minor fraction is bound to the carbon nanotubes (CNT). The polymers exchange between these two states with residence times on the nanotube surface of 24 ± 5 ms for SWCNT and of 54 ± 11 ms for MWCNT. The CNT concentration in the solution was determined by improved thermal gravimetric analysis (TGA) indicating that the concentration of SWCNT dispersed by F-127 was significantly higher than that for MWCNT. For SWCNT, the area per adsorbed Pluronic F-127 molecule is estimated to be about 40 nm(2).
J Gordon Millichap
Full Text Available The clinical and neuroradiological findings, and long-term intellectual prognosis in 10 patients (4 boys and 6 girls with congenital ocular motor apraxia (COMA are reviewed by researchers at Tottori University, Yonago, Japan.
Pauca, V. Paúl; Forkin, Michael; Xu, Xiao; Plemmons, Robert; Ross, Arun A.
Ocular recognition is a new area of biometric investigation targeted at overcoming the limitations of iris recognition performance in the presence of non-ideal data. There are several advantages for increasing the area beyond the iris, yet there are also key issues that must be addressed such as size of the ocular region, factors affecting performance, and appropriate corpora to study these factors in isolation. In this paper, we explore and identify some of these issues with the goal of better defining parameters for ocular recognition. An empirical study is performed where iris recognition methods are contrasted with texture and point operators on existing iris and face datasets. The experimental results show a dramatic recognition performance gain when additional features are considered in the presence of poor quality iris data, offering strong evidence for extending interest beyond the iris. The experiments also highlight the need for the direct collection of additional ocular imagery.
Aug 26, 2016 ... Keywords. ocular angiogenesis; corneal neovascularization; retinal neovascularization; diabetic retinopathy; age-related macular degeneration; retinopathy of prematurity; VEGF; PEDF; Flt-1; Flk-1; endostatin; angiopoietin; erythropoietin; Tie2; inflammation; complement; gene therapy; TLR-3; Robo4.
Rothova, A.; Meenken, C.; Buitenhuis, H. J.; Brinkman, C. J.; Baarsma, G. S.; Boen-Tan, T. N.; de Jong, P. T.; Klaassen-Broekema, N.; Schweitzer, C. M.; Timmerman, Z.
We conducted a prospective multicenter study of the efficacy of current therapeutic strategies for ocular toxoplasmosis in 149 patients. Treatment consisted of the following three triple-drug combinations: group 1, pyrimethamine, sulfadiazine, and corticosteroids; group 2, clindamycin, sulfadiazine,
ROTHOVA, A; MEENKEN, C; BRINKMAN, CJ; BAARSMA, GS; BOENTAN, TN; DEJONG, PTVM; KLAASSENBROEKEMA, N; SCHWEITZER, CMC; TIMMERMAN, Z; DEVRIES, J; ZAAL, MJW; KIJLSTRA, A
We conducted a prospective multicenter study of the efficacy of current therapeutic strategies for ocular toxoplasmosis in 149 patients. Treatment consisted of the following three triple-drug combinations: group 1, pyrimethamine, sulfadiazine, and corticosteroids; group 2, clindamycin, sulfadiazine,
Pepper, Amber N; Ledford, Dennis K
Nasal and ocular challenges facilitate the evaluation of subjective and objective responses to defined allergen or irritant exposure. Nasal and ocular allergen challenges are the gold standard to diagnose allergic rhinitis and conjunctivitis, respectively, and aid in the evaluation of novel therapies in clinical trials. Additionally, nasal and ocular allergen challenges might help identify medically relevant allergens in clinical practice. Nonspecific or irritant challenges evaluate mucosal hyperreactivity. Direct mucosal challenges, which can be performed in an office or research setting, expose the participant to higher allergen doses than common in the natural environment. Park studies and environmental chambers, which are most practical in clinical trials, more closely simulate natural allergen exposure. International consensus guidelines for nasal and ocular challenges do not exist. Therefore the positivity criteria, methodologies, and extract or allergen preparations used in challenges vary in the literature. Regardless of these limitations, nasal and ocular challenges are helpful clinical and research tools for nasal and ocular diseases. Copyright © 2018 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Jury, William A.; Russo, David; Streile, Gary; El Abd, Hesham
Although volatile organic compounds located in buried waste repositories or distributed through the unsaturated soil zone have the potential to migrate to the atmosphere by vapor diffusion, little attention has been paid in the past to estimating the importance of volatilization losses. In this paper a screening model is introduced which evaluates the relative volatilization losses of a number of organic compounds under standard soil conditions. The model is an analytic solution to the problem wherein the organic chemical is located at time zero at uniform concentration in a finite layer of soil covered by a layer of soil devoid of chemical. The compound is assumed to move by vapor or liquid diffusion and by mass flow under the influence of steady upward or zero water flow while undergoing first-order degradation and linear equilibrium adsorption. Loss to the atmosphere is governed by vapor diffusion through a stagnant air boundary layer. Calculations are performed on 35 organic compounds in two model soils with properties characteristic of sandy and clayey soil. The model identifies those compounds with high potential for loss during 1 year after incorporation under 100 cm of soil cover and also is used to calculate the minimum soil cover thickness required to reduce volatilization losses to insignificant levels during the lifetime of the compound in the soil. From the latter calculation it was determined that certain compounds may volatilize from deep subsurface locations or even groundwater unless the soil surface is sealed to prevent gas migration.
Ng, Alison; Evans, Katharine; North, Rachel; Purslow, Christine
Eye cosmetics usage is commonplace and whilst some products such as eyeliner are applied with close proximity to the ocular surface, there is little knowledge of the short- and long-term ocular effects of eye cosmetic formulations. This study aimed to investigate the use of eye cosmetics and identify any relationships between ocular comfort and cosmetic usage. Results were collated from an online survey comprising 23 questions that recorded demographics, Ocular Surface Disease Index (OSDI) score, extent and range of eye cosmetic use and perceived comfort differences with and without eye cosmetics. The 1360 female respondents (median age 25, interquartile range 20-34 years) completed the survey; 83% reported using eye cosmetics regularly (≥ 3 times per week) with mascara being most commonly used. Fifty three per cent used at least three different eye cosmetics products regularly. OSDI scores of cosmetics users were similar to non-users (p = 0.083), but perceived comfort was greater when cosmetics were not used (p cosmetics users (use of products cosmetics were used. Median OSDI scores suggested a trend towards reduced comfort amongst eyeliner users (p = 0.07) although frequency and type of cosmetic products used did not appear to influence OSDI scores. This study shows the use of multiple eye cosmetics is extensive and associated with the perception of ocular discomfort. With such widespread use of these products, more research is required to assess the effect on the ocular surface and tear film, which may be underestimated. Ophthalmic & Physiological Optics © 2012 The College of Optometrists.
Karlsson, Ulf; Kirby, Thomas; Orrison, William; Lionberger, Margaret
Purpose: Ocular lens, retina, and olfactory bulb exposure are common concerns in contemporary radiotherapy practice. Methods to clinically localize soft tissue structures (i.e., lens and retina) are varied and often imprecise. We hypothesized that eyelid markers constituted a better reference point than the commonly used lateral canthus marker for lateral beam simulations, unless diagnostic computed tomography or ultrasound examinations were available and/or used. Methods and Materials: Sixty-six pre-Magnetic Resonance Image, normal, orbital computed tomography scans from adult patients were used to measure (a) sagittal distances from eyelid to posterior lens surface, from lateral canthus to posterior lens surface and to the globe's posterior pole, (b) supero-inferior distances in the lateral projection from the lens to the cribriform plate, and (c) common dimensions to establish internal validity of the measurements. Results: The eyelid to lens and retina topography is individually more constant than that from the canthus. There is little if any supero-inferior separation between the lens and the cribriform plate lateral projections. Conclusions: The lateral canthus does not specify lens or retina locations. Eyelid markers of known size provide more accurate anatomical information. Lateral beam ocular globe shielding has to be individualized. Lens shielding is questionable if the olfactory bulb needs to be irradiated by a lateral beam
Ricardo Cardona Villa
Full Text Available El ojo es uno de los órganos más sensibles y está permanentemente expuesto a diversos agentes ambientales. Dado que la conjuntiva es un tejido inmunológicamente activo, no es sorprendente que sea un sitio común de respuestas alérgicas. Las alergias oculares son un grupo de enfermedades que afectan la superficie conjuntival y están asociadas usualmente a reacciones de hipersensibilidad tipo 1. Pueden ser divididas en varias categorías: conjuntivitis alérgica estacional, conjuntivitis alérgica perenne, queratoconjuntivitis vernal y queratoconjuntivitis atópica. La inflamación de la superficie ocular produce prurito, lagrimeo, edema conjuntival y fotofobia. Como en otras enfermedades alérgicas, se puede desarrollar una condición crónica, acompañada de remodelación de los tejidos oculares. Las estrategias para el tratamiento de la alergia ocular han aumentado exponencialmente y los clínicos disponen de un inventario cada vez mayor de agentes dirigidos a la protección del ojo contra la inflamación. En este trabajo presentamos una revisión sobre las principales formas de alergia ocular, haciendo énfasis en el cuadro clínico, el diagnóstico y las nuevas opciones terapéuticas disponibles en la actualidad. The eye, one of the most sensitive organs, is permanently exposed to different environmental agents. Since the conjunctiva is an immunologically active tissue, it is not surprising for it to be a common site for allergic responses. Ocular allergies constitute a group of diseases affecting the conjunctival surface; they are usually associated with type 1 hypersensitivity reactions. This disorder can be divided into several categories: seasonal allergic conjunctivitis, perennial allergic conjunctivitis, vernal keratoconjunctivitis and atopic keratoconjunctivitis. Ocular surface inflammation results in itching, tearing, conjunctival edema, and photophobia. As is the case with other allergic diseases, a chronic situation can also
Full Text Available Sports related ocular injury is one of the most important reasons of morbidity, blindness and labor loss. Especially children and those who play paintball, basketball and ice hockey are at high risk. Sports can be classified as high risk group, moderate risk group and low risk group according to the risk of these injuries. The extent of the trauma to the eye depends on the shape, velocity and rigidity of the trauma object. Physician can have an opinion about the severity of the trauma by having a carefully taken anamnesis and physical examination. In this manner, sports physicians should do the first aid procedures to the injury and should know in which cases decide not to continue the game. The most important feature of sports-related ocular injury is 90% of these injuries can be preventable in nature. Protective eyeglasses usage and taking simple precautions substantially protects player from serious ocular injuries.
Gupta, Vishali; Shoughy, Samir S; Mahajan, Sarakshi; Khairallah, Moncef; Rosenbaum, James T; Curi, Andre; Tabbara, Khalid F
Ocular tuberculosis is an extrapulmonary tuberculous condition and has variable manifestations. The purpose of this review is to describe the clinical manifestations of ocular tuberculosis affecting the anterior and posterior segments of the eye in both immunocompetent and immunocompromised patients. Review of literature using Pubmed database. Mycobacterium tuberculosis may lead to formation of conjunctival granuloma, nodular scleritis, and interstitial keratitis. Lacrimal gland and orbital caseating granulomas are rare but may occur. The intraocular structures are also a target of insult by M. tuberculosis and may cause anterior granulomatous uveitis, anterior and posterior synechiae, secondary glaucoma, and cataract. The bacillus may involve the ciliary body, resulting in the formation of a localized caseating granuloma. Posterior segment manifestations include vitritis, retinal vasculitis, optic neuritis, serpiginous-like choroiditis, choroidal tubercules, subretinal neovascularization, and, rarely, endophthalmitis. The recognition of clinical signs of ocular tuberculosis is of utmost importance as it can provide clinical pathway toward tailored investigations and decision making for initiating anti-tuberculosis therapy.
Mariana Mayorquín Ruiz
Full Text Available El ultrasonido ocular es un estudio dependiente del operador. Un buen estudio ecográfico debe tener como base el conocimiento de la anatomía y fisiología normales y de los cambios producidos en diferentes enfermedades, así como los cambios tras una cirugía ocular o trauma. El conocimiento de los fenómenos físicos producidos por el ultrasonido es la base para entender y reconocer la presencia de artefactos en el ultrasonido ocular. Esta revisión tiene como objetivo hacer un recuento de los artefactos que pueden ocasionar confusión al interpretar una imagen ecográfica, así como explicar la base física en la que se basan, reduciendo de esta manera los errores de interpretación y diagnósticos.
Raverty, Stephen A; Rhodes, Linda D; Zabek, Erin; Eshghi, Azad; Cameron, Caroline E; Hanson, M Bradley; Schroeder, J Pete
In the Salish Sea, the endangered Southern Resident Killer Whale (SRKW) is a high trophic indicator of ecosystem health. Three major threats have been identified for this population: reduced prey availability, anthropogenic contaminants, and marine vessel disturbances. These perturbations can culminate in significant morbidity and mortality, usually associated with secondary infections that have a predilection to the respiratory system. To characterize the composition of the respiratory microbiota and identify recognized pathogens of SRKW, exhaled breath samples were collected between 2006-2009 and analyzed for bacteria, fungi and viruses using (1) culture-dependent, targeted PCR-based methodologies and (2) taxonomically broad, non-culture dependent PCR-based methodologies. Results were compared with sea surface microlayer (SML) samples to characterize the respective microbial constituents. An array of bacteria and fungi in breath and SML samples were identified, as well as microorganisms that exhibited resistance to multiple antimicrobial agents. The SML microbes and respiratory microbiota carry a pathogenic risk which we propose as an additional, fourth putative stressor (pathogens), which may adversely impact the endangered SRKW population.
Prevalência de transtornos oculares na população de idosos residentes na cidade de Veranópolis, RS, Brasil Prevalence of ocular diseases in a population of elderly residents of the city of Veranópolis, Brazil
Flávio Antônio Romani
Full Text Available OBJETIVO: Avaliar os transtornos oculares e a sua prevalência em pessoas com 80 anos de idade, ou mais, na cidade de Veranópolis, Rio Grande do Sul, Brasil. MÉTODOS: 187 idosos foram submetidos a exame oftalmológico por meio de inspeção externa, motilidade extrínseca, medidas de acuidade visual para longe e perto, tonometria de aplanação, biomicroscopia, cicloplegia, fundoscopia direta e esquiascopia estática. RESULTADOS: As doenças mais prevalentes foram: presbiopia em 173 (92,5% pacientes, catarata em 160 (85,6%, ectrópio senil em 130 (69,5%, hipermetropia em 130 (69,5% e a degeneração macular relacionada à idade (DMRI em 59 (31,5%. Na população estudada, 85 (45,4% pacientes apresentaram baixa visual acentuada cujas causas principais eram a catarata em 46 (54,1% e erros de refração em 16 (18,9% dos idosos. A principal causa de queixas dos idosos foi relacionada com a presença de ectrópio senil. CONCLUSÃO: Doenças comuns como a catarata e os erros de refração continuam a ser um desafio para os oftalmologistas, pois são importantes causas de dificuldade visual nos idosos, com conseqüente perda de qualidade em suas vidas.ABSTRACT PURPOSE: To evaluate the prevalence of diseases of the eye in a population aged 80 years and above in the city of Veranopolis, Rio Grande do Sul, Brazil. METHODS: 187 elderly people were submitted to ophthalmologic tests including external inspection, ocular motility examination, visual acuity determination for near and far distance, applanation tonometry, biomicroscopy, cyclopegia, direct fundus examination and static skiascopy. RESULTS: The most prevalent disease was presbyopia in 173 (92,5% patients, cataract in 160 (85,6%, age-related ectropion in 130 (69,5%, hypermetropia in 130 (69,5% and age-related macular degeneration (ARMD in 59 (31,5% patients. 85 (45,4% patients presented marked low vision whose main causes were cataract in 46 (54,1% and refractive error in 16 (18,9% of the studied
Kruijt, Bastiaan; Franssen, Luuk; Prick, Liesbeth J. J. M.; van Vliet, Johannes M. J.; van den Berg, Thomas J. T. P.
Albinism is an inherited disorder that affects the melanin biosynthesis pathway, which results in reduced or absent pigment formation. This may lead to increased light transmission through the iris and more reflected light from the fundus. Both these effects contribute to the occurrence of ocular
Rasmussen, Peter K; Coupland, Sarah E; Finger, Paul T
IMPORTANCE The clinical features of the follicular subtype of ocular adnexal lymphoma (OAL) have not been previously evaluated in a large cohort. OBJECTIVE To characterize the clinical features of follicular OAL. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective multicenter study tha...
Hayashi, Hisamitsu; Sugiyama, Yuichi
The reduced expression of the bile salt export pump (BSEP/ABCB11) at the canalicular membrane is associated with cholestasis-induced hepatotoxicity due to the accumulation of bile acids in hepatocytes. We demonstrated previously that 4-phenylbutyrate (4PBA) treatment, a U.S. Food and Drug Administration-approved drug for the treatment of urea cycle disorders, induces the cell-surface expression of BSEP by prolonging the degradation rate of cell-surface-resident BSEP. On the other hand, BSEP mutations, E297G and D482G, found in progressive familial intrahepatic cholestasis type 2 (PFIC2), reduced it by shortening the degradation rate of cell-surface-resident BSEP. Therefore, to help the development of the medical treatment of cholestasis, we investigated the underlying mechanism by which 4PBA and PFIC2-type mutations affect the BSEP degradation from cell surface, focusing on short-chain ubiquitination. In Madin-Darby canine kidney II (MDCK II) cells expressing BSEP and rat canalicular membrane vesicles, the molecular mass of the mature form of BSEP/Bsep shifted from 170 to 190 kDa after ubiquitin modification (molecular mass, 8 kDa). Ubiquitination susceptibility of BSEP/Bsep was reduced in vitro and in vivo by 4PBA treatment and, conversely, was enhanced by BSEP mutations E297G and D482G. Moreover, biotin-labeling studies using MDCK II cells demonstrated that the degradation of cell-surface-resident chimeric protein fusing ubiquitin to BSEP was faster than that of BSEP itself. In conclusion, BSEP/Bsep is modified with two to three ubiquitins, and its ubiquitination is modulated by 4PBA treatment and PFIC2-type mutations. Modulation of short-chain ubiquitination can regulate the change in the degradation rate of cell-surface-resident BSEP by 4PBA treatment and PFIC2-type mutations.
Chhonker, Yashpal S; Prasad, Yarra Durga; Chandasana, Hardik; Vishvkarma, Akhilesh; Mitra, Kalyan; Shukla, Praveen K; Bhatta, Rabi S
Fungal keratitis is the major cause of vision loss worldwide. Amphotericin-B is considered as the drug of choice for fungal infections. However, its use in ophthalmic drug delivery is limited by the low precorneal residence at ocular surface as a result of blinking reflex, tear turnover and nasopharyngeal drainage. We report Amphotericin-B loaded lecithin/chitosan nanoparticles for prolonged ocular application. The prepared nanoparticles were in the size range of 161.9-230.5 nm, entrapment efficiency of 70-75%, theoretical drug loading of 5.71% with positive zeta potential of 26.6-38.3 mV. As demonstrated by antifungal susceptibility against Candida albicans and Aspergillus fumigatus, nanoparticles were more effective than marketed formulation. They exhibited pronounced mucoadhesive properties. In-vivo pharmacokinetic studies in New Zealand albino rabbit eyes indicated improved bioavailablity (∼ 2.04 fold) and precorneal residence time (∼ 3.36 fold) by nanoparticles prepared from low molecular weight chitosan as compared with marketed formulation. Copyright © 2014. Published by Elsevier B.V.
Full Text Available Purpose: We report a rare case of ocular injury due to potassium permanganate (KMnO4 granules in a child. Methods: This is a retrospective case report. Results: A 2-year-old boy was transferred to our emergency room with severe pain in his right eye, inflamed eyelids, and brownish stains on his fingers. Chemical injury was suspected. Copious eye irrigation was immediately performed. Diffuse brownish splotches were then observed at the inferior bulbar conjunctiva. Otherwise, systemic organs were intact. Complete eye exam under general anesthesia revealed a 5-mm epithelial defect at the central cornea, along with generalized conjunctival injection and limbal ischemia, inferiorly. Multiple semi-dissolved granules of KMnO4 trapped in the inferior fornix were identified. The chemical particles were gradually washed out and removed; however, the brownish stains remained. The patient received preservative-free steroid, antibiotic eye drops, and lubricants as regular management for mild to moderate degree of ocular burn. Pseudomembrane developed early and transformed into symblepharon within a few days after the injury. Membrane adhesion was lysed, and more aggressive medications were then substituted. Commercial amniotic membrane (PROKERA® was also applied to promote wound healing and to prevent recurrence of symblepharon. The ocular surface was eventually restored, and corneal transparency was preserved. Conclusion: Ocular injury with the granular form of KMnO4 is rare. Its toxicity is comparable to concentrated KMnO4 solution. However, the dissolved particles that had been absorbed in the stained conjunctiva were continuously released and damaged the ocular surface more than we primarily anticipated. Awareness of this condition and prompt management yield a good treatment outcome.
Pedroza-Seres, M; Serna-Ojeda, J C; Flores-Suárez, L F
Sclerodermatomyositis is an overlap syndrome of myositis and scleroderma, with dermatological, muscular and joint involvement, but may also present with ocular manifestations. A 57 year-old woman presented with ophthalmological manifestations, including scleral thinning 360°, and the presence of cells in the anterior and posterior chamber. Oriented physical examination and laboratory studies led to the diagnosis, with the need for systemic treatment. Sclerodermatomyositis is a rare disease. Its diagnosis needs thorough clinical and laboratory studies, and its management should be multidisciplinary when inflammatory ocular manifestations may be present. Copyright © 2016 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.
Full Text Available Keratoconus is the most common corneal ectatic disorder, the cause of which is largely unknown. Many factors have been implicated, and the ocular allergy is being one of them. The commonly proposed pathogenesis includes the release of inflammatory mediators due to eye rubbing which may alter the corneal collagen and lead to corneal ectasias. The onset of keratoconus is often early in cases associated with allergy and routine corneal topography may detect subtle forms of keratoconus. These cases may require early keratoplasty and are at an increased risk of having acute corneal hydrops. Surgical outcomes are similar to primary keratoconus cases. However, post-operative epithelial breakdown may be a problem in these cases. Control of allergy and eye rubbing is the best measure to prevent corneal ectasias in cases of ocular allergy.
Kalirai, H; Müller, P L; Jaehne, D; Coupland, S E
Melanoma is the most common type of primary cancer to affect the adult eye. Approximately 95% of ocular melanomas are intraocular and arise from the uvea (i. e. iris, ciliary body, and choroid), while the remaining 5% are located in the conjunctiva. Although both uveal and conjunctival melanomas are thought to derive from malignantly transformed melanocytes, uveal melanoma is clinically and biologically distinct from conjunctival melanoma, and indeed from its more common cutaneous counterpart. Intense efforts have been recently made to understand the molecular biology involved in the development of ocular melanomas, and in their progression. Molecular advances, particularly for uveal melanoma, have enhanced prognostication and the identification of rational therapeutic targets for disseminated disease. In this review, recent advances in the molecular characterisation of both uveal and conjunctival melanomas are discussed, and how these may be used to develop personalised therapeutic strategies.
Flynn, T H
OBJECTIVES: To describe the clinical characteristics of ocular injuries sustained in hurling in the south of Ireland and to investigate reasons for non-use of protective headgear and eye wear. METHODS: Retrospective review of the case notes of 310 patients who attended Cork University Hospital or Waterford Regional Hospital between 1 January 1994 and 31 December 2002 with ocular injuries sustained during a hurling match. A confidential questionnaire on reasons for non-use of protective headgear and eye wear was completed by 130 players. RESULTS: Hurling related eye injuries occurred most commonly in young men. Fifty two patients (17%) required hospital admission, with hyphaema accounting for 71% of admissions. Ten injuries required intraocular surgical INTERVENTION: retinal detachment repair (5); macular hole surgery (1); repair of partial thickness corneal laceration (1); repair of globe perforation (1); enucleation (1); trabeculectomy for post-traumatic glaucoma (1). Fourteen eyes (4.5%) had a final best corrected visual acuity (BCVA) of <6\\/12 and six (2%) had BCVA <3\\/60. In the survey, 63 players (48.5%) reported wearing no protective facemask while playing hurling. Impairment of vision was the most common reason cited for non-use. CONCLUSIONS: Hurling related injury is a significant, and preventable, cause of ocular morbidity in young men in Ireland. The routine use of appropriate protective headgear and faceguards would result in a dramatic reduction in the incidence and severity of these injuries, and should be mandatory.
Dinn, Robert B; Harris, Alon; Marcus, Peter S
Visual changes in pregnancy are common, and many are specifically associated with the pregnancy itself. Serous retinal detachments and blindness occur more frequently during preeclampsia and often subside postpartum. Pregnant women are at increased risk for the progression of preexisting proliferative diabetic retinopathy, and diabetic women should see an ophthalmologist before pregnancy or early in the first trimester. The results of refractive eye surgery before, during, or immediately after pregnancy are unpredictable, and refractive surgery should be postponed until there is a stable postpartum refraction. A decreased tolerance to contact lenses also is common during pregnancy; therefore, it is advisable to fit contact lenses postpartum. Furthermore, pregnancy is associated with a decreased intraocular pressure in healthy eyes, and the effects of glaucoma medications on the fetus and breast-fed infant are largely unknown. Obstetricians & Gynecologists, Family Physicians. After completion of this article, the reader will be able to list the various ocular changes that occur during pregnancy, summarize the ocular disturbances that occur with preeclampsia and diabetes, and describe the management of some ocular problems during pregnancy.
Assessment of the use of cryopreserved x freeze-dried amniotic membrane (AM for reconstruction of ocular surface in rabbit model Avaliação do uso da membrana amniótica (MA criopreservada x liofilizada na reconstrução da superfície ocular em coelhos
Rodrigo Doyle Libera
Full Text Available PURPOSE: To determine the efficacy of freeze-dried amniotic membrane (AM for reconstruction of the ocular surface in rabbit eyes. METHODS: The sterilized, freeze-dried amniotic membrane (lyophilized or FD-AM is a preservative method that uses the drying by freezing process to maintain the AM well preserved for a long time even at room temperature. This paper is an experimental animal interventional study. One eye of each of 15 male New Zealand rabbits (1.5 - 3.0 kg had the central cornea marked with a 6.0 mm trephine. The marked area was deepithelialized with a No.15 blade. The denuded corneal surface was covered as follows: Group 1: cryopreserved AM (n=6; Group 2: freeze-dried AM (n=6; and Group 3: not covered (control group, n=3. The AM in group 1 and 2 and the periphery of the denuded area in group 3 were secured with continuous 10-0 nylon sutures. The clinical evaluation was made by a blinded observer and graded on a four-point scale (1= minimal, 4= marked for conjunctival and ciliary hyperemia, eyelid edema, corneal neovascularization, corneal opacity and reepithelialization on postoperative (PO days 1, 7 and 30 . After PO day 30, the rabbits were euthanized and their corneas were sent for histopathological and ultrastructural analysis to evaluate tissue inflammation, reepithelialization, and basement membrane integrity. RESULTS: Two eyes in group 2 had a corneal infection and were excluded from the analysis. No statistically significant differences among the three groups were found (p>0.05 regarding the clinical evaluation on 1st, 7th and 30th PO days. On transmission electron microscopy, the basement membrane in lyophilized and control groups was more continuous and homogeneous than in the glycerol group. CONCLUSIONS: The freeze-drying method seems to be a good option to preserve human amniotic membrane to be used in ocular surface reconstruction. This preservative method reduces the preservation costs and may enhance the use of AM
Kubasch, A S; Meurer, M
Albinism can be divided into oculocutaneous albinism (OCA) and ocular albinism (OA). In the differential diagnostics these can be distinguished from rarer syndromes with partial albinism, which are frequently associated with susceptibility to infections and neurological symptoms. The OCA is an autosomal recessive inherited disease of melanin biosynthesis, which leads to complete or partial loss of melanin in the skin, hair follicles and eyes. Of the seven currently known subtypes (OCA 1-7), four are well-characterized (OCA 1-4). These are based on gene mutations, which code for tyrosinase, a key enzyme in melanin synthesis and for further proteins. These play an important role in the catalytic activity of tyrosinase and the structure and function of melanosomes. In the presence of these subtypes, the clinical symptoms and the course of the disease show a pronounced variability, especially in the type and extent of pigmentation of the skin and hair as well as the severity of eye involvement, which makes the phenotypic classification difficult. Treatment priorities are a consistent protection from UV light for prophylaxis against skin cancer and regular preventive investigations. The ocular alterations typical for albinism necessitate timely diagnostics and care by institutions specialized in ophthalmology. Novel strategies for systemic treatment of subtypes of albinism are in preclinical testing. The OA without skin involvement shows X‑linked inheritance, is much rarer and is characterized by reduced pigmentation of the retina and iris, nystagmus and macular hypoplasia, sometimes with substantial loss of visual acuity. The typical ocular symptoms of OA can be manifested to a varying extent in all forms of OCA.
Babar, T.F.; Khan, M.T.; Marwat, M.; Shah, A.; Murad, Y.; Khan, M.D.
To describe the patterns of ocular trauma, cause of injury and its effects on eye. A retrospective case series. Medical records of 1105 patients admitted with ocular trauma were reviewed. The details of patients regarding age, gender, literacy, cause of injury and its effects on eye were entered into specially-designed performa. Sample selection consisted of all patients with history of ocular trauma and who were admitted to hospital. Population details consisted patients who were referred to the hospital from all parts of N.W.F.P. Thus, the frequency of trauma in the hospital admissions was analysed. Ophthalmic trauma comprised 6.78% of the hospital admission. One thousand one hundred and five patients presented with eye injuries. Out of them, 21 patients suffered from trauma to both eyes. Almost 80% patients were male and 69% patients were below 30 years of age. Delayed presentation was more common and 63.61% patients presented after one week. Open globe injuries were more common (520 eyes (46.18%)) than closed globe injuries (484 eyes (42.98%)). 23.26% of open globe injuries were associated with intraocular and intra-orbital foreign bodies. Superficial non-perforating, eyelid and adnexal and burns were seen in 122 eyes (10.83%). Among the complications, lens damage and hyphema was seen in more than 50% of the patients, 16.60% eyes were infected at the time of admission and 4.88% of eyes needed enucleation or evisceration. The common causes of injury were violence in 37.37%, occupational in 24.43% and domestic accidents in 19.18%. Ophthalmic trauma is a major public health problem. Majority of the involved are male and under 30 years of age. Delayed presentation is more common. Open globe injuries are more frequent. Violence and occupational injuries are the major causes. (author)
Flores Ojeda, Desireé
En el presente trabajo se lleva a cabo una revisión bibliográfica de la diabetes en relación con las diferentes patologías oculares a las que está asociada. La diabetes, es una enfermedad crónica que comporta un importante problema sanitario y social, que afecta a muchos órganos. De entre todos ellos, el ojo parece afectarse especialmente por los cambios de glucosa en sangre. Una vez entendida la estructura del ojo humano, el trabajo estudia las partes especialmente afectadas en pacientes ...
Hamel, Christian P
Genetic ocular diseases are inherited Mendelian conditions (prevalence 1/1000) in which any tissue of the eye could be involved (cornea, lens, iridocomeal angle, vitrous, retina, choroid, sclera). More than 200 genes are responsible for inherited retinal dystrophies and even more genes remain to be identified. These genes belong to many metabolisms essential to the photoreceptor function. Gene therapy and retinal prosthesis are the two most promising therapeutic strategies currently in clinical trials which are expected to provide visual improvement in short term.
Leonard, T J; Kerr Muir, M G; Kirkby, G R; Hitchings, R A
Thirty-seven patients with ocular hypertension (OH) and 29 age matched controls were studied. Intraocular pressure (IOP) measurements were made in the sitting position and, immediately after changing posture, in the lying position. Sixty-three (85%) of the OH eyes and all the control eyes showed either stable IOP readings on changing posture of small elevations up to 3 mmHg. Eleven (15%) of the OH eyes showed larger elevations of IOP, between 5 and 9 mmHg when the patients changed to the lyin...
Full Text Available The health of ocular surface is maintained by the ocular surface(cornea and conjunctiva, accessory lacrimal gland and meibomian gland, the main lacrimal gland and the lachrymal function units between them, any damage in which can lead to the failure of integrity and normal function of tear film. With the development of medical science, more and more eye surgeries are operated to treat eye diseases. However, preoperative anesthetic applications, operation process, preservatives in the eye drops may lead to tear film instability and/or abnormal manifestation on eye surface which may cause dry eyes.
Costache, Mariana; Pătraşcu, Oana Maria; Dumitru, Adrian; Costache, Diana; Voinea, Liliana Mary; Simionescu, Olga; Sajin, Maria
Ocular melanoma is rare in clinical practice. In this study, we present three cases of ocular melanoma surgically removed in the Department of Ophthalmology of the Emergency University Hospital of Bucharest, Romania, and diagnosed in the Department of Pathology of the same hospital using conventional histopathological techniques and immunohistochemical tests.
Full Text Available There is a high prevalence of ocular defects in children with developmental disabilities. This study evaluated visual disability in a group of 200 cerebral palsy (CP patients and found that 68% of the children had significant visual morbidity. These findings emphasize the need for an early ocular examination in patients with CP.
Full Text Available Yueh-Chang Lee, Cheng-Jen Chiu Department of Ophthalmology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan, ROC Abstract: This case report describes a female toddler with manifestations of ocular leech infestation. A 2-year-old girl was brought to our outpatient clinic with a complaint of irritable crying after being taken to a stream in Hualien 1 day previous, where she played in the water. The parents noticed that she rubbed her right eye a lot. Upon examination, the girl had good fix and follow in either eye. Slit-lamp examination showed conjunctival injection with a moving dark black–brown foreign body partly attached in the lower conjunctiva. After applying topical anesthetics, the leech, measuring 1 cm in length, was extracted under a microscope. The patient began using topical antibiotic and corticosteroid agents. By 1 week after extraction, the patient had no obvious symptoms or signs, except for a limited subconjunctival hemorrhage, and no corneal/scleral involvement was observed. Keywords: leech, ocular foreign body, conjunctival reaction, pediatric ophthalmology
Liu, Guang-Cong; Wang, Fang; Gao, Yan-Yan; Yang, Zheng; Hu, Li-Wen; Gao, Qian; Ri, Jun-Chol; Liu, Yang
The influence of albedo on ocular UV exposure has seldom been reported. This paper aimed to explore the enhancement effect on measured ocular UV radiation due to a sand surface compared to measured ocular UV radiation due to a grass surface. We measured ambient and ocular UV radiation over the beach and grass surface in Sanya City of China (18.4°N, 109.7°E). The experimental apparatus was composed of a manikin and a dual-detector spectrometer. Integration of both UVA and UVB radiation was used to denote UV radiation. Then biologically effective ocular UVB radiation (UVBE) and the ratios of UVBE of two surfaces were calculated. Maximum of ocular UV radiation versus time over the two surfaces is bimodal. UVBE on the beach is significantly larger than UVBE on the sand, and UVBE peaked at different solar elevation angle (SEA) over the two surfaces (about 53° and 40° on the beach and grass, respectively, according to Bayesian regression). The maximum of ocular UVBE ratios is greater than two, which peaked SEA was about 50°. One hour's cumulative radiation under sunny weather exceeds thresholds for photokeratitis, conjunctivitis and lens damage. Higher albedo significantly increased biological ocular UV radiation. Tourists on tropical beaches should take protective measures and avoid facing the sun directly, especially when SEA is around 50°. Copyright © 2014 Elsevier B.V. All rights reserved.
Price, J L; Cleary, B
Clearly, faculty must work hard with residents to explore the nature of their resistance to a program's learning and growth opportunities. Initial steps to a deeper, more effective, and longer-lasting change process must be pursued. If resident resistance is mishandled or misunderstood, then learning and professional growth may be sidetracked and the purposes of residency training defeated. Listening to the whole person of the resident and avoiding the trap of getting caught up in merely responding to select resident behaviors that irritate us is critical. Every faculty member in the family practice residency program must recognize resistance as a form of defense that cannot immediately be torn down or taken away. Resident defenses have important purposes to play in stress reduction even if they are not always healthy. Residents, especially interns, use resistance to avoid a deeper and more truthful look at themselves as physicians. A family practice residency program that sees whole persons in their residents and that respects resident defenses will effectively manage the stress and disharmony inherent to the resistant resident.
Ebere C. Anyanwu
Full Text Available Patients with photosensitive epilepsy are susceptible to seizures due to photoparoxysmal response (PPR. This response adversely precipitates factors that modify the functional status of the visual system. Such factors may or may not be evident superficially, but may lead to ocular defects due to trauma, hormonal imbalance, abnormal intraocular pressure (IOP, or any other reflex-inducing stimuli. The extent to which photosensitive epileptic patients suffer from PPR-related ocular defects has not been documented fully. In this investigation, ocular defects in patients with photosensitive epilepsy are studied using visual-evoked response (VER. A total of 212 photosensitive epileptic patients were studied to ascertain the magnitude and distribution of ocular defects using the changes in EEG and visual-evoked potential (VEP; 51% of the patients were female, the age range was 146 years. The major ocular defects and complications found were visual field defects, optic nerve abnormalities, nystagmus, cataracts, amblyopia, and migraine. These findings were analyzed according to age and sex. The relationship between the ocular abnormalities and the interpretations of the changes in the characteristics of the VEP indicated that optic-related atrophies, visual defects, optic neuritis, chiasmal compression, nystagmus, migraine headache, cataracts, and amblyopia were prevalent in photosensitive epileptic patients at varying degrees. The results showed that although ocular defects in photosensitive epilepsy may not be obvious differentially, VEP can be used in their diagnosis, contrary to earlier studies reporting that VEP is not of much value in epilepsy diagnosis.
Venkata Madusudanarao Kanukollu
Full Text Available BACKGROUND Ocular trauma is a major cause of preventable ocular blindness in the world. The present available data represents the tip of iceberg. The data pertaining to ocular trauma is just hospital based data which does not accurately represent the population at risk. The ocular morbidity may be disproportionate to the severity of injury. Though eyes represent only 0.21% of body surface area and 4% of facial area, they are the third most common trauma exposed areas after hands and feet. MATERIALS AND METHODS Our study group consisted of 341 patients who attended ophthalmology OPD with history of ocular trauma of whom 221 were males and 121 were females. The study was conducted over a period of one year. A complete anterior and posterior segment evaluation of all the patients was done. Other accessory ocular and systemic investigations wherever essential were done. RESULTS The ocular trauma was more common in males (64.52% predominantly affecting patients of 20-40 years age group (36.07%. Most often the injuries were occupation related (73.90% and the most common work related injury observed was extraocular foreign body in 134 patients (39.29%. Closed globe injuries were more common as compared to open globe injuries. Eyes with better visual acuity at presentation had better visual prognosis. Blinding trauma was observed in 29 patients (8.50%. CONCLUSION Ocular injuries are more commonly occupation related and mostly effect young males who are the main work force of our society. Stringent implementation of preventive norms in industries to all the workers and safety precautions during sports, driving need to be enforced.
Full Text Available Various ocular surface disorders like alkali burns and corneal ulcers can all cause damage to the cornea and conjunctiva, and often induce corneal neovascularization(CNVthat affects the visual function. However, amniotic membranes(AMcan promote the rapid epithelization of acute injured corneas and conjunctiva defects, diminish scarring, and perform anti-inflammatory effect. Therefore, AM has been widely used in ocular surface reconstructions and treatment of CNV. But the key problem is how to fix the AM. Only ensuring the adhesive time and cover area with convenient operation and little stimulation can achieve the best curative effect. This article reviews the methods of AM fixation in AM patch technique.
Nair, Akshay Gopinathan; Patil-Chhablani, Preeti; Venkatramani, Devendra V; Gandhi, Rashmin Anilkumar
Myasthenia gravis (MG) is a disease that affects the neuro-muscular junction resulting in classical symptoms of variable muscle weakness and fatigability. It is called the great masquerader owing to its varied clinical presentations. Very often, a patient of MG may present to the ophthalmologist given that a large proportion of patients with systemic myasthenia have ocular involvement either at presentation or during the later course of the disease. The treatment of ocular MG involves both the neurologist and ophthalmologist. Thus, the aim of this review was to highlight the current diagnosis, investigations, and treatment of ocular MG. PMID:25449931
Jones, D. R.; Scobie, I. N.; Sarkies, N. J.
A blind painful eye may harbour an unsuspected malignant melanoma. We report a case of ocular melanoma that presented with confusion owing to direct extension via the optic nerve into the anterior cranial fossa.
Belser, Jessica A; Rota, Paul A; Tumpey, Terrence M
Respiratory viruses (including adenovirus, influenza virus, respiratory syncytial virus, coronavirus, and rhinovirus) cause a broad spectrum of disease in humans, ranging from mild influenza-like symptoms to acute respiratory failure. While species D adenoviruses and subtype H7 influenza viruses are known to possess an ocular tropism, documented human ocular disease has been reported following infection with all principal respiratory viruses. In this review, we describe the anatomical proximity and cellular receptor distribution between ocular and respiratory tissues. All major respiratory viruses and their association with human ocular disease are discussed. Research utilizing in vitro and in vivo models to study the ability of respiratory viruses to use the eye as a portal of entry as well as a primary site of virus replication is highlighted. Identification of shared receptor-binding preferences, host responses, and laboratory modeling protocols among these viruses provides a needed bridge between clinical and laboratory studies of virus tropism.
Jafari, Alireza Keshtkar; Anvari, Faramarz; Ameri, Ahmad; Bozorgui, Shima; Shahverdi, Nooshin
Although the incidence of ocular trauma has been clearly described in developed countries, few published data are available on the epidemiology and the effects of parameters that can influence the incidence and severity of ocular injuries in Iran. The present study tried to determine epidemiological aspects of ocular traumatic injuries and evaluate their effects on different types of ocular injury. The case series included 1950 consecutive patients with acute ophthalmic trauma presented to the emergency ward of Farabi Hospital in Tehran. Information was collected by interviewing patients and having them fill in a questionnaire. The final diagnosis was made by a medical resident. If there was a difficulty or doubt in diagnosis or classification, confirmation of diagnosis was made by senior faculty. Ocular injuries were classified into globe and non-globe injuries according to the site of injury. Mechanical globe injuries were classified according to Birmingham Eye Trauma Terminology (BETT) into closed and open injuries. The mean age of patients was 28.8 ± 12.8 years; 87.6% were male. The most common causes of injury were work-related (49.0%) and chance events (42.0%). The most frequent ocular injury was globe injury (95.6%), including mechanical (77.6% closed and 5.9% open), chemical (7.6%), photic (2.3%) and thermal (2.2%) injuries. Non-globe injury also occurred in 10.8% of patients; both globe and non-globe injuries occurred in 6.5% of patients. The hospitalization rate in all patients was 8.8%. Previous history of eye trauma was significantly more common in the group with isolated globe injuries (P < 0.001). History of eye trauma is a risk factor for globe injuries and female gender is a risk factor only for non-globe injuries. These two factors may predict future eye injury and increase its risk by 5.2 and 1.6 times, respectively.
Dunia Cruz Izquierdo
Full Text Available Se realizó una revisión sobre el trauma ocular y su manejo en pacientes politraumatizados. Entre las causas más frecuentes de trauma ocular se encuentran los accidentes domésticos, laborales, juegos, actividades recreativas y deportivas. Involucran en un alto por ciento a niños y jóvenes, y predomina el sexo masculino en casi todos los trabajos revisados. No solo en Cuba sino en el mundo, el trauma ocular es fuente importante de ceguera unilateral o bilateral. Se presenta un breve compendio de los términos y definiciones actuales que son utilizados para el manejo del trauma ocular, su clasificación y la ventaja que ofrece aplicar el Puntaje del Trauma Ocular, OTS (Ocular Trauma Score, para el pronóstico de la agudeza visual final de acuerdo a los hallazgos clínicos encontrados en la evaluación inicial. Se hace referencia a los pacientes con politrauma y los aspectos a tener en cuenta por el oftalmólogo para tomar conducta cuando estos presentan heridas penetrantes o perforantes y tienen compromiso vital. En estos casos se hace necesaria la colaboración urgente de múltiples especialistas para primero mantener al paciente con vida y luego disminuir las complicaciones que repercuten en su pronóstico visual.A review was made on the ocular trauma and its management in multitrauma patients. The most common causes comprise domestic and occupational accidents, games, recreational and sport activities. It involves more frequently a high percentage of young people, with male prevalence in almost all the reviewed papers. Ocular trauma is an important source of unilateral or bilateral blindness not only in Cuba but worldwide as well. A brief summary of the current terms and definitions used to manage ocular trauma, their classification and the advantage of the Ocular Trauma Score (OTS to know the possible final visual acuity, according to the clinical findings at the emergency room, were presented. Reference was also made to the multitrauma
Myrna Serapião dos Santos
Full Text Available PURPOSE: To establish current definition, classification and staging, and to develop diagnosis and treatment recommendations for ocular allergy, by using Delphi approach. METHODS: Ten Latin American experts on ocular allergy participated in a 4-round Delphi panel approach. Four surveys were constructed and answered by panelists. A two-thirds majority was defined as consensus. Definition, classification, staging and diagnosis and treatment recommendations were the main outcomes. RESULTS: "Ocular allergy" was proposed as the general term to describe ocular allergic diseases. Consensus regarding classification was not reached. Signs and symptoms were considered extremely important for the diagnosis. It was consensus that a staging system should be proposed based on the disease severity. Environmental control, avoidance of allergens and the use of artificial tears were recommended as first line treatment. The secondary treatment should include topical anti-histamines, mast cell stabilizers and multi actions drugs. Topical non-steroidal anti-inflammatory and vasoconstrictors were not recommended. Topical corticosteroids were recommended as third line of treatment for the most severe keratoconjunctivitis. Consensus was not reached regarding the use of systemic corticosteroids or immunosuppressant. Surgical approach and unconventional treatments were not recommended as routine. CONCLUSION: The task of creating guidelines for ocular allergies showed to be very complex. Many controversial topics remain unsolved. A larger consensus including experts from different groups around the world may be needed to further improve the current recommendations for several aspects of ocular allergy.
Full Text Available Purpose: To review current knowledge about ocular effects of sulfur mustard (SM and the associated histopathologic findings and clinical manifestationsMethods: Literature review of medical articles (human and animal studies was accomplished using PubMed, Scopus and ISI databases. A total of 274 relevant articles in English were retrieved and reviewed thoroughly.Results: Eyes are the most sensitive organs to local toxic effects of mustard gas. Ocular injuries are mediated through different toxic mechanisms including: biochemical damages, biomolecular and gene expression modification, induction of immunologic and inflammatory reactions, disturbing ultrastructural architecture of the cornea, and long-lasting corneal denervation. The resulting ocular injuries can roughly be categorized into acute or chronic complications. Most of the patients recover from acute injuries, but a minority of victims will suffer from chronic ocular complications. Mustard gas keratopathy (MGK is a devastating late complication of SM intoxication that proceeds from limbal stem cell deficiency (LSCD.Conclusion: SM induces several different damaging changes in case of ocular exposure; hence leading to a broad spectrum of ocular manifestations in terms of severity, timing and form. Unfortunately, no effective strategy has been introduced yet to inhibit or restore these damaging changes.
Full Text Available Los traumatismos oculares durante la práctica deportiva son relativamente frecuentes, pueden acontecer en el contexto de cualquier deporte y son muy variados, tanto en su origen, gravedad y forma de presentación clínica (traumatismos incisos, contusos o inciso-contusos. A pesar de que el diagnóstico precoz y un tratamiento adecuado a cargo de un oftalmólogo especialista suele ayudar a mejorar el pronóstico de estos casos, es cierto que en algunas situaciones las lesiones oculares secundarias al traumatismo son clínicamente irreversibles. El autor revisa la repercusión clínica ocular de los accidentes deportivos con compromiso de la órbita, de los párpados, del segmento anterior y/o posterior del globo ocular, y de las vías ópticas. La mayoría de estas lesiones se pueden evitar optimizando el estado físico (y ocular antes de la práctica deportiva, y utilizando la técnica y el material adecuado para cada situación. Asimismo una buena educación deportiva desde la infancia y la utilización de gafas de protección ocular adaptadas a cada deporte juegan un papel esencial en la prevención de estos accidentes.
Rowe, Fiona; Wright, David; Brand, Darren; Jackson, Carole; Price, Alison; Walker, Linda; Harrison, Shirley; Eccleston, Carla; Maan, Tallat; Scott, Claire; Vogwell, Linda; Peel, Sarah; Robson, Leonie; Akerman, Nicola; Dodridge, Caroline; Howard, Claire; Shipman, Tracey; Sperring, Una; Yarde, Sue; Rowe, Fiona; Macdiarmid, Sonia; Freeman, Cicely
Ocular causes of reading impairment following stroke include visual field loss, eye movement impairment and poor central vision. Non ocular causes may include cognitive errors or language impairment. The purpose of this study was to identify all patients referred with suspected visual impairment who had reported reading difficulty to establish the prevalence of ocular and non ocular causes. Prospective, multicentre, observation study with standardised referral and assessment forms across 21 sites. Visual assessment included visual acuity measurement, visual field assessment, ocular alignment, and movement and visual inattention assessment. Multicentre ethical approval and informed patient consent were obtained. A total of 915 patients were recruited, with a mean age of 69·18 years (standard deviation 14·19). Reading difficulties were reported by 177 patients (19·3%), with reading difficulty as the only symptom in 39 patients. Fifteen patients had normal visual assessment but with a diagnosis of expressive or receptive aphasia. Eight patients had alexia. One hundred and nine patients had visual field loss, 85 with eye movement abnormality, 27 with low vision and 39 patients with visual perceptual impairment. Eighty-seven patients had multiple ocular diagnoses with combined visual field, eye movement, low vision or inattention problems. All patients with visual impairment were given targeted treatment and/or advice including prisms, occlusion, refraction, low vision aids and scanning exercises. Patients complaining of reading difficulty were mostly found to have visual impairment relating to low vision, eye movement or visual field loss. A small number were found to have non ocular causes of reading difficulty. Treatment or advice was possible for all patients with visual impairment. © 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.
Ocular tumours at the Tata Memorial Hospital, Bombay, form about 0.14% of all the proved cancer cases. In case of unilateral retinoblastoma with the other eye being not non-seeing for any reason, enucleation is advised, as the diagnosis may sometimes be in doubt. If after enucleation, optic nerve and/or peribulbar tissues are found to be involved, post-operative irradiation is given to the whole orbit. In bilateral retinoblastoma the more affected eye is enucleated and an attempt is made to preserve vision in the other eye. A tumour dose of 3500 to 4000 rad in about 4 weeks is given with a cobalt beam using a direct anterior field. A cataract that may develop has to be taken care of. Lateral and/or medial fields are used with deep X-rays. In certain cases, an implant of cobalt-60 or gold-198 grain is done. For carcinoma of conjuctiva, small lesions or early lesions are excised and a beta radiation dose of 2000 rad weekly for about 4 to 5 weeks is given; larger lesions require enucleation or exenteration followed by irradiation with super-voltage radiation. Post-irradiation sarcomas may develop many years later. Irradiation is repeated for recurrences.
Ocular tumours at the Tata Memorial Hospital, Bombay, form about 0.14% of all the proved cancer cases. In case of unilateral retinoblastoma with the other eye being not non-seeing for any reason, enucleation is advised, as the diagnosis may sometimes be in doubt. If after enucleation, optic nerve and/or peribulbar tissues are found to be involved, post-operative irradiation is given to the whole orbit. In bilateral retinoblastoma the more affected eye is enucleated and an attempt is made to preserve vision in the other eye. A tumour dose of 3500 to 4000 rad in about 4 weeks is given with a cobalt beam using a direct anterior field. A cataract that may develop has to be taken care of. Lateral and/or medial fields are used with deep X-rays. In certain cases, an implant of cobalt-60 or gold-198 grain is done. For carcinoma of conjuctiva, small lesions or early lesions are excised and a beta radiation dose of 2000 rad weekly for about 4 to 5 weeks is given; larger lesions require enucleation or exenteration followed by irradiation with super-voltage radiation. Post-irradiation sarcomas may develop many years later. Irradiation is repeated for recurrences. (M.G.B.)
Clune, John W.; Denver, Judith M.
Nitrate is a common contaminant in groundwater and surface water throughout the Nation, and water-resource managers need more detailed small-scale watershed research to guide conservation efforts aimed at improving water quality. Concentrations of nitrate in Bucks Branch are among the highest in the state of Delaware and a scientific investigation was performed to provide water-quality information to assist with the management of agriculture and water resources. A combination of major-ion chemistry, nitrogen isotopic composition and age-dating techniques was used to estimate the residence time and provide a chemical and isotopic analysis of nitrate in the groundwater in the surficial aquifer of the Bucks Branch watershed in Sussex County, Delaware. The land use was more than 90 percent agricultural and most nitrogen inputs were from manure and fertilizer. The apparent median age of sampled groundwater is 18 years and the estimated residence time of groundwater contributing to the streamflow for the entire Bucks Branch watershed at the outlet is approximately 19 years. Concentrations of nitrate exceeded the U.S. Environmental Protection Agency drinking-water standard of 10 milligrams per liter (as nitrogen) in 60 percent of groundwater samples and 42 percent of surface-water samples. The overall geochemistry in the Bucks Branch watershed indicates that agriculture is the predominant source of nitrate contamination and the observed patterns in major-ion chemistry are similar to those observed in other studies on the Mid-Atlantic Coastal Plain. The pattern of enrichment in nitrogen and oxygen isotopes (δ15N and δ18O) of nitrate in groundwater and surface water indicates there is some loss of nitrate through denitrification, but this process is not sufficient to remove all of the nitrate from groundwater discharging to streams, and concentrations of nitrate in streams remain elevated.
Hamade, Issam H; Tabbara, Khalid F
To determine the effect of steroid treatment on visual outcome and ocular complications in patients with presumed ocular tuberculosis. Retrospective review of patients with presumptive ocular tuberculosis. The clinical diagnosis was made based on ocular findings, positive purified protein derivative (PPD) testing of more than 15 mm induration, exclusion of other causes of uveitis and positive ocular response to anti-tuberculous therapy (ATT) within 4 weeks. Group 1 included patients who had received oral prednisone or subtenon injection of triamcinolone acetonide prior to ATT. Group 2 included patients who did not receive corticosteroid therapy prior to administration of ATT. Among 500 consecutive new cases of uveitis encountered in 1997-2007 there were 49 (10%) patients with presumed ocular tuberculosis. These comprised 28 (57%) male and 21 (43%) female patients with a mean age of 45 years (range 12-76 years). Four (20%) patients in group 1 had initial visual acuity of 20/40 or better, in comparison to eight (28%) patients in group 2. At 1-year follow-up, six (30%) patients in group 1 had a visual acuity of 20/40 or better compared with 20 (69%) patients in group 2 (p = 0.007). Of 20 eyes (26%) in group 1 that had visual acuity of < 20/50 at 1-year follow up, 14 (70%) eyes developed severe chorioretinal lesion (p = 0.019). Early administration of corticosteroids without anti-tuberculous therapy in presumed ocular tuberculosis may lead to poor visual outcome compared with patients who did not receive corticosteroids prior to presentation. Furthermore, the severity of chorioretinitis lesion in the group of patients given corticosteroid prior to ATT may account for the poor visual outcome. © 2009 The Authors. Journal compilation © 2009 Acta Ophthalmol.
activity similar to that of free amphotericin B against Candida albicans. The in vivo ocular pharmacokinetic study suggested that the PLA-g-CS nanoparticles have the advantage of prolonging residence time at the ocular surface. The corneal penetration study showed that the PLA-g-CS nanoparticles could penetrate into the cornea. Conclusion: Our results suggest that this nanoparticulate vehicle based on a PLA-g-CS copolymer might be a promising system for effective ocular delivery of amphotericin B. Keywords: chitosan, poly(lactic acid, nanoparticles, amphotericin B
Wladis, Edward J; Swamy, Supraja; Herrmann, Alyssa; Yang, Jinhong; Carlson, J Andrew; Adam, Alejandro P
Rosacea-related cutaneous inflammation is a common cause of ocular surface disease. Currently, there are no specific pharmacologic therapies to treat ocular rosacea. Here, we aimed at determining the differences in intracellular signaling activity in eyelid skin from patients with and without ocular rosacea. This was an observational, comparative case series including 21 patients undergoing lower lid ectropion surgery at one practice during 2013 and 2014 (18 patients with rosacea, 13 control patients), and 24 paraffin-embedded archival samples from Albany Medical Center, selected randomly (12 patients with rosacea, 12 control patients). Cutaneous biopsies resulting from elective lower lid ectropion surgery were analyzed by Proteome Profiler Human Phospho-Kinase Array, Western blot, and/or immunohistochemistry. Samples derived from ocular rosacea patients showed increased levels of phosphorylated (active) p38 and Erk kinases. Phosphoproteins were mainly localized to the epidermis of affected eyelids. This finding provides a novel potential therapeutic target for treatment of ocular rosacea and possibly other forms of rosacea. Further testing is required to determine if p38 and Erk activation have a causal role in ocular rosacea. The selective activation of keratinocytes in the affected skin suggests that topical pathway inhibition may be an effective treatment that will ultimately prevent ocular surface damage due to ocular rosacea.
Full Text Available Inflammation is a complex process that implies the interaction between cells and molecular mediators, which, when not properly “tuned,” can lead to disease. When inflammation affects the eye, it can produce severe disorders affecting the superficial and internal parts of the visual organ. The nucleoside adenosine and nucleotides including adenine mononucleotides like ADP and ATP and dinucleotides such as P1,P4-diadenosine tetraphosphate (Ap4A, and P1,P5-diadenosine pentaphosphate (Ap5A are present in different ocular locations and therefore they may contribute/modulate inflammatory processes. Adenosine receptors, in particular A2A adenosine receptors, present anti-inflammatory action in acute and chronic retinal inflammation. Regarding the A3 receptor, selective agonists like N6-(3-iodobenzyl-5′-N-methylcarboxamidoadenosine (CF101 have been used for the treatment of inflammatory ophthalmic diseases such as dry eye and uveoretinitis. Sideways, diverse stimuli (sensory stimulation, large intraocular pressure increases can produce a release of ATP from ocular sensory innervation or after injury to ocular tissues. Then, ATP will activate purinergic P2 receptors present in sensory nerve endings, the iris, the ciliary body, or other tissues surrounding the anterior chamber of the eye to produce uveitis/endophthalmitis. In summary, adenosine and nucleotides can activate receptors in ocular structures susceptible to suffer from inflammatory processes. This involvement suggests the possible use of purinergic agonists and antagonists as therapeutic targets for ocular inflammation.
Full Text Available Rho kinases (ROCKs have a crucial role in actin-cytoskeletal reorganization and thus are involved in broad aspects of cell motility, from smooth muscle contraction to neurite outgrowth. The first marketed ROCK inhibitor, called fasudil, has been used safely for treatment of cerebral vasospasm since 1995 in Japan. During the succeeding decades ROCK inhibitors have been applied in many pathological conditions from central nervous system disorders to cardiovascular disease as potential therapeutic agents or experimental tools to help understand the underlying (pathomechanisms. In 2014, a fasudil derivate named ripasudil was accepted for clinical use in glaucoma and ocular hypertension. Since ROCK kinases are widely expressed in ocular tissues, they have been implicated in the pathology of many ocular conditions such as corneal dysfunction, glaucoma, cataract, diabetic retinopathy, age-related macular degeneration, and retinal detachment. This paper aims to provide an overview of the most recent status/application of ROCK inhibitors in the field of eye disease.
Comparison of the Efficacy of Carboxymethylcellulose 0.5%, Hydroxypropyl-guar Containing Polyethylene Glycol 400/Propylene Glycol, and Hydroxypropyl Methyl Cellulose 0.3% Tear Substitutes in Improving Ocular Surface Disease Index in Cases of Dry Eye.
Maharana, Prafulla K; Raghuwanshi, Sapna; Chauhan, Ashish K; Rai, Vaishali G; Pattebahadur, Rajesh
To compare the efficacy of carboxymethylcellulose 0.5% (CMC), hydroxypropyl-guar containing polyethylene glycol 400/propylene glycol (PEG/PG), and hydroxypropyl methylcellulose 0.3% (HPMC) as tear substitutes in patients with dry eye. A retrospective evaluation of cases presenting with symptoms of dry eye from July 2014 to June 2015 was done. Patients with Ocular Surface Disease Index (OSDI) scoring >12 were included in the study. Parameters such as age, gender, Schirmer test (ST), and tear film breakup time (TBUT) were recorded on day 0, week 1, and week 4. For analysis, cases were divided into three groups; Group 1 - CMC, Group 2 - PEG/PG, and Group 3 - HPMC. Overall, 120 patients were included in the study. Demographic data and baseline characteristics were comparable among the groups. Group 2 had significant improvement in percentage change in OSDI (weeks 0-1, 0-4, and 1-4, P = 0.00), TBUT (weeks 0-1, P = 0.01; 0-4, P = 0.006; and 1-4, P = 0.007), and in ST (weeks 0-1, P = 0.02; 0-4, P = 0.002; and 1-4, P = 0.008) compared to Group 1 at all follow-ups. Group 3 had improvements similar to Group 2, but it was not at all follow-ups (improvement in percentage change OSDI [weeks 0-1, 0-4, and 1-4, P = 0.00], TBUT [weeks 0-1, P = 0.10; 0-4, P = 0.03; and 1-4, P = 0.04], and in ST [weeks 0-1, P = 0.007; 0-4, P = 0.03; and 1-4, P = 0.12]). No significant difference was found between Groups 2 and 3. Hydroxypropyl-guar containing PEG/PG and HPMC as tear substitutes are better than CMC. While HPMC was comparable to PEG/PG in subjective improvement, the objective improvement was not consistent.
Fabiano, Angela; Chetoni, Patrizia; Zambito, Ylenia
Mucoadhesive nanoparticles were compared with non-aggregated constituent polymers for effect on pre-corneal residence of dexamethasone phosphate (DP) or met-enkephalin (ME), administered by eye-drops to rabbits. Deepening the knowledge of ophthalmic nanoparticulate systems in terms of ability to prolong pre-corneal residence. Medicated nanoparticles resulted from gelation of quaternary ammonium-chitosan conjugate or its thiolated derivative with hyaluronan in the presence of drug. Particles were analyzed by light scattering. Dialysis removed non-encapsulated drug, dynamic dialysis measured drug-polymer interactions, and lyophilization-stabilized product. Dispersions were regenerated from lyophilized products. Also solutions of non-thiolated or thiolated chitosan derivative were administered. Mean drug residence time (MRT) in tears was determined by collecting samples from lower marginal tear strip of albino rabbits using capillaries. Nanoparticle size of regenerated dispersions was 400-430 nm (DP-systems), 360-370 nm (ME-systems); the drug content was 2.5 mg/mL (DP) or 0.3 mg/mL (ME). The MRT for DP nanoparticles from non-thiolated derivative was higher than that for non-aggregated polymer, due to stronger concurrent interactions of positively charged nanoparticles with ocular surface and drug. Thiolated polymer nanoparticles and non-aggregated parent polymer, both interacting weakly with DP, showed similar MRT values. The MRT of ME could only be enhanced by protecting drug from enzymatic hydrolysis. This was done by nanoparticle systems, whereas non-aggregated polymers were ineffective. Developing a nanoparticle system rather than a solution of mucoadhesive polymer, for prolonging pre-corneal residence, is convenient, provided nanoparticles interact strongly with both ocular surface and drug, or protect drug from metabolic degradation.
Ness, T; Hengel, H
Vaccinations are very effective measures for prevention of infections but are also associated with a long list of possible side effects. Adverse ocular effects following vaccination have been rarely reported or considered to be related to vaccinations. Conjunctivitis is a frequent sequel of various vaccinations. Oculorespiratory syndrome and serum sickness syndrome are considered to be related to influenza vaccinations. The risk of reactivation or initiation of autoimmune diseases (e. g. uveitis) cannot be excluded but has not yet been proven. Overall the benefit of vaccination outweighs the possible but very low risk of ocular side effects.
Martha G Domínguez Expósito
Full Text Available El carcinoma metastásico del ojo es considerado la neoplasia maligna que más frecuente se encuentra de forma intraocular. Solo cerca del 10 % de las personas que tienen una o más lesiones metastásicas intraoculares son detectadas clínicamente antes de la muerte. A menudo, el carcinoma metastásico ocular es diagnosticado por el oftalmólogo ante la presencia de síntomas oculares. Las lesiones están localizadas con preferencia en coroides. Nos motivo a realizar la presentación de este caso la presencia de lesiones intraoculares múltiples tumorales metastásicos en un paciente cuyo síntoma de presentación fue la disminución de la agudeza visualThe eye metastatic carcinoma is considered the most frequently found intraocular malignant neoplasia. Only 10 % of the persons with one or more metastatic intraocular injuries are clinically detected before death. The metastatic ocular carcinoma is often diagnosed by the ophthalmologist in the presence of ocular symptoms. The injuries are preferably located in the choroid. The appearance of multiple metastatic intraaocular tumoral injuries in a patient whose chief complaint was the reduction of visual acuity motivated us to presente this case
Vignesh, Ammapati Paul Pandian; Srinivasan, Renuka
Purpose To study the ocular manifestations of rheumatoid arthritis and to correlate the role of anti-cyclic citrullinated peptide antibody (anti-CCP antibody) with the ocular manifestations. Methods Three-hundred and ninety-two eyes of the 196 rheumatoid arthritis patients who attended the ophthalmology outpatient department underwent a detailed ocular examination using slit lamp biomicroscopy and ophthalmoscopy. The tear function of all the patients was assessed using Schirmer’s test, tear film break-up time and ocular surface staining. The anti-CCP antibody titers for all the rheumatoid arthritis patients were estimated using enzyme-linked immunosorbent assay tests. Results Seventy-seven patients (135 eyes, 39%) out of the 196 patients studied had ocular manifestations typical of rheumatoid arthritis. Dry eye was the most common manifestation (28%, 54 patients). Of the patients, 78% was females (60 patients). The mean duration of rheumatoid arthritis in patients with ocular manifestations was 5.4±2.7 years and without ocular manifestations was 2.1±1.6years. Three percent of the patients had episcleritis (six patients). Scleritis was present in 2% of the patients (four patients). Peripheral ulcerative keratitis and sclerosing keratitis was present in 1% of the population each (two patients each). Eighty-five percent (66 patients) had bilateral manifestations 15% (eleven patients) had unilateral manifestations. There was a strong association between the presence of anti-CCP antibodies and ocular manifestations of rheumatoid arthritis which was shown by the statistically significant P-value of <0.0001. Conclusion Ocular manifestations are a significant part of the extra-articular manifestation of rheumatoid arthritis. Dry eye was the most common ocular manifestation. There was a statistically significant association between the presence of anti-CCP antibodies specific to rheumatoid arthritis and the ocular manifestations. PMID:25750517
The patient was recalled regularly for follow‑up at 3 month intervals for ophthalmic examinations and she was rehabilitated cosmetically with customised ocular prosthesis during the various stages of her developmental growth. Keywords: Custom ocular prosthesis, enucleation, impression technique, ocular defect, ...
John F. Fisher
Full Text Available The training of physicians in the past century was based primarily on responsibility and the chain-of-command. Those with the bulk of that responsibility in the fields of pediatrics and internal medicine were residents. Residents trained the medical students and supervised them carefully in caring for patients. Most attending physicians supervised their teams at arm's length, primarily serving as teachers of the finer points of diagnosis and treatment during set periods of the day or week with a perfunctory signature on write-ups or progress notes. Residents endeavored to protect the attending physician from being heavily involved unless they were unsure about a clinical problem. Before contacting the attending physician, a more senior resident would be called. Responsibility was the ultimate teacher. The introduction of diagnosis-related groups by the federal government dramatically changed the health care delivery system, placing greater emphasis on attending physician visibility in the medical record, ultimately resulting in more attending physician involvement in day-to-day care of patients in academic institutions. Without specified content in attending notes, hospital revenues would decline. Although always in charge technically, attending physicians increasingly have assumed the role once dominated by the resident. Using biographical experiences of more than 40 years, the author acknowledges and praises the educational role of responsibility in his own training and laments its declining role in today's students and house staff.
Fisher, John F
The training of physicians in the past century was based primarily on responsibility and the chain-of-command. Those with the bulk of that responsibility in the fields of pediatrics and internal medicine were residents. Residents trained the medical students and supervised them carefully in caring for patients. Most attending physicians supervised their teams at arm's length, primarily serving as teachers of the finer points of diagnosis and treatment during set periods of the day or week with a perfunctory signature on write-ups or progress notes. Residents endeavored to protect the attending physician from being heavily involved unless they were unsure about a clinical problem. Before contacting the attending physician, a more senior resident would be called. Responsibility was the ultimate teacher. The introduction of diagnosis-related groups by the federal government dramatically changed the health care delivery system, placing greater emphasis on attending physician visibility in the medical record, ultimately resulting in more attending physician involvement in day-to-day care of patients in academic institutions. Without specified content in attending notes, hospital revenues would decline. Although always in charge technically, attending physicians increasingly have assumed the role once dominated by the resident. Using biographical experiences of more than 40 years, the author acknowledges and praises the educational role of responsibility in his own training and laments its declining role in today's students and house staff.
Full Text Available BACKGROUND The eye is especially susceptible to the symptoms of allergic rhinitis, itching (pruritus, tearing (epiphora and redness (erythema because it lacks a mechanical barrier that could prevent the deposition of allergens, such as pollen on the conjunctival surface. These ocular symptoms have been described as examples of the type 1 immediate hypersensitivity reaction. A number of recently published clinical studies apparently support the positive effect of intranasal steroidal sprays on ocular allergy symptoms. The aim of the study is to evaluate the role of intranasal steroids in relieving ocular symptoms in allergic rhinitis. MATERIALS AND METHODS 60 subjects who had seasonal allergic rhinitis with ocular symptoms came to Outpatient Department of Chalmeda Anand Rao Hospital in the year 2015-2016. Randomly, each intranasal steroid is given to 12 patients to a total of 60 patients for 4 weeks 2 puffs in each nostril twice daily and the clinical response is observed. RESULTS A subjective improvement in ocular symptoms was observed in 11 of the 12 patients treated with fluticasone furoate, 8 of 12 patients with fluticasone propionate, 7 of the 12 patients with mometasone furoate, 6 of the 12 patients with beclomethasone and 6 of the 12 patients with budesonide. CONCLUSION Intranasal corticosteroids, which are used for seasonal allergic rhinitis with ocular symptoms are effective in controlling of ocular symptoms. Among these, intranasal corticosteroids, which are used for allergic rhinitis, fluticasone furoate is more effective in relieving ocular symptoms in our study.
Shen Jie; Sun Minjie; Ping Qineng; Ying Zhi; Liu Wen, E-mail: Pingqn2004@yahoo.com.cn [School of Pharmacy, China Pharmaceutical University, 24 Tongjia Xiang, Nanjing (China)
The present work investigates the effect of liquid lipid incorporation on the physicochemical properties and ocular drug delivery enhancement of nanostructured lipid carriers (NLCs) and attempts to elucidate in vitro and in vivo the potential of NLCs for ocular drug delivery. The CyA-loaded or fluorescein-marked nanocarriers composed of Precifac ATO 5 and Miglyol 840 (as liquid lipid) were prepared by melting-emulsion technology, and the physicochemical properties of nanocarriers were determined. The uptake of nanocarriers by human corneal epithelia cell lines (SDHCEC) and rabbit cornea was examined. Ex vivo fluorescence imaging was used to investigate the ocular distribution of nanocarriers. The in vitro cytotoxicity and in vivo acute tolerance were evaluated. The higher drug loading capacity and improved in vitro sustained drug release behavior of lipid nanoparticles was found with the incorporation of liquid lipid in lipid nanoparticles. The uptake of nanocarriers by the SDHCEC was increased with the increase in liquid lipid loading. The ex vivo fluorescence imaging of the ocular tissues indicated that the liquid lipid incorporation could improve the ocular retention and penetration of ocular therapeutics. No alternation was macroscopically observed in vivo after ocular surface exposure to nanocarriers. These results indicated that NLC was a biocompatible and potential nanocarrier for ocular drug delivery enhancement.
Shen Jie; Sun Minjie; Ping Qineng; Ying Zhi; Liu Wen
The present work investigates the effect of liquid lipid incorporation on the physicochemical properties and ocular drug delivery enhancement of nanostructured lipid carriers (NLCs) and attempts to elucidate in vitro and in vivo the potential of NLCs for ocular drug delivery. The CyA-loaded or fluorescein-marked nanocarriers composed of Precifac ATO 5 and Miglyol 840 (as liquid lipid) were prepared by melting-emulsion technology, and the physicochemical properties of nanocarriers were determined. The uptake of nanocarriers by human corneal epithelia cell lines (SDHCEC) and rabbit cornea was examined. Ex vivo fluorescence imaging was used to investigate the ocular distribution of nanocarriers. The in vitro cytotoxicity and in vivo acute tolerance were evaluated. The higher drug loading capacity and improved in vitro sustained drug release behavior of lipid nanoparticles was found with the incorporation of liquid lipid in lipid nanoparticles. The uptake of nanocarriers by the SDHCEC was increased with the increase in liquid lipid loading. The ex vivo fluorescence imaging of the ocular tissues indicated that the liquid lipid incorporation could improve the ocular retention and penetration of ocular therapeutics. No alternation was macroscopically observed in vivo after ocular surface exposure to nanocarriers. These results indicated that NLC was a biocompatible and potential nanocarrier for ocular drug delivery enhancement.
oral chloramphenicol provided the basis for comparison. 20 adult male rabbits were randomly but equally divided into two main groups based on the route of administration of the drug (i.e ocular or oral). In each group of ten rabbits equal number of rabbits were randomly divided into test (n=5) and control (n=5) subgroups.
• A new attention to post-natally acquired infections. Previously, most attention was focused on infection during pregnancy, and the risk of congenital disease, with the feeling that infection in older individuals was benign, without a substantial risk of disease morbidity, such as ocular involvemen...
Reddy, Sagili Chandrasekhara
To report various ocular injuries caused by durian fruit. Three cases of ocular injuries were described in young patients, due to accidental fall of durian fruit on the forehead and face, while they were taking rest/sleeping /playing under the durian tree. The ocular injuries observed were lacerating injury of cornea with iris incarceration, hyphema, superficial penetrating injury of sclera and angle recession glaucoma in the right eye of first patient; lacerating injury of cornea with iris prolapse in the left eye of second patient; subconjunctival haemorrhage, traumatic mydriasis and superficial penetrating injury of sclera, commotion retinopathy and macular edema in the left eye of third patient. Vision improved to normal in all the eyes following surgical/ medical/optical treatment. Evidence of penetrating injury (because of thorns) and blunt injury (because of weight) can be seen in the eyes when durian fruit falls on the face. Vision can be recovered fully with immediate and appropriate treatment in these cases. The ocular injuries can be prevented by educating the public to wear protective metal frame wide goggles and not to sleep/take rest under the durian tree.
Ferreira, T.; Verbist, B.M.; Buchem, M. van; Osch, T. van; Webb, A.
The ocular motor nerves (OMNs) comprise the oculomotor, trochlear and the abducens nerves. According to their course, they are divided into four or five anatomic segments: intra-axial, cisternal, cavernous and intra-orbital and, for the abducens nerve, an additional interdural segment. Magnetic
Secchi, Antonio; Deligianni, Velika
Superficial ocular tissues are frequently exposed to damage produced by chemical compounds applied on or around the ocular surface for cosmetic, therapeutic or accidental reasons. An experimental test measuring objectively and in a reproducible way any potential damaging effect would certainly help in prospectively minimizing unwanted effects. The Draize eye test, although commonly employed to date, does not seem to be quite satisfactory in this respect. The limits of the Draize eye test and the results of some modified versions of the test are analysed. In particular, the good predictivity of the so-called low-volume Draize eye test and the recent findings of studies on the in-vitro and ex-vivo alternatives to the Draize eye test are presented. The Draize eye test, despite criticisms, has been used in the clinical setting for a long time and still remains the reference protocol. To date, only a combination of alternative methods, none of which is devoid of serious criticisms, seems to be able to exhaustively recognize potential irritants and avoiding for that purpose, in some cases, the use of living animals.
Candia, Oscar A; Alvarez, Lawrence J
This article discusses three largely unrecognized aspects related to fluid movement in ocular tissues; namely, (a) the dynamic changes in water permeability observed in corneal and conjunctival epithelia under anisotonic conditions, (b) the indications that the fluid transport rate exhibited by the ciliary epithelium is insufficient to explain aqueous humor production, and (c) the evidence for fluid movement into and out of the lens during accommodation. We have studied each of these subjects in recent years and present an evaluation of our data within the context of the results of others who have also worked on electrolyte and fluid transport in ocular tissues. We propose that (1) the corneal and conjunctival epithelia, with apical aspects naturally exposed to variable tonicities, are capable of regulating their water permeabilities as part of the cell-volume regulatory process, (2) fluid may directly enter the anterior chamber of the eye across the anterior surface of the iris, thereby representing an additional entry pathway for aqueous humor production, and (3) changes in lens volume occur during accommodation, and such changes are best explained by a net influx and efflux of fluid.
Kanukollu Venkata Madusudana Rao
Full Text Available BACKGROUND This prospective study aimed to evaluate the incidence of ocular manifestations in head injury and their correlation with the intracranial lesions. MATERIALS AND METHODS A total of 108 consecutive cases of closed head injury admitted in the neurosurgical ward of a tertiary teaching hospital underwent a thorough ophthalmic assessment. Clinical examination, radiological imaging and Glasgow Coma Scale (GCS were applied to grade the severity of injury. RESULTS Total number of 108 patients of head injury were examined of which 38 patients had ocular manifestations (35.18%. Of these, 85.18% were males, 84% of injuries were due to road traffic accidents and 16% were due to fall from a height. The ocular manifestations were as follows- Orbital complications were seen in 6 patients (15.8%. Anterior segment manifestations included black eyes seen in 10 patients (26.3%, subconjunctival haemorrhage in 10.5% of patients (4 patients, corneal involvement in 21% of patients (8 patients and pupillary involvement in 50% of patients (19 patients. Posterior segment manifestations were seen in 26.3% of patients (10 patients and were as follows- Purtscher’s retinopathy in 2 patients and optic atrophy in 5 patients. Cranial nerve palsies were seen in 15 patients (39.47% and supranuclear movement disorders were seen in 3 patients (8%. CONCLUSION Even though, neurosurgeons perform comprehensive clinical examination including eye examination, the main purpose is limited to aid topical diagnosis of neurological lesions. This study emphasises the importance of a detailed eye examination by an ophthalmologist to prevent irreversible visual loss in addition to aiding in the neurological diagnosis. Pupillary involvement, papilloedema and ocular motor paresis pointed to a more severe head injury. This observational prospective study helped us to correlate the severity of head injuries in association with ocular findings in patients admitted in neurosurgical ward
Shi, Chaowen; Cao, Xiaowei; Chen, Xiang; Sun, Zhaorui; Xiang, Zou; Zhao, Hang; Qian, Weiping; Han, Xiaodong
Lung resident mesenchymal stem cells (LR-MSCs) are important regulators of pathophysiological processes including tissue repair and fibrosis, inflammation, angiogenesis and tumor formation. Therefore, increasing attention has focused on the functional differentiation of LR-MSCs. However, the distinction between the undifferentiated and differentiated LR-MSCs, which are closely related and morphologically similar, is difficult to achieve by conventional methods. In this study, by employing the TAT Peptide-conjugated Au nanostars (AuNSs) as an intracellular probe, we developed a method for the identification of LR-MSC differentiation by surface-enhanced Raman scattering (SERS) spectroscopy. SERS spectra were analyzed using principal component analysis (PCA) that allowed unambiguous distinction of subtypes and monitoring of component changes during cellular differentiation. Furthermore, to ascertain whether co-culture with alveolar epithelial type II (ATII) cells and incubation with transform growth factor (TGF)-β were involved in regulating the differentiation of LR-MSCs, we investigated the protein expression levels of epithelial markers and fibroblastic markers on LR-MSCs. Our results demonstrated that co-culture with ATII cells or incubation with TGF-β could induce the differentiation of LR-MSCs as confirmed by SERS analysis, a method that is capable of noninvasive characterization of and distinction between subtypes of LR-MSCs during differentiation. We have provided a new tool that may facilitate stem cell research. Copyright © 2015 Elsevier Ltd. All rights reserved.
Olliver, E. A.; Edmonds, D. A.; Shaw, J.
The coastal deltas of the world are vital ecosystems that disproportionately support the world's population and biological productivity. Recent studies indicate vegetation may have significant influence on the development and structure of the deltaic islands composing these deltas. However, there is little convincing data drawn from natural systems. Here we present a 2D numerical modeling study of the interaction of surface water flow and vegetation on Wax lake Delta, LA, USA. We use a seamless digital elevation model (DEM) of the Wax Lake Delta (WLD) as the initial topographic condition. The deltaic island elevation data for the DEM is derived from LiDAR data, while the channel and delta front bathymetry is derived from single and multi-beam data. The upstream boundary conditions are set by discharge data from the USGS gauge located in the Wax Lake Outlet at Calumet, LA and the downstream water level boundary condition comes from tidal data from the NOAA gauge located in the Atchafalaya Delta at Amerada Pass, LA. The deltaic islands in our seamless DEM are populated by two general vegetation communities of different canopy density and height: a subaerial-intermediate community and a subaqueous community. In our study we explore how variations in discharge coming into the delta and extent of the general vegetation communities at different times of the year influence the transport pathways and residence time of surface water on the levees and within the interdistributary wetlands of the deltaic islands. A better understanding of vegetation's influence on these elements of deltaic island development and organization could prove valuable for informing design of wetland restoration projects.
Moraru, Andreea; Panfil, Madălina; Totolici, Geanina; Brănişteanu, Daniel; Costin, Dănut; Schmitzer, Speranţa
Ocular Toxocariasis is a parasitosis caused by Toxocara catis/canis larvae localized in the eye. The most frequent clinical manifestations are the central retinal granuloma, peripheral retinal granuloma and chronic endophthalmitis. Secondary complications due to the presence of parasite in the posterior segment of the eye may have significant consequences on visual function. We present the case of a 23 years old patient, admitted for progressive decrease of the right eye BCVA during the last 6 months. After performing clinical examination and serological tests we established the diagnosis of ocular Toxocariasis. The patient presented a particular form of the disease consisting in the presence of both a central retinal granuloma and a peripheral one. We performed 23G pars plana vitrectomy and membrane peeling. VA improved as soon as the first month after surgery.
Full Text Available We report the case of a 52-year-old woman with advanced colorectal cancer who was treated with oxaliplatin on a FOLFOX schedule. After 3 cycles of chemotherapy, she started to complain of visual loss, altered color vision and neurological symptoms. Due to the suspicion of ocular and neurological toxicity, antineoplastic treatment was stopped. Her visual field showed a concentric bilateral scotoma and the electrooculogram test revealed severe impairment of the retinal pigment epithelium. Visual acuity, color vision and visual field recovered completely 8 months later, although electrooculogram remained abnormal. Ocular toxicity has been reported as an infrequent adverse event of oxaliplatin. Findings in this case indicate toxicity of this chemotherapeutic agent on the retinal pigment epithelium, which has not been reported before. This damage could be permanent, and it thus differs from previously described oxaliplatin-induced ocular toxicities, which are usually transient and reversible. With increasing use of oxaliplatin as first-line treatment in advanced colorectal cancer, we have to be aware of this possible toxicity.
Santoro, Colleen M.; Duchsherer, Nicole L.; Grainger, David W.
Silver in various forms has long been recognized for antimicrobial properties, both in biomedical devices and in eyes. However, soluble drugs used on the ocular surface are rapidly cleared through tear ducts and eventually ingested, resulting in decreased efficacy of the drug on its target tissue and potential concern for systemic side effects. Silver nanoparticles were studied as a source of anti-microbial silver for possible controlled-release contact lens controlled delivery formulations. ...
Full Text Available Ocular myasthenia gravis is an autoimmune disorder of the neuromuscular junction. Diplopia and ptosis are common symptoms at the onset of ocular myasthenia gravis. It may occur due to the antibodies developed against various drugs. We are reporting a case of ocular myasthenia gravis which was developed in a patient post angiography which may be due to antibody developed against the dye used in angiography.
Samir S. Shoughy
Full Text Available Systemic lupus erythematosus (SLE is a chronic multisystem autoimmune disease. Ocular complications occur in up to one-third of patients with SLE. The ocular findings may represent the initial manifestation of the disease and may lead to severe ocular morbidity and loss of vision. Early diagnosis and prompt management of patients with SLE are mandatory and require collaboration between the ophthalmologist and the rheumatologist.
Shoughy, Samir S; Tabbara, Khalid F
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease. Ocular complications occur in up to one-third of patients with SLE. The ocular findings may represent the initial manifestation of the disease and may lead to severe ocular morbidity and loss of vision. Early diagnosis and prompt management of patients with SLE are mandatory and require collaboration between the ophthalmologist and the rheumatologist.
Abstract. Background: There is a phobia among doctors for the residency training program, since the establishment of ... Materials and Methods: Structured questionnaires were administered to residents at 3 training institutions in Nigeria. Results: ... Keywords: Decentralization, motivation, perception, remuneration, residents.
Nerrant, Elodie; Tilikete, Caroline
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system leading to disability, especially in young patients. Acute or chronic lesions of MS within the brainstem and the cerebellum frequently result in ocular motor disorders. This review encompasses the spectrum of ocular motor disorders in patients with MS emphasizing prevalence, examination findings, diagnostic features, functional consequences, classification of MS course, and management of these disturbances of ocular motility. Ocular motor manifestations of MS can occur acutely in relapse or chronically, the latter as a consequence of previous relapses or as a chronic course of the disease. The most frequent and specific acute ocular motor manifestation is uni- or bilateral internuclear ophthalmoplegia (INO). The most frequent chronic manifestations include INO and cerebellar ocular motor disorders such as gaze-evoked nystagmus, saccadic hypermetria, and lack of vestibulo-ocular reflex inhibition. The most disabling syndrome is pendular nystagmus. The high prevalence of ocular motor manifestations emphasizes the importance of neuro-ophthalmological examination among patients with MS. Because chronic manifestations may cause minimal or no symptoms, a systematic investigation of the most common manifestations should be performed in daily practice. Appropriate treatment may improve visual outcome in some of these ocular motor disorders.
Rasmussen, Peter Kristian; Ralfkiaer, E.; Prause, J.U.
Purpose To characterize the clinicopathological features of follicular lymphoma of the ocular adnexal region. Methods Retrospective nation-based study of Danish patients with ocular adnexal follicular lymphoma from January 1st 1980 through December 31st 2009. Results Twenty-four patients with ocu......Purpose To characterize the clinicopathological features of follicular lymphoma of the ocular adnexal region. Methods Retrospective nation-based study of Danish patients with ocular adnexal follicular lymphoma from January 1st 1980 through December 31st 2009. Results Twenty-four patients...
Akman, Orkun; Kösemehmetoğlu, Kemal
The impact of visual disorders and color vision deficiency on the occupational life has been previously investigated by several studies. In this study, we aimed to evaluate the prevalence of visual disorders among Turkish pathologists and their perceptions on visual disorders. A survey composed of 14 questions about ocular diseases and perceptions to these diseases has been introduced to the volunteering pathologists or pathology residents, participating in the 23rd Congress of Pathology. Ninety-three pathologists or pathology residents participated in the survey. Of the participants, 25 (26.9%) were residents, 30 (32.3%) were pathology specialists, and 36 (38.7%) were academicians. The mean duration for working as a pathologist was 15 years. The vast majority (%93.5) of the participants had at least one type of refractive error; the two most common disorders were myopia (77.0%) and astigmatism (64.4%). Sixty-four of the participants (68.8%) claimed an increase in their refractive error after working in the pathology department. Eyeglasses (56/87, 64.4%), contact lenses (14/87, 16.1%), or both (9/87, 10.3%) were used in order to correct the refractive error; however, only 31 of the participants (33.3%) preferred using eyeglasses during microscopy. While 65 participants (69.9%) never had conjunctivitis, 26 participants (28.0%) had at least one conjunctivitis attack. None of the participants claimed to be color blind. Conjunctivitis and refractive errors are quite prevalent among pathologists. Refractive errors were also found to increase during the pathology practice. Most of the pathologists do not consider visual disorders (mostly refractive errors) as a negative factor during their career decision making, except a color vision defect.
Jeon, Hyun Sun; Youn, Sang Woong; Jeon, Hee Eun; Kim, Joo Hyun; Hyon, Joon Young
To investigate transepidermal water loss (TEWL) from the ocular area in dry eye disease (DED) and evaluate the correlation between ocular TEWL and other DED parameters. Transepidermal water loss from the ocular area in 56 eyes with DED and 38 healthy eyes was measured using a Tewameter TM300 that was equipped with custom made goggles (measuring temperature 24°C-26°C and relative humidity 35%-45%). The DED group was classified into two subgroups, aqueous deficient dry eye (ADDE) and evaporative dry eye (EDE). Correlations between ocular TEWL and other DED parameters, such as tear osmolarity, tear break-up time (TBUT), corneal staining, conjunctival staining, Schirmer I test, Ocular Surface Disease Index (OSDI), and Visual Analogue Scale score were evaluated. Ocular TEWL was significantly higher in the DED group (63.0 ± 12.2 g/h/m2) than in the control group (54.7 ± 14.2 g/h/m2; P = 0.003). Although there was no significant difference, TEWL was higher in the ADDE subgroup (64.0 ± 10.7 g/h/m2) compared with the EDE subgroup (61.1 ± 14.9 g/h/m2). Tear break-up time, corneal staining score, and OSDI were significantly correlated with ocular TEWL (P < 0.05) in all participants. Ocular TEWL loss was negatively correlated with Schirmer I test value in the DED group. Ocular TEWL was significantly higher in DED patients compared with controls, reflecting higher tear evaporation in DED patients. Patients who have shorter Schirmer I test values tend to have higher TEWL values. Not only EDE but also ADDE patients may have increased tear evaporation.
Saboo, Ujwala S; Amparo, Francisco; Abud, Tulio B; Schaumberg, Debra A; Dana, Reza
To assess the vision-related quality of life (QOL) in a cohort of patients with ocular graft-versus-host disease (GVHD). Prospective study. Eighty-four patients diagnosed with chronic ocular GVHD. We assessed the vision-related QOL with the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). The symptoms of ocular GVHD were assessed using the Ocular Surface Disease Index (OSDI) and Symptom Assessment in Dry Eye (SANDE) questionnaires. We assessed vision-related QOL with the NEI-VFQ-25 and compared the scores obtained from patients with ocular GVHD with those from a healthy population. In the ocular GVHD population, we also evaluated the associations between the NEI-VFQ-25 and the dry eye symptoms measured by the OSDI and SANDE questionnaires, age, duration of disease, best-corrected visual acuity (BCVA), corneal fluorescein staining (CFS), tear break-up time, and Schirmer test. The mean composite NEI-VFQ-25 score in patients with ocular GVHD was 76.5±17. Compared with healthy subjects, patients with ocular GVHD reported reduced scores on all NEI-VFQ-25 subscales (each P vision (P = 0.11). The NEI-VFQ-25 composite scores significantly correlated with OSDI (R = -0.81, P vision-related QOL. This study highlights the impact of ocular GVHD on the vision-related QOL, and thus the importance of comprehensive diagnosis and treatment of this condition. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
%) patients. Conclusion: There is still a great need for the definitive diagnoses of ocular lesions, and retinal lesions in particular as well as appropriate treatment of ocular HIV/AIDS. Keywords: ocular HIV/AIDS, Guinness Ophthalmic Kaduna
Full Text Available A rare occurrence of ocular subconjunctival dirofilariasis in a 53-year-old healthy Indian male working in Dubai, UAE presenting with an acute red eye is reported. Surgical excision under topical anesthesia was carried out uneventfully in the outpatient clinic. The live worm removed from the subconjunctival space was identified as Dirofilaria repens on the basis of microscopic examination and histopathology. Surgical excision of subconjunctival dirofilariasis is safe in an outpatient setting and curative precluding the need for further systemic antihelminthics.
Voinea, L; Palamariu, M
Ocular pathology at the patients with chronic hemodialysis improves important alterations of the anterior and posterior pole less studied up to the present time. We examined a group of ninety-six follow-up patients at Nephrology Clinical of "Carol Davila" Hospital between twenty one-seventy years old. The pathological aspects were related with: the value of biochemical constants (urea, calcium, phosphate), length of hemodialysis treat and arterial pressure. The most alterations of posterior pole were at the papilla (papillar edema, papillar uncolored and vascular alterations as a result of advanced atherosclerogenic processes and optical ischemic neuropathy, characteristics of these patients.
Keel, Stuart; Xie, Jing; Foreman, Joshua; Taylor, Hugh R; Dirani, Mohamed
To determine the prevalence of vision loss due to ocular trauma in Australia. The National Eye Health Survey (NEHS) is a population-based cross-sectional study that examined 3098 non-Indigenous Australians (aged 50-98 years) and 1738 Indigenous Australians (aged 40-92 years) living in 30 randomly selected sites, stratified by remoteness. An eye was considered to have vision loss due to trauma if the best-corrected visual acuity was worse than 6/12 and the main cause was attributed to ocular trauma. This determination was made by two independent ophthalmologists and any disagreements were adjudicated by a third senior ophthalmologist. The sampling weight adjusted prevalence of vision loss due to ocular trauma in non-Indigenous Australians aged 50 years and older and Indigenous Australians aged 40 years and over was 0.24% (95%CI: 0.10, 0.52) and 0.79% (95%CI: 0.56, 1.13), respectively. Trauma was attributed as an underlying cause of bilateral vision loss in one Indigenous participant, with all other cases being monocular. Males displayed a higher prevalence of vision loss from ocular trauma than females in both the non-Indigenous (0.47% vs. 1.25%, p=0.03) and Indigenous populations (0.12% vs. 0.38%, p=0.02). After multivariate adjustments, residing in Very Remote geographical areas was associated with higher odds of vision loss from ocular trauma. We estimate that 2.4 per 1000 non-Indigenous and 7.9 per 1000 Indigenous Australian adults have monocular vision loss due to a previous severe ocular trauma. Our findings indicate that males, Indigenous Australians and those residing in Very Remote communities may benefit from targeted health promotion to improve awareness of trauma prevention strategies. Copyright © 2017 Elsevier Ltd. All rights reserved.
Kugadas, Abirami; Christiansen, Stig Hill; Sankaranarayanan, Saiprasad
–induced keratitis. We find that in health, the presence of microbiota strengthened the ocular innate immune barrier by significantly increasing the concentrations of immune effectors in the tear film, including secretory IgA and complement proteins. Consistent with this view, Swiss Webster (SW) mice...... that are typically resistant to P. aeruginosa–induced keratitis become susceptible due to the lack of microbiota. This was exemplified by increased corneal bacterial burden and elevated pathology of the germ free (GF) mice when compared to the conventionally maintained SW mice. The protective immunity was found...... for microbiota in regulating susceptibility to ocular keratitis. We predict that these results will have significant implications for contact lens wearers, where alterations in the ocular commensal communities may render the ocular surface vulnerable to infections....
Schornack, Muriel M; Baratz, Keith H
The purpose of this study is to report a case of fluid-ventilated scleral rigid gas permeable lens use in the management of ocular cicatricial pemphigoid. A 74-year-old woman was referred to our clinic in May 2007 with a 4-year history of ocular pain and declining visual acuity. She had been diagnosed with ocular cicatricial pemphigoid by her previous eye care provider. Despite aggressive systemic and topical therapy, she developed persistent corneal epithelial defects in both eyes (3 mm in diameter OD, 4 mm x 8 mm OS). Her best spectacle-corrected visual acuity was significantly reduced (20/150 OD, hand motion OS). She was fit with Jupiter scleral lenses for continuous wear to help preserve corneal integrity and visual function. Within 6 weeks of initiation of scleral lens wear, her corneal epithelial defects had healed and progression of stromal thinning was arrested. Her visual acuity with the scleral lenses was 20/50 OD and hand motion in the left eye. Her ocular surface and visual function have been maintained for 17 months after the initiation of scleral lens wear. If severe ocular cicatricial pemphigoid threatens corneal integrity despite traditional management, scleral contact lenses may play a role in the visual rehabilitation and ocular surface protection in select patients with this disease.
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ocular esthesiometer. 886.1040 Section 886.1040 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED.... An ocular esthesiometer is a device, such as a single-hair brush, intended to touch the cornea to...
This study was aimed at conducting ophthalmic sonographic examination of Nigerian indigenous dogs to provide baseline information on some major ocular parameters. Healthy eyes of eighty (80) indigenous dogs were used for the study. The dogs were adequately restrained physically and the structure of the ocular ...
Full Text Available Introduction: This article aimed to review the literatures on visual impairments and ocular changes in premature infants with low birth weight and gestational age.Methods: Five electronic databases including: PubMed, Web of Science, Science direct, Ovid, and Scopus were searched. Original articles published until 2015 describing preterm infants were reviewed. Repetitive and derivative articles were excluded.Results: Out of 100 unique, potentially relevant articles, 42 studies that addressed and met the inclusion criteria were evaluated.Conclusion: Prematurity affects ocular structures (from anterior to posterior segment and functions. Premature infants are at risk of myopization. Concerning the changes in premature infants, a significant increase is found in axial length, intraocular pressure, and central corneal thickness; moreover, high incidence of retinal changes is reported as a result of prematurity. On the other hand, visual acuity, tear, electroretinogram, and visual evoked potential responses decrease with prematurity. The most common ophthalmic disorders in preterm infants are myopia and retinopathy of prematurity, which could affect life quality due to reduced visual acuity.
Full Text Available H Mohammed J Hassan,1–3 Georgios Mariatos,1,2 Theocharis Papanikolaou,4 Akshatha Ranganath,1,2 Hala Hassan51Barnsley Hospital NHS Foundation Trust, Barnsley, UK; 2The Rotherham NHS Foundation Trust, Rotherham, UK; 3University of Sheffield, Sheffield, UK; 4North Middlesex University Hospital, London, UK; 5Corneal and External Disease Service, Moorefield's Eye Hospital NHS Foundation Trust, London, UKAim: In this paper, we will try to highlight the importance of various investigations and their crucial role in identifying whether the defect is structural or functional.Case history: A 24-year-old woman presented with ocular complications after bungee jumping. Subsequently, although all ophthalmic signs resolved, she complained of decreased vision in her left eye.Conclusion: Initial ophthalmic injury was detected by optical coherence tomography scan showing a neurosensory detachment of the fovea. This was not initially detected on slit-lamp examination or fluorescein angiography. On later examination, although the optical coherence tomography scan showed no structural damage, electrodiagnostic tests showed a functional defect at the fovea.Keywords: bungee jumping, optical coherence tomography, OCT, pattern electroretinogram, PERG, ocular complications
Ferreira, Teresa [Department of Radiology, Leiden University Medical Center (Netherlands)], E-mail: T.A.Ferreira@lumc.nl; Verbist, Berit [Department of Radiology, Leiden University Medical Center (Netherlands)], E-mail: B.M.Verbist@lumc.nl; Buchem, Mark van [Department of Radiology, Leiden University Medical Center (Netherlands)], E-mail: M.A.van_Buchem@lumc.nl; Osch, Thijs van [C.J. Gorter for High-Field MRI, Department of Radiology, Leiden University Medical Center (Netherlands)], E-mail: M.J.P.van_Osch@lumc.nl; Webb, Andrew [C.J. Gorter for High-Field MRI, Department of Radiology, Leiden University Medical Center (Netherlands)], E-mail: A.Webb@lumc.nl
The ocular motor nerves (OMNs) comprise the oculomotor, trochlear and the abducens nerves. According to their course, they are divided into four or five anatomic segments: intra-axial, cisternal, cavernous and intra-orbital and, for the abducens nerve, an additional interdural segment. Magnetic resonance imaging is the imaging method of choice in the evaluation of the normal and pathologic ocular motor nerves. CT still plays a limited but important role in the evaluation of the intraosseous portions at the skull base and bony foramina. We describe for each segment of these cranial nerves, the normal anatomy, the most appropriate image sequences and planes, their imaging appearance and pathologic conditions. Magnetic resonance imaging with high magnetic fields is a developing and promising technique. We describe our initial experience with a Phillips 7.0 T MRI scanner in the evaluation of the brainstem segments of the OMNs. As imaging becomes more refined, an understanding of the detailed anatomy is increasingly necessary, as the demand on radiology to diagnose smaller lesions also increases.
Full Text Available Ammapati Paul Pandian Vignesh, Renuka Srinivasan Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India Purpose: To study the ocular manifestations of rheumatoid arthritis and to correlate the role of anti-cyclic citrullinated peptide antibody (anti-CCP antibody with the ocular manifestations.Methods: Three-hundred and ninety-two eyes of the 196 rheumatoid arthritis patients who attended the ophthalmology outpatient department underwent a detailed ocular examination using slit lamp biomicroscopy and ophthalmoscopy. The tear function of all the patients was assessed using Schirmer’s test, tear film break-up time and ocular surface staining. The anti-CCP antibody titers for all the rheumatoid arthritis patients were estimated using enzyme-linked immunosorbent assay tests.Results: Seventy-seven patients (135 eyes, 39% out of the 196 patients studied had ocular manifestations typical of rheumatoid arthritis. Dry eye was the most common manifestation (28%, 54 patients. Of the patients, 78% was females (60 patients. The mean duration of rheumatoid arthritis in patients with ocular manifestations was 5.4±2.7 years and without ocular manifestations was 2.1±1.6years. Three percent of the patients had episcleritis (six patients. Scleritis was present in 2% of the patients (four patients. Peripheral ulcerative keratitis and sclerosing keratitis was present in 1% of the population each (two patients each. Eighty-five percent (66 patients had bilateral manifestations 15% (eleven patients had unilateral manifestations. There was a strong association between the presence of anti-CCP antibodies and ocular manifestations of rheumatoid arthritis which was shown by the statistically significant P-value of <0.0001.Conclusion: Ocular manifestations are a significant part of the extra-articular manifestation of rheumatoid arthritis. Dry eye was the most common ocular manifestation. There was a
Sharma, Anil Kumar; Arya, Amit; Sahoo, Pravat Kumar; Majumdar, Dipak Kanti
Inflammation of the eye is a usual clinical condition that can implicate any part of the eye. The nomenclature of variety of such inflammations is based on the ocular part involved. These diseases may jeopardize normal functioning of the eye on progression. In general, corticosteroids, antihistamines, mast cell stabilizers and non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat inflammatory diseases/disorders of the eye. There have been several attempts via different approaches of drug delivery to overcome the low ocular bioavailability resulting from shorter ocular residence time. The features like safety, ease of elimination and ability to sustain drug release have led to application of biopolymers in ocular therapeutics. Numerous polymers of natural origin such as gelatin, collagen, chitosan, albumin, hyaluronic acid, alginates etc. have been successfully employed for preparation of different ocular dosage forms. Chitosan is the most explored biopolymer amongst natural biopolymers because of its inherent characteristics. The emergence of synthetic biopolymers (like PVP, PACA, PCL, POE, polyanhydrides, PLA, PGA and PLGA) has also added new dimensions to the drug delivery strategies meant for treatment of ophthalmic inflammations. The current review is an endeavor to describe the utility of a variety of biomaterials/polymers based drug delivery systems as carrier for anti-inflammatory drugs in ophthalmic therapeutics. Copyright © 2016 Elsevier B.V. All rights reserved.
Full Text Available Background: Prevalence estimates of ocular diseases in a given district are important to plan the programs of eye care services. This study aimed to describe the burden of ocular diseases as an initial step in improving eye care services in underdeveloped areas in Indonesia.Methods: A cross-sectional study was performed among residents of Perobatang Village in Southwest Sumba district in July 2016. Eye examinations were conducted by ophthalmologists, and visual acuity was measured by optometrists. Participants were provided with appropriate treatment according to diagnosis. Surgical services were offered two months after the examination.Results: After eximining a total of 667 of 1,459 (46% residents, the result showed that the most frequent ocular problems were presbyopia (30.8%, cataract (12.8%, refractive error (11.3%, and pterygium (10.7%. The proportion of myopia was 5.9%, hyperopia was 5.0%, and astigmatism was 2.2%. Moreover, the proportion of blindness was 10%. Cataract caused blindness in 44 participants. Other causes of blindness included age-related macular degeneration, retinopathy, optic atrophy, glaucoma, retinal detachment and trauma.Conclusion: The burden of ocular problems in Perobatang Village, Southwest Sumba, Eastern Indonesia was high. These findings showed the importance of public health action from local government and non-governmental organizations to improve eye care services in Southwest Sumba district.
Nieto, Alejandra; Hou, Huiyuan; Sailor, Michael J.; Freeman, William R.; Cheng, Lingyun
Porous silicon (pSi) microparticles have been investigated for intravitreal drug delivery and demonstrated good biocompatibility. With the appropriate surface chemistry, pSi can reside in vitreous for months or longer. However, ocular distribution and clearance pathway of its degradation product, silicic acid, are not well understood. In the current study, rabbit ocular tissue was collected at different time point following fresh pSi (day 1, 5, 9, 16, and 21) or oxidized pSi (day 3, 7, 14, 21, and 35) intravitreal injection. In addition, dual-probe simultaneous microdialysis of aqueous and vitreous humor was performed following a bolus intravitreal injection of 0.25 mL silicic acid (150 μg/mL) and six consecutive microdialysates were collected every 20 min. Silicon was quantified from the samples using inductively coupled plasma-optical emission spectroscopy. The study showed that following the intravitreal injection of oxidized pSi, free silicon was consistently higher in the aqueous than in the retina (8.1 ± 6.5 vs. 3.4 ± 3.9 μg/mL, p = 0.0031). The area under the concentration-time curve (AUC) of the retina was only about 24% that of the aqueous. The mean residence time was 16 days for aqueous, 13 days for vitreous, 6 days for retina, and 18 days for plasma. Similarly, following intravitreal fresh pSi, free silicon was also found higher in aqueous than in retina (7 ± 4.7 vs. 3.4 ± 4.1 μg/mL, p = 0.014). The AUC for the retina was about 50% of the AUC for the aqueous. The microdialysis revealed the terminal half-life of free silicon in the aqueous was 30 min and 92 min in the vitreous; the AUC for aqueous accounted for 38% of the AUC for vitreous. Our studies indicate that aqueous humor is a significant pathway for silicon egress from the eye following intravitreal injection of pSi crystals. PMID:24036388
Ahmad M. Mansour
Full Text Available Purpose. To discuss an unusual presentation of ocular toxocariasis. Methods. Case report. Results. A 40-year-old woman presented with decreased vision in the left eye with a long history of recurrent red eye from uveitis. Eosinophilia and positive ELISA titers for Toxocara canis favored the diagnosis of ocular toxocariasis. Over 3 months, an anterior scleral mass had a rapid growth raising the possibility of medulloepithelioma, which rarely can mimic uveitic syndromes. Surgical plan changed from local excision to enucleation. Histopathology demonstrated a large homogeneous mass of chronic inflammatory cells with inflammation of the overlying thinned out sclera, medial rectus insertion, and limbal cornea. The triad of peripheral granuloma, eosinophilia, and positive blood serology established the diagnosis of ocular toxocariasis. Conclusions. Ocular toxocariasis can mimic ocular malignancy such as medulloepithelioma in adults and rarely presents as an anterior scleral mass.
Full Text Available OBJETIVO: Comparar as correlações dos componentes oculares (comprimento axial, comprimento do segmento anterior, poder médio da córnea, profundidade da câmara vítrea e poder refrativo equivalente com o erro refrativo total do olho portador da menor e da maior ametropia em anisométropes. MÉTODOS: Foi realizado um "survey" analítico conduzido em população de 68 anisométropes de duas ou mais dioptrias atendida no Ambulatório da Clinica Oftalmológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo Os anisométropes foram submetidos à refração estática objetiva e subjetiva, ceratometria e biometria ultra-sônica. RESULTADOS: Não houve diferença significativa entre os valores dos componentes oculares medidos dos olhos portadores da menor e da maior ametropia. Os olhos portadores da menor ametropia apresentaram as mesmas correlações significantes observadas em olhos emétropes, ou seja, correlação da refração com comprimento do segmento anterior e comprimento axial, e correlação do comprimento axial com poder corneano e profundidade da câmara vítrea. Os olhos portadores da maior ametropia apresentaram correlação significante da refração com o comprimento axial e do comprimento axial com a profundidade da câmara vítrea. Ainda em ambos os olhos observou-se correlação significante do poder do cristalino com a profundidade da câmara anterior. CONCLUSÃO: Os olhos portadores da menor ametropia desenvolveram as correlações mais freqüentemente observadas nos olhos emétropes. Os olhos portadores da maior ametropia não desenvolveram as mesmas correlações dos emétropes.PURPOSE: To asses the correlation between ocular components (axial length, anterior segment length, corneal power, vitreous length and equivalent power of the eye and refractive error in eyes with higher and lower ametropia of subjects with anisometropia. METHODS: An analytical survey was carried out in 68 patients
Full Text Available OBJETIVO: determinar a prevalência de sinais e sintomas de doença da superfície ocular (OSD em pacientes em uso crônico de hipotensores oculares tópicos. MÉTODOS: Neste estudo transversal, foram recrutados 40 pacientes consecutivos, provenientes do ambulatório de glaucoma de um hospital público localizado no Rio de Janeiro, Brasil. Os mesmos deveriam apresentar: idade maior ou igual a 18 anos, diagnóstico de hipertensão ocular ou glaucoma primário de ângulo aberto e deveriam estar em uso da mesma terapia hipotensora ocular há pelo menos seis meses. Foram considerados: sexo, idade, medicação utilizada e duração do tratamento. Todos os pacientes foram submetidos à avaliação da superfície ocular que incluiu: entrevista por meio do questionário Ocular Surface Disease Index® (OSDI®, tempo de rotura do filme lacrimal, biomicroscopia, avaliação da superfície ocular com fluoresceína e com rosa Bengala. RESULTADOS: A média de pontuação do OSDI® foi 24,6 ± 20,7. A maioria dos pacientes (67,5% apresentou uma pontuação anormal no questionário do OSDI®. Em 25% dos pacientes, a pontuação foi compatível com sintomas leves, em 12,5% com sintomas moderados e em 30% com sintomas graves. Blefarite e ceratite ponteada foram diagnosticadas em 42,5% e 20% dos pacientes respectivamente. Instabilidade do filme lacrimal foi observada em 75% dos pacientes, enquanto que alteração da superfície ocular foi evidenciada pelo teste de rosa bengala em 35% dos pacientes. Foi encontrada correlação positiva (r=0,4 estatisticamente significativa (p=0,01 entre a pontuação do OSDI® e o tempo de duração do tratamento com hipotensores oculares tópicos. CONCLUSÃO: Pacientes em uso crônico de hipotensores oculares tópicos apresentam alta prevalência de sinais e sintomas de OSD. Existe correlação significativa entre a duração do tratamento e a gravidade dos sintomas de OSD.
Full Text Available Purpose: To investigate the effects of religious fasting during the month of Ramadan on intraocular pressure (IOP, refractive error, corneal tomography and biomechanics, ocular biometry, and tear film layer properties. Methods: This prospective study was carried out one week before and in the last week of Ramadan. Ninety-four eyes of 94 healthy adult volunteers (54 males and 40 females with a mean ± SD age of 35.12 ± 9.07 were enrolled in this study. Patients with any systemic disorder, ocular disease, or a history of previous surgery were excluded. Corneal tomography and biomechanics, ocular biometry, IOP, refractive error, and tear break up time (TBUT were evaluated in non-fasting and fasting periods by the Pentacam (Oculus, Corvis ST (Oculus, IOL Master (Carl Zeiss, computerized tonometer (Topcon CT-1/CT-1P, auto kerato-refractometer (Topcon KR-1, and Keratograph 5M (Oculus, respectively. Results: There was no significant difference in the central corneal thickness (CCT between the study groups (P = 0.123 using the Pentacam while the Corvis ST showed a significant difference in all participants (P < 0.0001. Moreover, the peak distance (distance of the two surrounding peaks of the cornea at the highest concavity of male and female participants showed a significant difference between the fasting and non-fasting groups (P = 0.002. The anterior chamber depth (ACD using the Pentacam decreased in the male group (P = 0.004 in the fasting period. During the fasting period, computerized tonometer showed a decrease in IOP only in males in comparison to the non-fasting group (P = 0.018 while the Corvis ST showed decreased IOP in all participants (P < 0.0001. The steep keratometry (K2 in the corneal posterior surface appeared to be different in males between the study groups (P = 0.034. We were unable to show any significant difference in other ocular parameters between fasting and non-fasting periods. Conclusion: This study showed
Prabhakar S Krishnachary
Full Text Available Thelaziasis is an Arthropod-born disease of the eye and adnexa caused by Thelazia callipaeda, a nematode parasite transmitted by drosophilid flies to carnivores and humans. Because of its distribution mainly confined to South Asian countries and Russia, it is commonly known as Oriental Eye worm. It is often under-reported and not been given its due clinical importance. We report first case of human Thelaziasis from Hassan District, Karnataka. Five creamy-white, translucent worms were removed from the conjunctival sac of a 74-year-old male patient. Based on morphological characters, the worms were identified as nematodes belonging to the genus Thelazia and speciation was confirmed by CDC, Atlanta as callipaeda. Rarity of the disease and its ability to cause both extra and intraocular manifestations leading to ocular morbidity is the reason for presenting this case. From the available data, this is the first case report from Karnataka, India.
Terelak-Borys, Barbara; Skonieczna, Katarzyna; Grabska-Liberek, Iwona
Ocular ischemic syndrome is a rare condition, which is caused by ocular hypoperfusion due to stenosis or occlusion of the common or internal carotid arteries. Atherosclerosis is the major cause of changes in the carotid arteries. Ocular ischemic syndrome is manifested as visual loss, orbital pain and, frequently, changes of the visual field, and various anterior and posterior segment signs. Anterior segment signs include iris neovascularization and secondary neovascular glaucoma, iridocyclitis, asymmetric cataract, iris atrophy and sluggish reaction to light. Posterior eye segment changes are the most characteristic, such as narrowed retinal arteries, perifoveal telangiectasias, dilated retinal veins, mid-peripheral retinal hemorrhages, microaneurysms, neovascularization at the optic disk and in the retina, a cherry-red spot, cotton-wool spots, vitreous hemorrhage and normal-tension glaucoma. Differential diagnosis of ocular ischemic syndrome includes diabetic retinopathy and moderate central retinal vein occlusion. Carotid artery imaging and fundus fluorescein angiography help to establish the diagnosis of ocular ischemic syndrome. The treatment can be local, for example, ocular (conservative, laser and surgical) or systemic (conservative and surgical treatment of the carotid artery). Since the condition does not affect the eyes alone, patients with ocular ischemic syndrome should be referred for consultation to the neurologist, vascular surgeon and cardiologist.
Chang, Nam Sik; Kim, Jin Hwan; Kim, Jong Chul; Park, Cheong Hee; Cho, Jun Sik; Rhee, Byung Chull; Kim, Yong Baek
Ultrasound B-scan examination of traumatized eve is safe, cheap and easy diagnostic method for visualization of the posterior pole of the eye. Ophthalmoscopic visualization of the fundus of traumatized eye can be obscured by corneal opacity, anterior chamber hyphema, cataractous change of the lens, or hemorrhage of the citreous. Ultrasound B-scan examination of the posterior pole is imperative in such cases to detect any intraocular damage and the presence of a foreign body. So we performed ultrasound B-scan examination of traumatized eye seventy eight patients and analyzed those findings. All cases were confirmed by follow up examination of ophthalmoscopy and ultrasound, or surgery. The results were as follows; 1. The most common cause of the ocular injury was traffic accidents (19 patients, 24.4%),male was more commonly injured (63 patients, 80.8). and the most common age group was their 4th decade. 2. Summary of sonographically detected intraocular lesions were as follows; 1) Corneal opacity (44 patients)-hyphema 15, traumatic cataract 24, vitreous hemorrhage 31, retinal detachment 20, intraocular foreign body 4, etc. 2) Hyphemal (16 patients)-hyphema 16, vitreous hemorrhage 11, tretinal detachment 5, etc. 3) Traumatic cataract with no corneal or lens opacity (6 patients)-vitreous hemorrhage with or without retinal detachment 3, normal vitreous and retina 3. 4) Vitreous opacity(12 patients)-vitreous hemorrhage 12, retinal detachment 4, intraocular foreign body 3, etc. In all seventy eight patients with ocular trauma , we could demonstrate characteristic findings for each intraocular lesion. So we recognized the important role and high diagnostic accuracy of ultrasound B-scan examination for the evaluation of the posterior pole of traumatized eye
Chang, Nam Sik; Kim, Jin Hwan; Kim, Jong Chul; Park, Cheong Hee; Cho, Jun Sik; Rhee, Byung Chull; Kim, Yong Baek [Chungnam National University Hospital, Deajeon (Korea, Republic of)
Ultrasound B-scan examination of traumatized eve is safe, cheap and easy diagnostic method for visualization of the posterior pole of the eye. Ophthalmoscopic visualization of the fundus of traumatized eye can be obscured by corneal opacity, anterior chamber hyphema, cataractous change of the lens, or hemorrhage of the citreous. Ultrasound B-scan examination of the posterior pole is imperative in such cases to detect any intraocular damage and the presence of a foreign body. So we performed ultrasound B-scan examination of traumatized eye seventy eight patients and analyzed those findings. All cases were confirmed by follow up examination of ophthalmoscopy and ultrasound, or surgery. The results were as follows; 1. The most common cause of the ocular injury was traffic accidents (19 patients, 24.4%),male was more commonly injured (63 patients, 80.8). and the most common age group was their 4th decade. 2. Summary of sonographically detected intraocular lesions were as follows; 1) Corneal opacity (44 patients)-hyphema 15, traumatic cataract 24, vitreous hemorrhage 31, retinal detachment 20, intraocular foreign body 4, etc. 2) Hyphemal (16 patients)-hyphema 16, vitreous hemorrhage 11, tretinal detachment 5, etc. 3) Traumatic cataract with no corneal or lens opacity (6 patients)-vitreous hemorrhage with or without retinal detachment 3, normal vitreous and retina 3. 4) Vitreous opacity(12 patients)-vitreous hemorrhage 12, retinal detachment 4, intraocular foreign body 3, etc. In all seventy eight patients with ocular trauma , we could demonstrate characteristic findings for each intraocular lesion. So we recognized the important role and high diagnostic accuracy of ultrasound B-scan examination for the evaluation of the posterior pole of traumatized eye.
Barsotti, Giovanni; Sgorbini, Micaela; Marmorini, Paola; Corazza, Michele
To determine the prevalence and describe ocular abnormalities in healthy Standardbred foals within 48 h of birth. One hundred and two neonatal foals. All foals had an unassisted delivery. On the basis of physical examination and the results of hematological and biochemical parameters, all foals were unaffected by systemic diseases. A complete ophthalmic examination was performed within 48 h of birth. Foals with ocular hemorrhages were re-examined weekly until the abnormalities were resolved. 65/102 (63.7%) foals did not show ocular abnormalities, while in 37/102 (36.3%) cases, ocular abnormalities were present. Retinal and subconjunctival hemorrhages were recorded in 19/102 (18.6%), and in 13/102 (12.7%), respectively. In 4/102 (3.9%) animals, an entropion of the lower eyelid was present. Only one foal (1%) showed a congenital nuclear unilateral cataract. No other ocular abnormalities were detected. However, all foals showed various degrees of remnants of hyaloid system. One week after the first ocular examination, retinal hemorrhages had resolved in 100% of the eyes, whereas subconjunctival hemorrhages had disappeared in all eyes by the second week following the first examination. The acquired ocular lesions observed with relatively high frequency in the examined healthy Standardbred foals were ocular hemorrhages, which always showed a good outcome. Although these abnormalities were present at birth, they were not considered strictly congenital but likely acquired during parturition. Instead, congenital ocular abnormalities were rarely diagnosed, and the entropion of the lower eyelid was the most common disease in the breed. © 2012 American College of Veterinary Ophthalmologists.
Peragallo, Jason; Biousse, Valérie; Newman, Nancy J
The purpose of this study is to review commonly encountered adverse ocular effects of illicit drug use. Drug and alcohol abuse can produce a variety of ocular and neuro-ophthalmic side effects. Novel, so-called 'designer', drugs of abuse can lead to unusual ocular disorders. Legal substances, when used in manners for which they have not been prescribed, can also have devastating ophthalmic consequences. In this review, we will systematically evaluate each part of the visual pathways and discuss how individual drugs may affect them.
Full Text Available La toxocariosis es una geohelmintiosis producida por la ingestión de
huevos de Toxocara canis y T. catis, cuyos hospederos definitivos son el perro y el gato. En el humano las larvas producen el Síndrome de Migración Larvaria Visceral y Ocular; en este último produce una enfermedad grave que puede semejar un retinoblastoma (1,2. Los niños son más susceptibles a adquirir esta infección (3. Nuestro objetivo es determinar la frecuencia de toxocariosis ocular en menores de edad con sintomatología ocular.
Tan, Li Li; Sanjay, Srinivasan; Morgan, Philip B
To evaluate the efficacy of infrared (IR) ocular thermography in screening for dry eye disease (DED). IR ocular thermography was performed on 62 dry eye and 63 age- and sex-matched control subjects. Marking of ocular surface and temperature acquisition was done using a novel 'diamond' demarcation method. 30 static- and 30 dynamic-metrics were studied and receiver operating characteristic curves were plotted. Efficacy of the temperature metrics in detecting DED were evaluated singly and in combination in terms of their area under the curve (AUC), Youden's index and discrimination power (DP). Absolute temperature of the extreme nasal conjunctiva 5s and 10s after eye opening were best detectors for DED. With threshold value for the first metric set at 34.7°C, sensitivity and specificity was 87.1% (95% CI: 76.2-94.3%) and 50.8% (95% CI: 37.9-63.6%) respectively. With threshold value for the second metric set at 34.5°C, sensitivity and specificity was 77.6% (95% CI: 64.7-87.5%) and 61.9% (95% CI: 48.8-73.9%) respectively. The two metrics had moderate accuracy and limited performances with AUC of 72% (95% CI: 63-81%) and 73% (95% CI: 64-82%); Youden index of about 0.4 and DP of 1.07 and 1.05 respectively. None of the dynamic metrics was good detector for DED. Combining metrics was not able to increase the AUC. This work suggests some utility for the application of IR ocular thermography for evaluation of dry eye patients. Copyright © 2016 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
Threatt, Jennifer; Williamson, Jennifer F; Huynh, Kyle; Davis, Richard M
An estimated 25.8 million children and adults in the United States, approximately 8.3% of the population, have diabetes. Diabetes prevalence varies by race and ethnicity. African Americans have the highest prevalence (12.6%), followed closely by Hispanics (11.8%), Asian Americans (8.4%) and whites (7.1%). The purpose of this article was to discuss the ocular complications of diabetes, the cultural and racial differences in diabetes knowledge and the role of telemedicine as a means to reach the undeserved who are at risk of complications. Information on the pathophysiology of ocular disease in patients with diabetes and the role of telemedicine in diabetes care was derived from a literature review. National Institutes of Health online resources were queried to present data on the racial and cultural understandings of diabetes and diabetes-related complications. The microvascular ocular complications of diabetes are discussed for retinopathy, cataracts, glaucoma and ocular surface disease. Racial and cultural differences in knowledge of recommended self-care practices are presented. These differences, in part, may explain health disparities and the increased risk of diabetes and its complications in rural minority communities. Finally, advances in telemedicine technology are discussed that show improvements in metabolic control and cardiovascular risk in adults with type 2 diabetes. Improving provider and patient understanding of diabetes complications may improve management and self-care practices that are important for diabetes control. Telemedicine may improve access to diabetes specialists and may improve self-management education and diabetes control particularly in rural and underserved communities.
Perez, Victor L; Barsam, Alexander; Duffort, Stephanie; Urbieta, Maitee; Barreras, Henry; Lightbourn, Casey; Komanduri, Krishna V; Levy, Robert B
Ocular complications occur after transplantation in 60% to 90% of chronic graft-versus-host disease (GVHD) patients and significantly impair vision-related quality of life. Ocular surface inflammation and dry eye disease are the most common manifestations of ocular GVHD. Ocular GVHD can be viewed as an excellent preclinical model that can be studied to understand the immune pathogenesis of this common and debilitating disease. A limitation of this is that only a few experimental models mimic the ocular complications after hematopoietic stem cell transplantation (HSCT) and have focused on the acute GVHD process. To address this issue, we used a preclinical animal model developed by our group where ocular involvement was preceded by systemic GVHD to gain insight regarding the contributing immune mechanisms. Employing this "matched unrelated donor" model enabled the development of clinical scoring criteria, which readily identified different degrees of ocular pathology at both the ocular surface and adnexa, dependent on the level of conditioning before HSCT. As far as we are aware, we report for the first time that these clinical and immune responses occur not only on the ocular surface, but they also heavily involve the lid margin region. In total, the present study reports a preclinical scoring model that can be applied to animal models as investigators look to further explore GVHD's immunologic effects at the level of the ocular surface and eyelid adnexa compartments. We speculate that future studies will use this clinical scoring index in combination with what is recognized histologically and correlated with serum biomarkers identified in chronic/ocular GVHD. Copyright © 2016 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
Kato, T; Hamanaka, T
Ocular signs and symptoms that occurred in people exposed to sarin gas in a subway sarin gas attack were studied. Among victims of sarin gas exposure, 96 were treated by us. Ocular signs and symptoms caused by sarin gas exposure included miosis, conjunctival injection, and ocular pain. Ocular signs and symptoms spontaneously resolved between three and 21 days after exposure in most cases. Treatment with 0.5% tropicamide ophthalmic solution was effective in decreasing ocular pain.
Stormly Hansen, Michael; Klefter, Oliver Niels; Julian, Hanne Olsen
Pemphigoid and pemphigus diseases as well as Stevens-Johnson syndrome present as vesiculobullous disorders of the skin and may additionally involve both the oral cavity and the ocular surface. Ocular involvement ranges from mild irritation and dry eye disease to chronic conjunctivitis, symblepharon......, eyelid malposition, ocular surface scarring and severe visual loss. In addition to diagnostic assessments, ophthalmologists must treat the dry eye and Meibomian gland dysfunction components of these diseases using a stepladder approach, including eyelid hygiene and lubricants. Topical anti...... by a multidisciplinary team representing ophthalmology, dermatology, otolaryngology, oral medicine and pathology, internal medicine and intensive care. Systemic treatments including corticosteroids, azathioprine, cyclophosphamide, cyclosporine and mycophenolate mofetil help control inflammation. Intravenous...
Victoria J. Vieira-Potter
Full Text Available Diabetes mellitus (DM is a metabolic disease defined by elevated blood glucose (BG. DM is a global epidemic and the prevalence is anticipated to continue to increase. The ocular complications of DM negatively impact the quality of life and carry an extremely high economic burden. While systemic control of BG can slow the ocular complications they cannot stop them, especially if clinical symptoms are already present. With the advances in biodegradable polymers, implantable ocular devices can slowly release medication to stop, and in some cases reverse, diabetic complications in the eye. In this review we discuss the ocular complications associated with DM, the treatments available with a focus on localized treatments, and what promising treatments are on the horizon.
the usual intestinal manifestations, leading to an earlier diagnosis. Thus, it is important to understand the clinical presentation of possible ocular manifestations in order to initiate appropriate treatment and to help prevent significant visual morbidity.
Mady, Rana; Grover, Will; Butrus, Salim
Though inflammatory bowel disease (IBD) has a specific predilection for the intestinal tract, it is a systemic inflammatory disorder affecting multiple organs, including the eye. Ocular complications directly related to IBD are categorized as primary and secondary. Primary complications are usually temporally associated with IBD exacerbations and tend to resolve with systemic treatment of the intestinal inflammation. These include keratopathy, episcleritis, and scleritis. Secondary complications arise from primary complications. Examples include cataract formation due to treatment with corticosteroids, scleromalacia due to scleritis, and dry eye due to hypovitaminosis A following gut resection. Some ocular manifestations of IBD can lead to significant visual morbidity and temporally associated complications can also be a herald of disease control. Furthermore, ocular manifestations of IBD can occasionally manifest before the usual intestinal manifestations, leading to an earlier diagnosis. Thus, it is important to understand the clinical presentation of possible ocular manifestations in order to initiate appropriate treatment and to help prevent significant visual morbidity. PMID:25879056
Alemayehu, W; Shamebo, M; Bedri, A; Mengistu, Z
A prospective ophthalmic evaluation of 74 newly diagnosed and 34 old (on follow-up) leukaemic patients, carried out from March 1990 to December 1995 is described. Primary ocular involvement, that is leukaemic retinal infiltrates, were detected in 32% of the newly diagnosed. In contrast, none of the old leukaemic patients had this lesion. In 69% of the new and 21% of the old cases, secondary ocular manifestations of leukaemia were observed. The major secondary ocular manifestation of leukaemia in both groups was intra-retinal haemorrhage. A variety of miscellaneous ocular findings, such as cataract, pterygium, pingeculae, etc. were detected in 36% of all leukemics. These findings indicate the importance of a complete ophthalmologic evaluation in the diagnosis, follow-up and management of leukaemic patients.
Full Text Available
Se presenta el caso de un paciente con un cisticerco retiniano, tratado sin éxito con praziquantel, quien a los cinco meses del tratamiento presentó fibrosis y desprendimiento de la retina. Se realizó intervención quirúrgica y se encontró el cisticerco vivo. Desde antes de la operación el paciente había perdido la visión por el ojo afectado. Se hace una revisión sobre oftalmocisticercosis y se recomienda tratamiento quirúrgico oportuno y no usar los antihelmínticos con efecto sobre los cisticercos, como son praziquantel y albendazol.
One case of ocular cysticercosis with retinal involvement, in which praziquantel treatment was ineffective, is presented. Five months after the medical treatment the patient presented with retinal detachment and fibrosis, loss of vision through the affected eye and at that time the parasite was observed alive. Surgical intervention was performed and the recovered cysticercus showed viability. A review on ophtalmocysticercosis is presented and recommendations are made to treat these cases by early surgery without prior administration of anticysticercus drugs such as praziquantel or albendazole.
Pamulapati, Chandrasena R; Schoenwald, Ronald D
The pharmacologically active compound (33% reduction in rabbit intraocular pressure recovery rate assay) 1-ethyl-6-fluoro-1,2,3,4-tetrahydroquinoline (MC4), which showed ocular hypotensive action and had optimum physicochemical properties, was characterized for its ocular absorption and distribution properties to better understand its in vivo potency in comparison with an inactive compound, N-ethyl-1,4-benzoxazine (MC1). Tissue distribution to various ocular tissues was determined after absorption by both corneal and conjunctival-scleral routes, following administration by the "topical infusion" technique. The rank order of penetration for both the compounds was cornea > iris-ciliary body > aqueous humor > lens > conjunctiva-sclera. Overall, MC4 had significantly higher concentrations than MC1 in various ocular tissues, but particularly in the iris-ciliary body, which is the site of action (biophase). Ocular disposition studies of the active compound MC4 were then conducted to characterize its elimination kinetics, and the pharmacokinetic parameters were determined by non-compartmental and moment analysis using equations specific to "topical infusion" technique: first-order absorption rate constant, 4.1 × 10(-4) min(-1) ; elimination rate constant, 0.012 min(-1) ; mean residence time, 39.6 min; steady-state volume of distribution, 0.721 mL; and aqueous humor ocular clearance, 8.44 µL/min. The results were consistent with the conclusion that MC4 is well absorbed and distributed to the active site. Copyright © 2011 Wiley-Liss, Inc.
Sharma, Anil Kumar; Arya, Amit; Sahoo, Pravat Kumar; Majumdar, Dipak Kanti
Inflammation of the eye is a usual clinical condition that can implicate any part of the eye. The nomenclature of variety of such inflammations is based on the ocular part involved. These diseases may jeopardize normal functioning of the eye on progression. In general, corticosteroids, antihistamines, mast cell stabilizers and non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat inflammatory diseases/disorders of the eye. There have been several attempts via different approaches of drug delivery to overcome the low ocular bioavailability resulting from shorter ocular residence time. The features like safety, ease of elimination and ability to sustain drug release have led to application of biopolymers in ocular therapeutics. Numerous polymers of natural origin such as gelatin, collagen, chitosan, albumin, hyaluronic acid, alginates etc. have been successfully employed for preparation of different ocular dosage forms. Chitosan is the most explored biopolymer amongst natural biopolymers because of its inherent characteristics. The emergence of synthetic biopolymers (like PVP, PACA, PCL, POE, polyanhydrides, PLA, PGA and PLGA) has also added new dimensions to the drug delivery strategies meant for treatment of ophthalmic inflammations. The current review is an endeavor to describe the utility of a variety of biomaterials/polymers based drug delivery systems as carrier for anti-inflammatory drugs in ophthalmic therapeutics. - Highlights: • Numerous eye inflammations pose troubles in vision functions. • Low bioavailability by conventional drug delivery systems due to eye constraints • Drug carriers ensuring improved bioavailability to the eye are need of the hour. • Chitosan - most explored amongst all biomaterials for ocular delivery. • Emergence of novel synthetic carriers in ophthalmology
Sharma, Anil Kumar, E-mail: firstname.lastname@example.org [Delhi Institute of Pharmaceutical Sciences and Research, Formerly College of Pharmacy, University of Delhi, Pushp Vihar, Sector III, New Delhi 110017,India (India); Arya, Amit; Sahoo, Pravat Kumar [Delhi Institute of Pharmaceutical Sciences and Research, Formerly College of Pharmacy, University of Delhi, Pushp Vihar, Sector III, New Delhi 110017,India (India); Majumdar, Dipak Kanti [School of Pharmaceutical Sciences, Apeejay Stya University, Sohna-Palwal Road, Gurgaon 122103 (India)
Inflammation of the eye is a usual clinical condition that can implicate any part of the eye. The nomenclature of variety of such inflammations is based on the ocular part involved. These diseases may jeopardize normal functioning of the eye on progression. In general, corticosteroids, antihistamines, mast cell stabilizers and non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat inflammatory diseases/disorders of the eye. There have been several attempts via different approaches of drug delivery to overcome the low ocular bioavailability resulting from shorter ocular residence time. The features like safety, ease of elimination and ability to sustain drug release have led to application of biopolymers in ocular therapeutics. Numerous polymers of natural origin such as gelatin, collagen, chitosan, albumin, hyaluronic acid, alginates etc. have been successfully employed for preparation of different ocular dosage forms. Chitosan is the most explored biopolymer amongst natural biopolymers because of its inherent characteristics. The emergence of synthetic biopolymers (like PVP, PACA, PCL, POE, polyanhydrides, PLA, PGA and PLGA) has also added new dimensions to the drug delivery strategies meant for treatment of ophthalmic inflammations. The current review is an endeavor to describe the utility of a variety of biomaterials/polymers based drug delivery systems as carrier for anti-inflammatory drugs in ophthalmic therapeutics. - Highlights: • Numerous eye inflammations pose troubles in vision functions. • Low bioavailability by conventional drug delivery systems due to eye constraints • Drug carriers ensuring improved bioavailability to the eye are need of the hour. • Chitosan - most explored amongst all biomaterials for ocular delivery. • Emergence of novel synthetic carriers in ophthalmology.
Iyer, Geetha; Srinivasan, Bhaskar; Agarwal, Shweta; Kamala Muralidharan, Seema; Arumugam, Sumathi
Stevens Johnson Syndrome (SJS) can lead to end stage corneal blindness. This study describes the comprehensive treatment measures and their outcomes in the management of ocular sequelae and complications of SJS. Four hundred sixty-four eyes of 232 patients of SJS who underwent surgical intervention (punctal cautery, mucus membrane grafting for lid margin keratinisation, fornix reconstructive procedures, tectonic procedures, keratoplasty and keratoprosthesis) were studied. It was a non-comparative, retrospective, interventional case series. The primary outcome was the change in the best corrected visual acuity (BCVA). Secondary outcome measures included an improvement in the ocular surface status as indicated by corneal epithelial fluorescein staining and Schirmer's I strip wetting. The BCVA and the ocular surface status improved and/or stabilized in > 70 % of eyes following punctal cautery (n = 160) and > 80 % of eyes following lid margin mucus membrane grafting (n = 238). BCVA improved in 50 % of eyes following fornix reconstructive procedures (n = 24) with COMET (n = 6), in 63.9 % eyes with the Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) lens (n = 36), in 81.8 % of eyes after cataract surgery (n = 22). A BCVA of ≥20/200 was achieved in 72.34 % of eyes following keratoprostheses procedures (n = 47). The mean duration of follow up was 53.3 ± 15.2 months. The ocular sequelae of Stevens Johnson Syndrome can be blinding. They need to be identified and addressed early to retard the continued deterioration of the ocular surface. Our study aims to highlight the problem as well as the importance of comprehensive measures in the management of this potentially blinding disorder.
Koch, K R; Trester, W; Müller-Uri, N; Trester, M; Cursiefen, C; Heindl, L M
Ocular prosthetics make a decisive contribution to the functional, esthetic and psychosomatic rehabilitation of patients after ocular extirpation. This article provides an overview of the fitting, daily care and complications of ocular prosthetics. The study comprised a PubMed literature review and own clinical results. Ocular prosthetics made from cryolite glass or perspex can be manufactured and fitted 5-8 weeks after removal of the eye. During this period a conformer is placed within the conjunctival sac in order to prevent scar formation and shrinking of the socket. Artificial eyes can be worn continuously, only interrupted by a short but regular cleaning procedure. Artificial tears and lid hygiene improve the comfort of wearing. Glass prostheses have to be renewed every 1-2 years, while perspex prostheses need to be polished once a year. Complications, such as giant papillary conjunctivitis or blepharoconjunctivitis sicca are facilitated by poor fit, increased age and inappropriate care of the prosthetic device. In the case of socket shrinkage or anophthalmic socket syndrome, surgical interventions are needed to re-enable the use of an artificial eye. Adequate fitting, daily care of ocular prosthetics and therapeutic management of associated complications are mandatory for a durable functional, esthetic and psychosomatic rehabilitation after ocular extirpation.
Ying, Li; Liu, Zhen-Guo; Chen, Wei; Gan, Jing; Wang, Wen-An
To investigate the changes of predictive ocular motor function in the patients with Parkinson's disease (PD), and to discuss its clinical value. Videonystagmography (VNG) was used to examine 24 patients with idiopathic Parkinson's disease, 15 males and 9 females, aged 61 +/- 6 (50-69), and 24 sex and age-matched healthy control subjects on random ocular saccade (with the target moving at random intervals to random positions) and predictive ocular saccade (with the 1.25-second light target moving 10 degrees right or left from the center). In the random ocular saccade program, the latency of saccade of the PD patients was 284 ms +/- 58 ms, significantly longer than that of the healthy controls (236 ms +/- 37 ms, P = 0.003). In the predictive ocular saccade pattern, the latency of saccades the PD patients was 150 ms +/- 138 ms, significantly longer than that of the healthy controls (59 ms +/- 102 ms, P = 0.002). The appearance rate of predictive saccades (with the latency of saccade <80 ms) in the PD group was 21%, significantly lower than that in the control group (31%, P = 0.003). There is dysfunction of predictive ocular motor control in the PD patients, and the cognitive function may be impaired at the early stage of PD.
Scherrer, Nicole M; Lassaline, Mary; Engiles, Julie
To determine the characteristics of and prognosis for ocular and periocular hemangiosarcoma in horses. Six horses treated for ocular or periocular hemangiosarcoma. A retrospective review of medical records from 2007 to 2015 was performed to identify horses with a histologic diagnosis of ocular or periocular hemangiosarcoma. Signalment (age, sex, breed), duration of clinical signs, prior treatment, tumor size and location, medical and surgical treatment including postoperative chemotherapy, follow-up time, and outcome were obtained from medical records. Histopathology was reviewed by a board-certified pathologist. In six horses diagnosed with ocular or periocular hemangiosarcoma, no breed, age, or sex was overrepresented. Sites included the temporal limbus (3), third eyelid (2), and uvea (1). With the exception of one horse with uveal hemangiosarcoma, 5/6 horses had lightly pigmented periocular haircoat. Histologic features of ocular hemangiosarcoma in 6/6 cases included high cellularity, nuclear pleomorphism, and inflammation with a mitotic index ranging from 0 to 8 mitoses per 10 consecutive 400× fields. Five of six tumors displayed solar elastosis, indicating ultraviolet light-induced damage to sub-epithelial collagen. Treatment included surgical excision in all cases and was not associated with recurrence in 4/6. Three cases that received ancillary treatment with topical mitomycin C had no postoperative recurrence. Two cases with postexcisional recurrence had histologic evidence of incomplete excision. Complete surgical excision may be associated with resolution of periocular and ocular hemangiosarcoma in horses. Etiopathogenesis may include exposure to ultraviolet light. © 2017 American College of Veterinary Ophthalmologists.
Kim, Young Shin; Sun, Hae Jung; Kim, Tae Hyong; Kang, Kui Dong; Lee, Sung Jin
To investigate the patterns and risk factors of the ocular manifestations of acquired immunodeficiency syndrome (AIDS) and their correlation with CD4+ count in the era of highly active antiretroviral therapy (HAART). This retrospective study examined 127 AIDS patients who presented to Soonchunhyang University Hospital. Data were collected from patient interviews, clinical examinations, and laboratory investigations. Ophthalmologic examinations included the best-corrected visual acuity, intraocular pressure, anterior segment and adnexal examination, and dilated fundus examination. Of the 127 patients with AIDS, 118 were on HAART and 9 were not. The mean CD4+ count was 266.7 ± 209.1 cells/µL. There were ocular manifestations in 61 patients (48.0%). The incidence of anterior segment manifestations was higher than posterior segment manifestations at 28.3% and 19.7%, respectively. The mean CD4+ count was significantly (p AIDS. In this study, anterior segment and external ocular manifestations occurred more frequently than posterior segment manifestations. Also, the mean CD4+ count was significantly lower in patients with posterior segment ocular manifestations versus anterior segment ocular manifestations. We found that CD4+ count and age >35 years were independent risk factors for developing ocular manifestations.
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Razeghinejad, Mohammad Reza; Banifatemi, Mohammad
To compare ocular biometric parameters in primary angle closure suspects (PACS), primary angle closure glaucoma (PACG) and acute primary angle closure (APAC). This cross-sectional study was performed on 113 patients including 33 cases of PACS, 45 patients with PACG and 35 subjects with APAC. Central corneal thickness (CCT), axial length (AL), anterior chamber depth (ACD) and lens thickness (LT) were measured with an ultrasonic biometer. Lens-axial length factor (LAF), relative lens position, corrected ACD (CACD) and corrected lens position were calculated. The parameters were measured bilaterally but only data from the right eyes were compared. In the APAC group, biometric parameters were also compared between affected and unaffected fellow eyes. Logistic regression analysis was performed to identify risk factors. No statistically significant difference was observed in biometric parameters between PACS and PACG eyes, or between affected and fellow eyes in the APAC group (P>0.05 for all comparisons). However, eyes with APAC had thicker cornea (P=0.001), thicker lens (PAPAC. In the APAC group, LAF (PAPAC.
Ileana Miguel Pérez
Full Text Available Se realizó estudio retrospectivo longitudinal de pacientes con traumatismos oculares mecánicos hospitalizados en el Instituto Superior de Medicina Militar "Dr. Luis Díaz Soto", desde 1988 hasta el 2002, con una casuística de 508 ojos de 479 pacientes. El procesamiento estadístico fue realizado con el mismo programa automatizado con el que se conformó la base de datos (Acces y se utilizaron de acuerdo con las características de las variables ß analizadas métodos estadísticos paramétricos y no paramétricos con una confiabilidad de un 95 % (a =0,05. Se obtiene una relación de 4:1 de predominio del sexo masculino, con una edad promedio de 27,4 años con valor mínimo de 2 años y máximo de 78 años. Los mecanismos más frecuentes de producción del accidente resultaron ser: las armas de fuego (22,7 % y la acción de martillar (21,4 %, teniendo en cuenta que el 38,2 % de los pacientes fueron militares. Las lesiones asociadas a los traumatismos más frecuentes resultaron ser el hipema y el hemovítreo, y se demostró que a medida que eran mayores disminuía considerablemente la agudeza visual final. Los traumatismos cerrados (41,3 % fueron más frecuentes y tuvieron mejores resultados visuales finales (66,7 % con visión mayor de 0.1 que el resto de los grupos de traumatismos abiertos (herida simple, contusión-herida, herida con CEIO y contusión-herida con CEIO. Las contusiones-heridas con CEIO fueron provocados en su mayoría por las armas de fuego y tuvieron los peores resultados visuales (60,5 % con visión menor de 0.1. La afectación del segmento posterior resultó ser un elemento que influyó de forma importante en los resultados visuales. Las complicaciones más frecuentes para los traumatismos cerrados fueron la hipertensión secundaria la catarata y el desprendimiento de retina. Para las heridas simples la catarata y para el resto de los traumatismos el desprendimiento de retina y la ptisis bulbi. Aproximadamente el 15 % de
Gifford, Paul; Li, Melanie; Lu, Helen; Miu, Jonathan; Panjaya, Monica; Swarbrick, Helen A
To investigate relationships between changes to corneal and ocular aberrations induced by orthokeratology (OK) and their influence on visual function. Eighteen subjects (aged 20 to 23 years) were fitted with OK lenses (BE Enterprises Pty Ltd, Australia), manufactured in Boston XO material (Bausch & Lomb Boston, Wilmington, MA), and worn overnight for seven nights. Corneal and ocular aberrations were simultaneously captured (Discovery, Innovative Visual Systems, Elmhurst, IL), and contrast sensitivity function was measured on days 1 and 7, within 2 and 8 hours after lens removal on waking. Data from the eye achieving the higher myopic correction were analyzed for changes over time. There was a significant refractive effect at all visits. Orthokeratology induced an increase in corneal and ocular root mean square higher order aberrations (HOAs) and a positive shift in spherical aberration (SA) on day 1, with further increases by day 7. Increases in root mean square coma became significant by day 7. Changes to corneal and ocular SA were similar on day 1; however, by day 7, there was a greater increase in corneal than ocular SA, indicating a change in internal SA. Orthokeratology led to an overall decrease in contrast sensitivity function, which was isolated to spatial frequency changes on day 1 at 1 cycle per degree and on day 7 at 1 and 8 cycles per degree. A greater positive shift in corneal compared with ocular SA on day 7 suggests a negative shift in internal SA, which would be consistent with an increased accommodative response. Lack of any difference on day 1 indicates that this may be an ocular adaptation response toward neutralizing induced positive SA, rather than a direct effect of SA changes on the accommodation mechanism.
Full Text Available BACKGROUND Chronic kidney disease affects every organ system including the eye. The aim of the study is to conduct a thorough ocular examination and to study the occurrence of various ocular manifestations exhibited by patients with chronic kidney disease and to analyse the findings. MATERIALS AND METHODS 100 patients from Department of Nephrology, Stanley Medical College diagnosed with chronic kidney disease were examined for ocular manifestations at the Department of Ophthalmology, Stanley Medical College. This is a cross-sectional, descriptive, non-interventional, hospital-based study. The period of study was from August 2010 to October 2011. RESULTS The commonest cause of CKD was hypertension in 47 pts. (52.2% followed by both diabetes and hypertension in 30 patients. Patients with only diabetes were 6 patients (6.7% and with other causes were 7 patients (7.8%.10% of patients were legally blind with visual acuity <6/60. In this study, 65 patients belonged to less than 50 years. 49.3% of the presenile patients had cataract. A reduced Schirmer’s value was noted in 54 eyes of the 200 eyes. The incidence of ocular surface disease in the study was 27%. 92 eyes out of 200 eyes studied showed hypertensive retinopathy. Higher grades of hypertensive retinopathy was more in advanced stages of CKD, i.e. 24 eyes in stage IV and 23 eyes in stage V. 51 eyes out of 40 diabetics showed diabetic retinopathy changes of which a majority of 25 eyes belonged to stage V disease. Prevalence of diabetic retinopathy in CKD patients is significantly more when compared to diabetic patients without CKD. CONCLUSION Study demonstrates that routine ocular evaluation is necessary in all patients with chronic kidney disease irrespective of the presence of ocular symptoms. It also highlights the occurrence of a variety of treatable ocular manifestations, which can become vision threatening if not taken care of at the earliest.
Spierer, Oriel; Felix, Elizabeth R.; McClellan, Allison L.; Parel, Jean Marie; Gonzalez, Alex; Feuer, William J.; Sarantopoulos, Constantine D.; Levitt, Roy C.; Ehrmann, Klaus; Galor, Anat
Purpose To examine associations between corneal mechanical thresholds and metrics of dry eye. Methods This was a cross-sectional study of individuals seen in the Miami Veterans Affairs eye clinic. The evaluation consisted of questionnaires regarding dry eye symptoms and ocular pain, corneal mechanical detection and pain thresholds, and a comprehensive ocular surface examination. The main outcome measures were correlations between corneal thresholds and signs and symptoms of dry eye and ocular pain. Results A total of 129 subjects participated in the study (mean age 64 ± 10 years). Mechanical detection and pain thresholds on the cornea correlated with age (Spearman's ρ = 0.26, 0.23, respectively; both P < 0.05), implying decreased corneal sensitivity with age. Dry eye symptom severity scores and Neuropathic Pain Symptom Inventory (modified for the eye) scores negatively correlated with corneal detection and pain thresholds (range, r = −0.13 to −0.27, P < 0.05 for values between −0.18 and −0.27), suggesting increased corneal sensitivity in those with more severe ocular complaints. Ocular signs, on the other hand, correlated poorly and nonsignificantly with mechanical detection and pain thresholds on the cornea. A multivariable linear regression model found that both posttraumatic stress disorder (PTSD) score (β = 0.21, SE = 0.03) and corneal pain threshold (β = −0.03, SE = 0.01) were significantly associated with self-reported evoked eye pain (pain to wind, light, temperature) and explained approximately 32% of measurement variability (R = 0.57). Conclusions Mechanical detection and pain thresholds measured on the cornea are correlated with dry eye symptoms and ocular pain. This suggests hypersensitivity within the corneal somatosensory pathways in patients with greater dry eye and ocular pain complaints. PMID:26886896
Perez, Victor L.; Barsam, Alexander; Duffort, Stephanie; Urbieta, Maitee; Barreras, Henry; Lightbourn, Casey; Levy, Robert B.
Ocular complications occur after transplant in 60–90% of chronic graft versus host disease (GVHD) patients and significantly impair vision-related quality of life. Ocular surface inflammation and dry eye disease (DED) are the most common manifestations of ocular GVHD (oGVHD). oGVHD can be viewed as an excellent pre- clinical model that can be studied to understand the immune pathogenesis of this common and debilitating disease. A limitation of this is that only a few experimental models mimic the ocular complications following HSCT and have focused on the acute GVHD process. To address this issue, we used a pre-clinical animal model developed by our group where ocular involvement was preceded by systemic GVHD to gain insight regarding the contributing immune mechanisms. Employing this "MUD" model enabled the development of a clinical scoring criterion, which readily identified different degrees of ocular pathology at both the ocular surface and adnexa dependent on the level of conditioning prior to HSCT. As far as we are aware we report that for the first time these clinical and immune responses occur not only on the ocular surface, but also heavily involve the lid margin region. In total, the present study reports a pre-clinical scoring model that can be applied to animal models as investigators look to further explore GVHD's immunologic effects at the level of the ocular surface and eyelid adnexa compartments. We speculate that future studies will use this clinical scoring index in combination with what is recognized histologically and correlated with serum biomarkers being identified in chronic/ocular GVHD. PMID:27492793
Mohammad Reza Razeghinejad
Full Text Available Purpose: To compare ocular biometric parameters in primary angle closure suspects (PACS, primary angle closure glaucoma (PACG and acute primary angle closure (APAC. Methods: This cross-sectional study was performed on 113 patients including 33 cases of PACS, 45 patients with PACG and 35 subjects with APAC. Central corneal thickness (CCT, axial length (AL, anterior chamber depth (ACD and lens thickness (LT were measured with an ultrasonic biometer. Lens-axial length factor (LAF, relative lens position, corrected ACD (CACD and corrected lens position were calculated. The parameters were measured bilaterally but only data from the right eyes were compared. In the APAC group, biometric parameters were also compared between affected and unaffected fellow eyes. Logistic regression analysis was performed to identify risk factors. Results: No statistically significant difference was observed in biometric parameters between PACS and PACG eyes, or between affected and fellow eyes in the APAC group (P>0.05 for all comparisons. However, eyes with APAC had thicker cornea (P=0.001, thicker lens (P<0.0001, shallower ACD (P=0.009, shallower CACD (P=0.003 and larger LAF (P<0.0001. Based on ROC curve analysis, lower ACD, and larger LT, LAF and CCT values were associated with APAC. In the APAC group, LAF (P<0.0001 and CCT (P=0.001 were significant risk factors. Conclusion: This study revealed no significant difference in biometric characteristics in eyes with PACS and PACG. However, larger LAF and CCT were predictive of APAC.
Georgina P. Ossani
Full Text Available Previous studies have shown ocular haemorrhages in choline-deficient rats. The aim of this paper is to study further the relationship between ocular and renal lesions and biochemical alterations in rats fed a choline-deficient diet. Fifty one weanling male Wistar rats, were divided into two groups. Thirty one of them were fed a choline-deficient diet and the rest was fed a choline-supplemented diet ad libitum. Animals from both groups were killed between the fifth and the eighth day. Urea, creatinine and homocysteine concentrations in blood were determined. Eyes were used for light microscopy study; high resolution light microscopy and the study of the retina as "rétine a plat". Kidneys were studied by light microscopy. Choline-supplemented rats did not show ocular or renal lesion. Choline-deficient rats that showed renal lesions, tubular or cortical necrosis, did not always have ocular changes. There were no ocular changes in the only choline-deficient rat without renal lesion. The ocular changes consisted mainly in haemorrhage in both cameras and ciliary and vitreous bodies. Correlations between ocular and renal lesion (r=0.72, pEstudios previos han demostrado hemorragia ocular en ratas deficientes en colina. El objetivo de este trabajo es profundizar en la relación entre las alteraciones oculares, renales y bioquímicas en ratas deficientes en colina. Cincuenta y una ratas Wistar macho recién destetadas fueron divididas en dos grupos: treinta y una fueron alimentadas con una dieta colino deficiente y el resto con colina suplementada ad-libitum. Los animales de ambos grupos fueron sacrificados entre el quinto y el octavo día. Se midió la concentración de urea, creatinina y homocisteína en sangre. Los ojos fueron estudiados por microscopía de luz, microscopía óptica de alta resolución y para el estudio de la retina como retina plana. Los riñones fueron estudiados por microscopía de luz. Las ratas suplementadas con colina no
Chorley, Adrian C; Baczynska, Katarzyna A; Benwell, Martin J; Evans, Bruce J W; Higlett, Michael P; Khazova, Marina; O'Hagan, John B
Ultraviolet radiation (UVR) increases with altitude; however, there are a number of other factors which may influence ocular exposure during flight. The aim of this study was to assess ocular UVR exposure of pilots in airline and off-shore helicopter operations on different aircraft types and to compare with exposure in a typical office environment. In-flight data were captured on equipment including a CCD array spectroradiometer on five return sector European airline flights and one transatlantic flight from London Gatwick in addition to four helicopter flights from Aberdeen Dyce airport. Further data were collected in an office environment from three workstations during summer and winter months. A wide variation in ocular UVA dose was found during flights. The main factor influencing exposure was the UVR transmission of the windshield, which fell into two distinct profile types. In an aircraft with good UVA blocking properties, ocular exposure was found to be equivalent to office exposure and did not exceed international guideline limits regardless of external conditions or flight time. Most aircraft assessed had poor UVA blocking windshields which resulted in an ocular exposure to the unprotected eye in excess of international guideline limits (up to between 4.5 to 6.5 times greater during one flight). No significant UVB dose was found. Pilots should be warned of the potential high UVA exposure during flight and advised on the use of sunglasses. A windshield labeling system would allow the pilot to tailor their eye protection practices to that particular aircraft.
Zemba, M; Avram, Corina Ioana; Ochinciuc, Uliana; Stamate, Alina Cristina; Camburu, Raluca Lăcrămioara
Ocular ischemic syndrome, also known as hypoperfusion/ hypotensive retinopathy or as ischemic oculopathy is a rare ocular disease determined by chronic arterial hypoperfusion through central retinal artery, posterior and anterior ciliary arteries. It is bilateral in 20% of the cases. Most often it appears due to severe occlusion of the carotid arteries (ICA, MCA>ECA), described in 1963 by Kearns and Hollenhorst. Occasionally it can be determined by the obstruction of ophtalmic artery or some arterities (Takayasu, giant cell arteritis). The risk factors are: age between 50-80 years, males (M:F = 2:1), arterial hypertension, diabetes, coronary diseases (5% of the cases develop ocular ischemic syndrome), vascular stroke, hemodialysis. The case we present is of an 63 years old man known with primary arterial hypertension, hypercholesterolemia, diabetes type 2 non insulin dependent and diagnosticated with ischemic cerebral stroke and bilateral obstruction of internal carotid arteries in march 2010, who is presenting for visual impairment in both eyes. The imaging investigations show important carotid occlusion and at the ophthalmologic evaluation there are ocular hypertension and rubeosis iridis at the right eye, optic atrophy at both eyes (complete in the right eye and partial in the left eye), with superior altitudinal visual field defect in left eye. The following diagnosis was established: Chronic ocular ischemic syndrome in both eyes with Neovascular glaucoma at the right eye, Anterior ischemic optic neuropathy at the left eye and laser panphotocoagulation at the right eye was started.
Gokulgandhi, Mitan R; Vadlapudi, Aswani Dutt; Mitra, Ashim K
Introduction The eye is considered as the most privileged organ because of the blood–ocular barrier that acts as a barrier to systemically administered xenobiotics. However, there has been a significant increase in the number of reports on systemic drug-induced ocular complications. If such complications are left untreated, then it may cause permanent damage to vision. Hence, knowledge of most recent updates on ever-increasing reports of such toxicities has become imperative to develop better therapy while minimizing toxicities. Areas covered The article is mainly divided into anterior and posterior segment manifestations caused by systemically administered drugs. The anterior segment is further elaborated on corneal complications where as the posterior segment is focused on optic nerve, retinal and vitreous complications. Furthermore, this article includes recent updates on acute and chronic ocular predicaments, in addition to discussing various associated symptoms caused by drugs. Expert opinion Direct correlation of ocular toxicities due to systemic drug therapy is evident from current literature. Therefore, it is necessary to have detailed documentation of these complications to improve understanding and predict toxicities. We made an attempt to ensure that the reader is aware of the characteristic ocular complications, the potential for irreversible drug toxicity and indications for cessation. PMID:22803583
Raiza Vega Montalvo
Full Text Available El ojo puede ser dañado accidentalmente por el uso de muchos productos de uso rutinario. Para facilitar la seguridad de los consumidores es necesario estimar el potencial de irritación ocular de estas sustancias químicas. Esta estimación está basada en los resultados obtenidos en el ensayo de Draize llevado a cabo en conejos. Sin embargo, avances en el desarrollo de la toxicología in vitro han permitido el uso de algunas alternativas para la evaluación del riesgo ocular; por lo que se presenta una revisión acerca de los diferentes métodos alternativos disponibles hasta el momento que permiten evaluar de una forma u otra los efectos tóxicos a nivel ocular.The eye may be accidentally damaged by many products of daily use. To guarantee the consumers’ safety it is necessary to estimate the eye irritation potential of these chemical substances. This estimation is based on the results obtained in the Draize rabbit eye irritation test. However, the advances attained in the development of in vitro toxicology have allowed the use of some alternatives to evaluate the ocular risk. Therefore, a review is made on the different alternative methods available up to now that make possible the evaluation in one way or another of the toxic effects at the ocular level.
Full Text Available Background and purpose of the study: Several polymeric systems have been used to fabricate ocular inserts for better ocular bioavailability and retention to drug of which gelling systems have shown advantages of convenient administration and increased contact time. The purpose of the present study was to develop a bioadhesive in-situe gelling ocular insert of Gatifloxacin using polymeric system of sodium alginate as gelling and chitosan as bioadhesive agent.Materials and methods: Polymeric ocular inserts of Gatifloxacin sesquehydrate (GS were composed using sodium alginate and chitosan with glycerin as plasticizer by solvent casting method. The ocular inserts were investigated for physicochemical properties (thickness, weight variation, folding endurance and surface pH, mechanical strength (tensile strength, elongation at break, swelling index, and bioadhesion parameters. In vitro release studies were carried using a fabricated donor-receptor compartment model. Results: Cumulative drug released from the formulation ranged from 95-99% within 8-12h. The formulation D (2% sodium alginate and 1% chitosan sustained the drug release for the longest period of time (12h. Zero-order release of the drug was from optimized formulation D. A high correlation coefficient (r=0.9845 was recorded between in vitro and in vivo drug release.Conclusion: Gatifloxacin sesquehydrate inserts have appreciable film forming properties and were found to posses good antimicrobial efficacy.
Cullen, Anthony P
To describe he role played by the United Nations Environmental Effects Panel with respect to the ocular effects of stratospheric ozone depletion and present the essence of the Health Chapter of the 2010 Assessment. A consideration of solar ultraviolet radiation (UVR) at the Earth's surface as it is affected by atmospheric changes and how these influence sunlight-related eye diseases. A review of the current Assessment with emphasis on pterygium, cataract, ocular melanoma, and age-related macular degeneration. Although the ozone layer is projected to recover slowly in the coming decades, continuing vigilance is required regarding exposure to the sun. Evidence implicating solar UVR, especially UVB, in every tissue of the eye continues to be amassed. The need for ocular UV protection existed before the discovery of the depletion of the ozone layer and will continue even when the layer fully recovers in approximately 2100.
Full Text Available AIM:To compare the effectiveness of topical cyclosporine A emulsion with that of oral doxycycline for rosacea associated ocular changes and dry eye complaints.METHODS:One hundred and ten patients with rosacea were screened. Thirty-eight patients having rosacea associated eyelid and ocular surface changes and dry eye complaints were included in the study. Patients were randomly divided into two groups:nineteen patients were given topical cyclosporine twice daily and nineteen patients were given oral doxycycline 100 mg twice daily for the first month and once daily for the following two months. Symptom and sign scores, ocular surface disease index questionnarie and tear function tests were evaluated at baseline and monthly for 3mo. Three months after results were compared with that of baseline.RESULTS:Mean values of symptom, eyelid sign and corneal/conjunctival sign scores of each treatment group at baseline and 3mo after treatments were compared and both drugs were found to be effective on rosacea associated ocular changes (P<0.001. Cyclosporine was more effective in symptomatic relief and in the treatment of eyelid signs (P=0.01. There was statistically significant increase in the mean Schirmer score with anesthesia and tear break up time scores in the cyclosporine treatment group compared to the doxycycline treatment group (P<0.05.CONCLUSION:Cyclosporine as a topical drug can be used in the treatment of rosacea associated ocular complications because it is more effective than doxycycline. In addition ocular rosacea as a chronic disease requires long term treatment and doxycycline has various side effects limiting its long term usage.
Mackay, Devin D; Garza, Philip S
The proficiency of nonophthalmologists with direct ophthalmoscopy is poor, which has prompted a search for alternative technologies to examine the ocular fundus. Although ocular fundus photography has existed for decades, its use has been traditionally restricted to ophthalmology clinical care settings and textbooks. Recent research has shown a role for nonmydriatic fundus photography in nonophthalmic settings, encouraging more widespread adoption of fundus photography technology. Recent studies have also affirmed the role of fundus photography as an adjunct or alternative to direct ophthalmoscopy in undergraduate medical education. In this review, the authors examine the use of ocular fundus photography as an educational tool and suggest future applications for this important technology. Novel applications of fundus photography as an educational tool have the potential to resurrect the dying art of funduscopy. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Mukhopadhyay, Somnath; Shome, Subrata; Bar, Prasenjit Kumar; Chakrabarti, Amit; Mazumdar, Swati; De, Avisek; Sadhukhan, Kaushik; Bala, Bivas
Rhinosporidiosis, a granulomatous disease caused by Rhinosporidium seeberi, is widely prevalent in Sri Lanka and southern parts of India. Besides the eye, the lacrimal passage and nasal cavity are affected. The most common ocular involvement is a subconjunctival bleeding mass. Our case, a 9-year-old girl from a rural background with a history of pond water bathing, presented with a marginal chalazion involving the left lower lid. She had a history of chalazion involving the same site three months earlier which was managed by incision and curettage. A decision of surgical exploration was made and the evacuated mass was examined histologically showing evidence of rhinosporidiosis. This type of clinical presentation for ocular rhinosporidiosis (as recurrent chalazion) has not been reported earlier in the literature. This case emphasises that the clinicians from this part of the world must consider ocular rhinosporidiosis as differential diagnosis in cases with recurrent chalazion especially in a rural background with a habit of pond water bathing.
Full Text Available A year long study of ocular injuries in children below the age of 15 years was conducted in the Ophthalmology Department of a general hospital. Fortyfour cases were studied. Of these 45.45% were in the age group of 6-10 years. The male to female ratio was 5.28 : 1. Pointed objects viz. sticks, wires etc. were found to be the common causative agents; the recent trend being of bow and arrow injuries. Ocular perforation was observed in 28 cases. On follow up of all the cases with ocular trauma, only 12 patients were found to have a visual acuity better than 6/18; perception of light was absent in 7 patients. A need for increased parental awareness and supervision of children is stressed upon.
Victoria Mary Lendrum Cohen
Full Text Available Victoria Mary Lendrum CohenSt. Bartholomew’s and Moorfields Eye Hospital, London UKAbstract: Most lymphomas that involve the ocular adnexal structure are low grade, B cell, non-Hodgkin’s lymphomas. The treatment depends upon the grade and stage of the disease. High grade lymhoma requires treatment with systemic chemotherapy whereas the localized low grade (extranodal marginal zone lymphoma can be successfully managed with local radiotherapy. Chlamydia psittaci infection is associated with low grade ocular lymphoma; however there is wide geographic variation in the strength of this association. Blanket antibiotic therapy is not advised unless there is proof of an infective agent. The monoclonal antibody, rituximab, may be successful for CD20 positive lymphoma, although it is likely that rituximab will have better long-term results when used in combination with systemic chemotherapy.Keywords: ocular adnexal lymphoma, mucosa associated lymphoid tissue, extranodal marginal zone lymphoma, Chlamydia psittaci, rituximab, radiotherapy, chemotherapy
This study was carried out to ascertain the perception of the residency ... the time of the study. Analysis of the respondents showed similar findings for both senior and junior levels of training. Discussion. The introduction of the residency training program .... Overseas training/ attachment should be re-introduced. 12. (10.1).
Ayaki, Masahiko; Kawashima, Motoko; Negishi, Kazuno; Kishimoto, Taishiro; Mimura, Masaru; Tsubota, Kazuo
The aim of the present study was to evaluate sleep and mood disorders in patients with irritating ocular diseases. The study design was a cross-sectional/case-control study conducted in six eye clinics. Out of 715 outpatients diagnosed with irritating ocular surface diseases and initially enrolled, 301 patients with dry eye disease (DED) and 202 age-matched control participants with other ocular surface diseases were analyzed. The mean Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS) scores were 6.4 ± 3.2 and 11.1 ± 5.7 for severe DED (n = 146), 5.5 ± 3.3 and 9.8 ± 4.0 for mild DED (n = 155), 5.5 ± 3.1 and 9.5 ± 6.6 for chronic conjunctivitis (n = 124), and 5.0 ± 3.3 and 8.9 ± 5.3 for allergic conjunctivitis (n = 78). There were significant differences among these diagnostic groups for PSQI (P sleep quality in patients with DED is significantly worse than in patients with other irritating ocular surface diseases and it is correlated with the severity of DED.
Full Text Available Ocular diseases include various anterior and posterior segment diseases. Due to the unique anatomy and physiology of the eye, efficient ocular drug delivery is a great challenge to researchers and pharmacologists. Although there are conventional noninvasive and invasive treatments, such as eye drops, injections and implants, the current treatments either suffer from low bioavailability or severe adverse ocular effects. Alternatively, the emerging nanoscience and nanotechnology are playing an important role in the development of novel strategies for ocular disease therapy. Various active molecules have been designed to associate with nanocarriers to overcome ocular barriers and intimately interact with specific ocular tissues. In this review, we highlight the recent attempts of nanotechnology-based systems for imaging and treating ocular diseases, such as corneal d iseases, glaucoma, retina diseases, and choroid diseases. Although additional work remains, the progress described herein may pave the way to new, highly effective and important ocular nanomedicines.
Gabal, M S; Raslan, O A
Mercury vapor exposed workers may show ocular changes, as well as other systems affection. A sample of 84 workers in preparing mercury fulminate were examined for conjunctival corneal and lenticular manifestation of long duration exposure, together with mercury urinary output. Lens changes were found in 50% of the involved workers while keratopathy as recorded in 34.5% of them. No statistically significant association was found between the occurrence of eye lesions and levels of urinary elimination of mercury. These results suggest local absorption of this element is most probably the underlying cause of ocular affection.
Reichl, Lars; Löwel, Siegrid; Wolf, Fred
We present an analytical approach for studying the coupled development of ocular dominance and orientation preference columns. Using this approach we demonstrate that ocular dominance segregation can induce the stabilization and even the production of pinwheels by their crystallization in two types of periodic lattices. Pinwheel crystallization depends on the overall dominance of one eye over the other, a condition that is fulfilled during early cortical development. Increasing the strength of intermap coupling induces a transition from pinwheel-free stripe solutions to intermediate and high pinwheel density states.
Jen, Melinda; Nallasamy, Sudha
Genetic skin diseases, or genodermatoses, often have extracutaneous manifestations. Ocular manifestations in particular can have significant clinical implications, like blindness. Other manifestations, such as the corneal opacities that occur in X-linked ichthyosis, are asymptomatic but characteristic of a particular genodermatosis. Ophthalmologic examination can aid in diagnosis when characteristic findings are seen. The genodermatoses with ocular manifestations will be reviewed, but neurocutaneous, syndromes, genetic pigmentary disorders, and genetic metabolic diseases are not included because they are covered elsewhere in this issue. Copyright © 2015 Elsevier Inc. All rights reserved.
Aggarwal, Himanshi; Kumar, Pradeep; Singh, Raghuwar Dayal
When an enucleation or exenteration procedure removes the entire orbital contents but not the eyelids, an abnormally large orbital socket is created that would require an equally sized volume enhancing, flush fitting ocular prosthesis. The solid acrylic prosthesis would rest on or in the lower fornix and owing to its weight, causes distortion of the lower eyelid and/or asymmetrical alignment of the entire palpebral fissure. The aim of this article was to describe a method of fabricating a pneumatic light weight custom ocular prosthesis using lost wax technique to overcome the deteriorating effects of conventional solid ocular prosthesis.
Simone Ribeiro Araújo de Almeida
Full Text Available OBJETIVO: Analisar os achados clínicos da tuberculose ocular e seus aspectos epidemiológicos. MÉTODOS: Foram revisados prontuários médicos de pacientes que foram atendidos no Departamento de Oftalmologia - setor de Uveíte e AIDS da Unifesp-EPM, São Paulo, Brasil, entre janeiro de 1999 e julho de 2002 e que tiveram diagnóstico de tuberculose ocular. Foram inclusos os pacientes que apresentaram PPD forte reator, epidemiologia positiva para tuberculose e lesão ocular que melhorou com tratamento específico. RESULTADOS: Foram analisados prontuários médicos de 17 pacientes, sendo 12 (70,6% do sexo feminino. A idade média foi de 54 (24-84 anos. O tempo médio entre o início dos sintomas e a primeira consulta foi de 100 dias. Os achados oculares foram inespecíficos nesta ocasião mas prevaleceram as alterações de segmento anterior e 41% dos pacientes apresentavam sinais de tuberculose sistêmica. Alterações como glaucoma, descolamento de retina e hemorragia vítrea foram responsáveis pela redução da acuidade visual. CONCLUSÃO: Embora pouco prevalente, a tuberculose ocular apresenta morbidade elevada. A inespecificidade da apresentação clínica da doença ocular pode atrasar o seu diagnóstico.PURPOSE: To analyze clinical findings of ocular tuberculosis and its epidemiological features. METHODS: Were reviewed clinical files of patients who attended the Ophthalmology - Uveitis and AIDS sector of UNIFESP-EPM, São Paulo, Brazil between January 1999 and July 2002 and had a diagnosis of ocular tuberculosis. Patients who had Mantoux test higher than 10 mm, epidemiological history of tuberculosis and ocular findings that improved after specific treatment were included. RESULTS: Seventeen medical files were analyzed, of those, 12 (70,6% were females. The mean age was 54 (24-84 years. The average time between symptoms and diagnosis was 100 days. Ocular findings at the first interview were multiple but most were at the anterior segment of
Masoudi, Simin; Zhao, Zhenjun; Willcox, Mark
Contact lenses are associated with discomfort during wear. This may be the result of stimulation of the ocular surface and production of pro-inflammatory mediators which are then released into the tears. This study examined changes in the concentration in tears of arachidonic acid metabolites (AAM) prostaglandins, cysteinyl leukotrienes, and resolvin-D 1 , as well as histamine in a general contact lens population in the morning and evening. Tears were collected twice a day (morning and evening) for up to 10 days on two different occasions (with and without contact lens wear) from 30 experienced contact lens wearers for analysis of AAM and a separate group (N = 33) for analysis of histamine. Ocular comfort was rated subjectively on an ordinal scale at each time of tear collection. Tears were analyzed using commercial immunoassay-based kits. Statistical analysis was performed using linear mixed model test. Ocular comfort decreased from morning to evening with and without contact lenses (p = 0.001), and the difference in comfort in the evening was greater with contact lens wear (80.9 ± 16.2 vs. 75.5 ± 16.8; p = 0.008). The total concentration of PGs (10.7 ± 10.8 ng/ml), cysteinyl leukotrienes (8.7 ± 0.38 ng/ml), resolvin-D 1 (1.6 ± 0.5 ng/ml), or histamine 13.8 ± 10.4 ng/ml) did not change during the day or during contact lens wear (p > 0.05). Prostaglandins, cysteinyl leukotrienes, resolvin-D1, or histamine concentrations did not alter in relation to changes in comfort of the eye during the day or during contact lens wear. These results suggest that release of these mediators is not responsible for contact lens discomfort.
Tan, Chai Lee; Fhun, Lai Chan; Tai, Evelyn Li Min; Abdul Gani, Nor Hasnida; Muhammed, Julieana; Tuan Jaafar, Tengku Norina; Ahmad Tajudin, Liza Sharmini; Wan Hitam, Wan-Hazabbah
Background. Ocular bartonellosis can present in various ways, with variable visual outcome. There is limited data on ocular bartonellosis in Malaysia. Objective. We aim to describe the clinical presentation and visual outcome of ocular bartonellosis in Malaysia. Materials and Methods. This was a retrospective review of patients treated for ocular bartonellosis in two ophthalmology centers in Malaysia between January 2013 and December 2015. The diagnosis was based on clinical features, support...
Joseph, A; Dua, H S; King, A J
To report the failure of amniotic membrane transplantation (AMT) for ocular surface reconstruction in patients with severe acute chemical and thermal burns. Four eyes of three patients who suffered severe chemical (n=3) and thermal (n=1) burns were studied. The aim of AMT was to prevent symblepharon formation, promote conjunctival regeneration, inhibit corneal melting by promoting epithelialisation, and to protect the ocular surface while associated lid burns were treated. AMT was used to cover the entire ocular surface of all the severely burnt and ischaemic eyes, 2-3 weeks after the injury. Where indicated, AMT was repeated by itself or in combination with other procedures in all patients. Three of the four eyes developed symblepharon and progressive corneal melt requiring urgent tectonic keratoplasty. All four eyes had persistent epithelial defects. Less than 25% of conjunctival regeneration occurred in three eyes. Two eyes autoeviscerated, one patient underwent lid sparing exenteration for a painful blind eye and one eye became phthysical. AMT did not help to restore the ocular surface or preserve the integrity of the eye in all our patients with severe acute burns, when used by itself or in combination with other surgical procedures. This reflects the extreme severity of the ocular burns in these patients and, in turn, draws attention to the fact that the current classification system does not adequately reflect such severity. In the current system such burns would be grouped under grade IV injuries to the eye (more than 50% limbal ischaemia). The prognosis of patients with 100% limbal ischaemia is much worse than patients with just over 50% limbal ischaemia. This inadequacy of the classification system probably also explains the difference between outcomes of management of grade IV burns (with AMT) in this series, compared with others.
Oliver, Sara; Sahi, Sharon K; Tantalo, Lauren C; Godornes, Charmie; Neblett Fanfair, Robyn; Markowitz, Lauri E; Lukehart, Sheila A; Marra, Christina M
Syphilis can have many clinical manifestations, including eye involvement, or "ocular syphilis." In 2015, an increase in reported cases of ocular syphilis and potential case clusters raised concern for an oculotropic strain of Treponema pallidum, the infectious agent of syphilis. Molecular typing was used to examine strains found in cases of ocular syphilis in the United States. In 2015, after a clinical advisory issued by the Centers for Disease Control and Prevention, pretreatment clinical specimens from US patients with ocular syphilis were sent to a research laboratory for molecular analysis of T. pallidum DNA. Molecular typing was conducted on these specimens, and results were compared with samples collected from Seattle patients diagnosed with syphilis, but without ocular symptoms. Samples were typed from 18 patients with ocular syphilis and from 45 patients with syphilis, but without ocular symptoms. Clinical data were available for 14 ocular syphilis patients: most were men, human immunodeficiency virus-infected, and had early syphilis. At least 5 distinct strain types of Treponema pallidum were identified in these patients, and 9 types were identified in the Seattle nonocular patients. 14d/g was the most common type in both groups. An unusual strain type was detected in a small cluster of ocular syphilis patients in Seattle. Ocular syphilis is a serious sequela of syphilis. In this preliminary study, clear evidence of a predominant oculotropic strain causing ocular syphilis was not detected. Identification of cases and prompt treatment is critical in the management of ocular syphilis.
About one-third of people over age 65 fall each year, and the frequency ... extra ocular muscles (resul ng in sluggish eye movement), etc. are situa ons which predisposes the elderly to accidental falls. Falls is very significant as a cause of ocular trauma in .... The predisposing factors to ocular injury among paediatrics and ...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ocular surgery irrigation device. 886.4360 Section... (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4360 Ocular surgery irrigation device. (a) Identification. An ocular surgery irrigation device is a device intended to be suspended over the...
7 subjects (1.3%) had monocular blindness with VA<3/60. 37 (3.3%) subjects had low vision with VA < 6/18-3/60. Conclusion: Most of the subjects were young people. Ocular disorders were encountered in computer users. Ocular health status of computer users can be improved through periodic ocular examination and ...
Department of Housing and Urban Development — The Resident Characteristics Report summarizes general information about households who reside in Public Housing, or who receive Section 8 assistance. The report...
Hochman, Jacob; Shen, DeFen; Gottesman, Michael M; Chan, Chi-Chao
Previously we demonstrated that intraperitoneal (IP) inoculation of Rev-2-T-6 mouse lymphoma into syngeneic Balb/c hosts resulted in brain metastasis, migration along the optic nerve sheath, and ocular infiltration. In a second model: intravitreal inoculation of Rev-2-T-6 cells, the developing lymphoma was largely confined within the eye, seldom breaching the retinal pigment epithelium to reside in the choroid and sclera. There was no retrograde infiltration into the brain. Here, we describe a third, complementary model, whereby intravitreal inoculation of Rev-2-T-6 cells into Balb/c mice, followed by repeated IP inoculations of anti-LFA-1/CD11a monoclonal antibodies, results in extensive infiltration of the choroid, sclera, conjunctiva, eyelids and orbit. Furthermore, the lymphoma cells metastasize along the optic nerve sheath into the brain, and through the contralateral optic nerve tract into the contralateral eye. There is no systemic involvement of the lymphoma. Furthermore, anti-LFA-1 treatment results in elevated levels of serum anti-Rev-2-T-6 antibodies. Inoculation of Rev-2-T-6 cells into the vitreous of severe combined immune deficient mice demonstrates a course of clinical signs and histopathological findings similar to those in immune-competent mice treated with anti-LFA-1 antibodies, including invasion of the contralateral eye. Taken together, these findings suggest that confinement of Rev-2-T-6 lymphoma cells to the eye depends on active immune surveillance using a population of effector cells expressing the cell surface integrin LFA-1. Impairing this protection enhances tumor aggressiveness within the eye, and the likelihood of early retrograde lymphoma metastasis into the brain and the contralateral eye.
and retroperitoneal regions of the body.1. Teratomas arising from the head and neck region are uncommon.4 We report a case of orbito-ocular teratoma in an infant. Case Report. A seventeen day-old baby ... intestinal glands and neural tissue with retinoblasts showing severe anaplasia. There was local infiltration and foci ...
Strabismus was found in thirteen subjects (35.1%). This was esotropia in 7(54%) and exotropia in 6 (46%) subjects. Refractive error was found in 32(86.5%) subjects and Cortical Visual Impairment (CVI) in 28(75.7%) subjects CVI, refractive errors and strabismus are the most common ocular findings in children with ...
May 6, 2011 ... progesterone, and androgen) actions, various physiological conditions such as age, menstrual cycle, pregnancy, and menopause, where the hormone milieu changes, affect vision.. Pregnancy results in a lot of hormonal changes in the body and the eyes are no exception. These ocular changes could.
Malaria is endemic in Nigeria. With the emergence of chloroquine resistance various modes of treatment including parenteral quinine are employed with consequent untoward effects. This article reports two cases of severe ocular toxicity, including mimicry of intracranial space‑occupying lesion, from treatment of malaria ...
Peter, Neena M; Pearson, Andrew R
Orbital apex syndrome (OAS) is a rare condition due to a range of pathological processes around the optic nerve foramen and the superior orbital fissure causing characteristic functional loss. It is a rare complication of trauma and results from penetrating injuries as well as those involving bony fractures. We present a case of OAS from non-penetrating ocular trauma without bony involvement.
Objective: To determine the prevalence of ocular disorders in adult (>15 years ) AIDS patients at PEPFAR clinic in Lagos, Nigeria. ... Conjunctival microvasculopathy 166 patients (41.5%), pingueculum in 114 (28.5%), pterygium in 76 (19.0%), refractive error in 93 (23.3%), cataract in 12 (3.0%), and 22 (5.5%) Glaucoma ...
Sharma, Namrata; Kaur, Manpreet; Agarwal, Tushar; Sangwan, Virender S; Vajpayee, Rasik B
Ocular chemical burns are an ophthalmic emergency and are responsible for 11.5%-22.1% of ocular injuries. Immediate copious irrigation is universally recommended in acute ocular burns to remove the offending agent and minimize damage. Conventional medical therapy consists of the use of agents that promote epithelialization, minimize inflammation, and prevent cicatricial complications. Biological fluids such as autologous serum, umbilical cord blood serum, platelet-rich plasma, and amniotic membrane suspension are a rich source of growth factors and promote healing when used as adjuncts to conventional therapy. Surgical treatment of acute ocular burns includes the debridement of the necrotic tissue, application of tissue adhesives, tenoplasty, and tectonic keratoplasty. Amniotic membrane transplantation is a novel surgical treatment that is increasingly being used as an adjunct to conventional treatment to promote epithelial healing, minimize pain, and restore visual acuity. Various experimental treatments that aim to promote wound healing and minimize inflammation are being evaluated such as human mesenchymal and adipose stem cells, beta-1,3 glucan, angiotensin-converting enzyme inhibitors, cultivated fibroblasts, zinc desferrioxamine, antifibrinolytic agents, antioxidants, collagen cross-linking, and inhibitors of corneal neovascularization. Copyright © 2017 Elsevier Inc. All rights reserved.
eye of human patients. Keywords. Bio-ceramics; hydroxyapatite; porous implant; ocular implant; in vivo study. 1. Introduction. Hydroxyapatite (HAp) is the principal inorganic consti- tuent of bone and teeth. The chemical similarity of this material with bone and teeth as well as its excellent bio- compatibility and bioactivity has ...
Jul 10, 2012 ... A snakebite constitutes a common acute medical emergency and has several systemic and even ocular consequences. According to Patil et al,1 the importance of this public health problem has largely been ignored by medical science. There are approximately 3 000 snake species worldwide, of which ...
Full Text Available Eleven histologically proved cases of ocular malignant lymphoma diagnosed and managed during the year 1974-81 are reported. The follow-up period ranges from 2-7 years. The difficulties in diagnosis, treatment and prognosis are discussed.
Saboo, Ujwala S; Amparo, Francisco; Shikari, Hasanain; Dana, Reza
To evaluate the prevalence of ocular hypertension (OHT) and glaucoma in patients with chronic ocular graft-versus-host disease (GVHD). We performed a retrospective chart review of 218 patients diagnosed with chronic ocular GVHD. Ocular hypertension was defined as intraocular pressure (IOP) ≥ 24 mmHg in either eye without any glaucomatous optic disc changes. Glaucoma suspect was defined as optic disc changes with a cup-to-disc ratio ≥ 0.7 in either eye or asymmetry of ≥ 0.3 between the two eyes. Glaucoma was defined by glaucomatous optic disc changes plus glaucomatous visual field defects in two consecutive reliable visual field tests. The number of cases of ocular hypertension, glaucoma, and glaucoma suspects was evaluated. Thirty-three patients (15 %) were diagnosed with OHT, eight patients (3.6 %) with suspicion of glaucoma, and one patient (0.4 %) with glaucoma. OHT occurred within 6 months of developing ocular GVHD in 60 % of the cases and within the first year in 76 %. High IOP normalized in 67 % of patients when the dosage of topical or systemic corticosteroids was lowered, and 27 % of patients required anti-glaucoma therapy. Ocular hypertension is a common complication in patients with ocular GVHD, with a prevalence of 15 %. The rise in intraocular pressure is often transient and resolves with management of corticosteroids in most cases. However, clinicians should be aware that nearly one-third of the patients with OHT might require anti-glaucoma treatment. The prevalences of glaucoma and suspicion of glaucoma were not higher than in the general population.
Full Text Available Ocular cystinosis is a rare disease characterised by the deposit of cystine crystals on the corneal surface, which hinder patients’ eyesight. Oral cysteamine is given as cysteamine; however, it does not reach the cornea due to the lack of corneal vascularization making necessary its administration by the topical ocular route. The aim of the present study is to determine the stability of an ophthalmic hydrogel of cysteamine, which can be potentially prepared at hospital pharmacy departments, under different preservation conditions during a follow-up of 30 days. Different physical and chemical parameters were evaluated: osmolality, pH and cysteamine concentration, which has been measured by a method of ultra performance liquid chromatography-tandem mass spectrometer (UPLC-MS/MS. Descriptive assays were also performed, such as transparency measurement and microbiological assays in order to verify its sterility. The obtained results allow us to conclude that the cysteamine hydrogel is stable during 30 days, being recommendable its preservation in refrigerated conditions.
Tabatabaei, Seyed Ali; Modanloo, Shokoufeh; Ghiyasvand, Arezoo Mohammadkhani; Pouryani, Abolghasem; Soleimani, Mohammad; Tabatabaei, Seyed Mehdi; Pakrah, Ahmad Reza; Masarat, Hamideh
To report the frequency, associated risk factors and characteristics of cases referred to Farabi Eye Hospital with ocular superglue injuries. In a descriptive cross-sectional study conducted between December 2012 and February 2013, patients with ocular superglue injuries were evaluated. Age, sex, educational level, location, time, mechanism, type, site and time of eye injury were gathered through interview using a customized questionnaire. All participants had given consent to undergo thorough eye examination. Over the course of three months, 105 patients with ocular superglue injuries enrolled in the study, including 56(53.3%) men and 49(46.7%) women with the mean age of 24.7±11.6 (range, 2 to 53)y. The right eye, left eye and both eyes were involved in 52%, 42% and 6% of the patients, respectively. Most of injuries had occurred at home (72.4%) and at night (55%). More than half of patients (52.4%) did not take any primary aids following the ocular injury. Patient carelessness (78.1%), childhood curiosity and lack of parental supervision (11.4%), storing superglue in inappropriate places and inadvertently using superglue as eye drops due to poor vision (2.9%), inadequate awareness of superglue applications [used to stick on artificial nails (3.8%), artificial eyelashes (1.9%) and broken tooth (1%)] and being assaulted with glue (1%) were common risk factors. The frequency of ocular superglue injuries in patients referred to Farabi Eye Hospital is relatively high. This finding underlines the importance of public education and awareness about superglue injuries to the eye and taking protective measures and safety strategies in order to prevent these injures.
Olubayo Umar Kolawole
Full Text Available AIM: To describe the epidemiology and outcome of ocular injuries requiring hospital admission in Ladoke Akintola University of Technology Teaching Hospital(LTH, Osogbo, Nigeria.METHODS: Retrospective chart review of all patients hospitalized for ocular injuries at LTH, Osogbo between April 2002 and March 2014 was undertaken. Information extracted from patients records were entered into a pre-designed form. Data were analyzed with Statistical Package for Social Sciences(SPSSversion 20. Logistic regression analysis was used to assess effects of different variables on the visual outcome of ocular injuries after treatment among the subjects. PRESULTS: One hundred and twenty-seven patients were hospitalized at LTH within the study period. The median age was 22.0y(range: 0.5-70.0and male: female ratio 2.6:1. Majority of the injuries(35.2%occurred within the home setting. Of the 127 patients, 74(58.3%had open globe Injuries(OGI, 34(26.8%had closed globe injuries(CGI, 7(5.5%had adnexal injuries, 6(4.7%had ruptured globes, 4(3.1%had chemical injuries, 1(0.8%patient each had retained intraocular foreign body and thermal eye injury. Two-thirds of patients managed for ocular injuries in this series had poor visual outcome. There were statistically significant associations between poor initial visual acuity(OR=13.24and OGI with poor visual outcome(OR=9.16.CONCLUSION: There is an urgent need for health education and, to put in place preventive strategies for ocular injuries. Developing countries need to build up capacity to offer complex anterior and posterior segment surgeries for those with severely injured eyes so as to improve the visual outcomes.
Background Dust exposure is a well-known occupational hazard for terrestrial workers and astronauts alike and will continue to be a concern as humankind pursues exploration and habitation of objects beyond Earth. Humankind’s limited exploration experience with the Apollo Program indicates that exposure to dust will be unavoidable. Therefore, NASA must assess potential toxicity and recommend appropriate mitigation measures to ensure that explorers are adequately protected. Visual acuity is critical during exploration activities and operations aboard spacecraft. Therefore, the present research was performed to ascertain the ocular toxicity of authentic lunar dust. Methods Small (mean particle diameter = 2.9 ± 1.0 μm), reactive lunar dust particles were produced by grinding bulk dust under ultrapure nitrogen conditions. Chemical reactivity and cytotoxicity testing were performed using the commercially available EpiOcularTM assay. Subsequent in vivo Draize testing utilized a larger size fraction of unground lunar dust that is more relevant to ocular exposures (particles testing indicated minimal irritancy potential based on the time required to reduce cell viability by 50% (ET50). Follow-up testing using the Draize standard protocol confirmed that the lunar dust was minimally irritating. Minor irritation of the upper eyelids was noted at the 1-hour observation point, but these effects resolved within 24 hours. In addition, no corneal scratching was observed using fluorescein stain. Conclusions Low-titanium mare lunar dust is minimally irritating to the eyes and is considered a nuisance dust for ocular exposure. No special precautions are recommended to protect against ocular exposures, but fully shielded goggles may be used if dust becomes a nuisance. PMID:22817808
Seyed Ali Tabatabaei
Full Text Available AIM: To report the frequency, associated risk factors and characteristics of cases referred to Farabi Eye Hospital with ocular superglue injuries. METHODS: In a descriptive cross-sectional study conducted between December 2012 and February 2013, patients with ocular superglue injuries were evaluated. Age, sex, educational level, location, time, mechanism, type, site and time of eye injury were gathered through interview using a customized questionnaire. All participants had given consent to undergo thorough eye examination. RESULTS: Over the course of three months, 105 patients with ocular superglue injuries enrolled in the study, including 56(53.3% men and 49(46.7% women with the mean age of 24.7±11.6 (range, 2 to 53y. The right eye, left eye and both eyes were involved in 52%, 42% and 6% of the patients, respectively. Most of injuries had occurred at home (72.4% and at night (55%. More than half of patients (52.4% did not take any primary aids following the ocular injury. Patient carelessness (78.1%, childhood curiosity and lack of parental supervision (11.4%, storing superglue in inappropriate places and inadvertently using superglue as eye drops due to poor vision (2.9%, inadequate awareness of superglue applications [used to stick on artificial nails (3.8%, artificial eyelashes (1.9% and broken tooth (1%] and being assaulted with glue (1% were common risk factors. CONCLUSION: The frequency of ocular superglue injuries in patients referred to Farabi Eye Hospital is relatively high. This finding underlines the importance of public education and awareness about superglue injuries to the eye and taking protective measures and safety strategies in order to prevent these injures.
Harris, Alon; Guidoboni, Giovanna; Arciero, Julia C; Amireskandari, Annahita; Tobe, Leslie A; Siesky, Brent A
To discuss the role of mathematical modeling in studying ocular hemodynamics, with a focus on glaucoma. We reviewed recent literature on glaucoma, ocular blood flow, autoregulation, the optic nerve head, and the use of mathematical modeling in ocular circulation. Many studies suggest that alterations in ocular hemodynamics play a significant role in the development, progression, and incidence of glaucoma. Although there is currently a limited number of studies involving mathematical modeling of ocular blood flow, regulation, and diseases (such as glaucoma), preliminary modeling work shows the potential of mathematical models to elucidate the mechanisms that contribute most significantly to glaucoma progression. Mathematical modeling is a useful tool when used synergistically with clinical and laboratory data in the study of ocular blood flow and glaucoma. The development of models to investigate the relationship between ocular hemodynamic alterations and glaucoma progression will provide a unique and useful method for studying the pathophysiology of glaucoma.
Tenkate, Thomas D
I read with interest a recent paper in your journal by Slagor et al on the risk of cataract in relation to metal arc welding (1). The authors highlight that even though welders are exposed to substantial levels of ultraviolet radiation (UVR), "no studies have reported data on how much UVR welders' eyes are exposed to during a working day. Thus, we do not know whether welders are more or less exposed to UVR than outdoor workers" (1, p451). Undertaking accurate exposure assessment of UVR from welding arcs is difficult, however, two studies have reported ocular/facial UVR levels underneath welding helmets (2, 3). In the first paper, UVR levels were measured using polysulphone film dosimeters applied to the cheeks of a patient who suffered from severe facial dermatitis (2). UVR levels of four times the American Conference of Governmental Industrial Hygienists (ACGIH) maximum permissible exposure (MPE) (4) were measured on the workers left cheek and nine times the MPE on the right cheek. The authors concluded that the workers dermatitis was likely to have been due to the UVR exposure received during welding. In the other paper, a comprehensive exposure assessment of personal UVR exposure of workers in a welding environment was reported (3). The study was conducted at a metal fabrication workshop with participants being welders, boilermakers and non-welders (eg, supervisors, fitters, machinists). Polysulphone film dosimeters were again used to measure UVR exposure of the workers, with badges worn on the clothing of workers (in the chest area), on the exterior of welding helmets, attached to 11 locations on the inside of welding helmets, and on the bridge and side-shields of safety spectacles. Dosimeters were also attached to surfaces throughout the workshop to measure ambient UVR levels. For welding subjects, mean 8-hour UVR doses within the welding helmets ranged from around 9 mJ/cm 2 (3×MPE) on the inside of the helmets to around 15 mJ/cm 2 (5×MPE) on the headband (a
Meera Suresh Joshi
Full Text Available BACKGROUND In India, an estimated 1.5-2.5% children below 2 years of age are developmentally delayed. A higher incidence of ocular disability is seen in these children, refractive errors and strabismus being most common. These can add to the overall burden of health as most of them have developmental comorbidities. The aim of the study is to study the ocular disorders in children with developmental delay. MATERIALS AND METHODS We studied 112 children between the 2-12 years of age diagnosed to have developmental delay. All the subjects underwent a detailed ophthalmic evaluation including visual acuity testing using Snellen’s charts (3m and 6m and Log MAR charts (recorded as per Snellen’s vision testing to maintain uniformity, cycloplegic refraction, torchlight and slit-lamp evaluation and dilated fundus examination. The data was tabulated and represented using bar diagrams, Pie charts and graphs. The results were expressed as percentages. Design-Cross-sectional, observational study. RESULTS 66 boys and 46 girls (total 112 were evaluated. The mean age of the study population was 7.8 years ± 2.4 SD. The aetiology of developmental delay was cerebral palsy (64%, Down syndrome (22%, autism (7%, intellectual disability (4.5% and 1 case each of congenital hypothyroidism and ataxia telangiectasia. The prevalence of ocular disorders was found to be 84.8%, which was slightly higher in girls (87% as compared to boys (83%. Refractive error (79.5% was the commonest ocular disorder followed by strabismus (46.4%. Astigmatism (44.6% was the commonest refractive error, which was divided into myopic astigmatism (19.6%, hyperopic astigmatism (13.8% and mixed astigmatism (11.2%. Simple hyperopia was seen in 21.9% subjects and simple myopia in 12.1%. Exotropia (52% was commoner than esotropia (48%. Other ocular abnormalities included optic atrophy, nystagmus, epicanthal folds, cataract, mongoloid slant, ptosis, telecanthus, conjunctival telangiectasia and
Zillka I. Terrientes
Full Text Available A preliminary baseline epidemiological malaria survey was conducted in the village of Punta Soldado, Colombia. Parasite prevalence and density as well as serological data were obtained from 151 asymptomatic children and adults. Fifty individuals were infected with Plasmodium falciparum. The mean parasite density was 184 parasites/mm3. Greater than 90 of the sample population were P. falciparum antibody positive as detected by the indirect immunofluorescent antibody test (IFAT. The enzyme-linked immunosorbent assay (ELISA was used to detect antibodies against the major merozoite surface protein (MSP-1 of P. falciparum. In this population, anti-MSP-1 antibody concentration is acquired in an age dependent manner with equal immunogenicity to both the N- and C-terminal regions of the molecule. Infection at the time of sampling was associated with a higher anti-MSP-1 antibody concentration than that found in non-infected individuals. Further studies are planned to assess the role of immune and non-immune factors in limiting the number of cases of severe malaria seen in this population.
Franco, Gianfábio Pimentel; de Barros, Alba Lúcia Bottura Leite; Nogueira-Martins, Luiz Antônio; Zeitoun, Sandra Salloum
Nursing residents may experience physical and emotional exhaustion from the daily life of attending the Program. The aim of this study was to determine the Burnout incidence among Nursing Residents. An investigative, descriptive, analytical, longitudinal-prospective study was conducted with 16 Residents over two years. The Maslach Burnout Inventory was used, translated and validated for Brazil, as well as a sociodemographic/occupational data tool. Of all residents, 17.2% showed high rates in Emotional Exhaustion and Depersonalization; 18.8% showed impaired commitment in Personal Accomplishment, 75% of which belonged to specialty areas, such as Emergency Nursing, Adult and Pediatric Intensive Care. Age and specialty area were positively correlated with Personal Accomplishment. One of the Residents was identified with changes in three subscales of the Maslach Burnout Inventory, thus characterized as a Burnout Syndrome patient. Nursing Residents have profiles of disease. Knowing these factors can minimize health risks of these workers.
Meyers, Valerie E.
This slide presentation reviews the use of ocular testing to determine the toxicity of lunar dust. The OECD recommendations are reviewed. With these recommendations in mind the test methodology was to use EpiOcular, tissues derived from normal human epidermal keratinocytes, the cells of which have been differentiated on cell culture inserts to form a multi-layered structure, which closely parallels the corneal epithelium and to dose the tissue with 100 mg dust from various sources. The in-vitro study provides evidence that lunar dust is not severely corrosive or irritating, however, in vitro tests have limitations, and in vivo tests provides a more complete scenario, and information, it is recommended that in vivo tests be performed.
Burcea, M; Avram, Corina-Ioana; Stamate, Alina-Cristina; Malciolu, R; Oprea, S; Zemba, M
The herpes simplex virus is one of the most common pathogens in humans, who are seropositive for the virus in 90% of the cases at the adult age. It determines reccurent infections in more than a third of the population and these infections depend on the immune response of the host. Ocular infections of newborns are due to the herpes simplex virus type 2, meanwhile type 1 is found predominantly at adults; almost all ocular structures can be affected. HSV-1 in the most frequent etiologic agent in infectious anterior uveitis (with the varicelo-zosterian virus) and it is responsible for 6-10% of all cases of anterior uveitis. More than half of the keratouveitides due to HSV will develop intraocular hypertension and open-angle secondary glaucoma, during reccurences and most of them will resolve after proper control of inflammation.
Mariana C. Oliveira
Full Text Available ABSTRACT. Oliveira M.C., Faleiro R.D., Santos C.C.A., Oliveira G.F., Daoualibi Y., Sonne L., Brito M.F. & Ubiali D.G. [Ocular and multicentric T-cell lymphoma in horse.] Linfoma de células T multicêntrico e ocular em equino. Revista Brasileira de Medicina Veterinária, 38(Supl.2:147-151, 2016. Setor de Anatomia Patológica, Departamento Epidemiologia e Saúde Pública, Universidade Federal Rural do Rio de Janeiro, BR 465 Km 7, Seropédica, RJ 23890-000, Brasil. E-mail: email@example.com A 10-year-old gelding, mixed breed had body score condition 3 (1-10, with reluctance to move due to the loss of visual acuity in both eyes, right eye swelling and marked dyspnea. The ophthalmic examination showed no response to threat of reflection, objects test or direct reflection and consensus of both eyes. Examination with visor magnifier and Finoff transilluminator revealed buftalmia, hyphema, aqueous flare, corneal neovascularization and posterior synechiae with irregular bulging of the iris in the right eye and aqueous flare, central anterior synechiae and mature cataract in the left eye. It was found corneal integrity in both eyes with the fluorescein test. Urine sample submitted for PCR to Leptospira sp. resulted negative. Euthanasia was performed after unsuccessful treatment attempts. At necropsy there was a mass in the right eyeball, the pleural surface of the diaphragm and the mesentery. There was multifocal to coalescing whitish nodules between 1 and 4 cm in diameter in the lung, filling about 80% of the lungs’ surface, mainly in the ventral region. Morphology of masses was histopathologically compatible with lymphoma. Anti-CD3 antibody resulted positive in all samples analyzed characterizing immunophenotypic T-cell lymphoma.
Mourao, Arnaldo P.; Campos, Tarcisio P.R.
Radiotherapy is an alternative to ocular enucleation. However, the irradiation of ocular region can bring deleterious effects due to the high doses, mainly in the lens, retina and in the bone structures in growth phase. Brachytherapy instead of teletherapy looks for departuring absorbed doses in tumor minimizing doses in the lens and the adjacent tissues of the eyeball (orbital region), avoiding deleterious effects. Thus, a three-dimensional computational voxel model and an analytical model were coupled, including the heterogeneous properties of the globe and the adjacent tissues. The analytical model was applied to define the thin structures of the ocular globe. This computational model is used to simulate orbital irradiation with ROPES and COMS ophthalmologic plaques placed on the sclera surface filled to ten and eight iodine-125 seeds, respectively. Simulations are performed on the MCNP5 code. The computational simulation allows evaluating how the dose rates are spatially distributed in the orbital volume. The results are normalized to 100% at the maximum dose on the tumor base, and by the applied source activity. The external globe structures receive 0.5% of the maximum internal dose. The crystalline lens dosimetry depends on the position and thickness of the tumor and the plaque diameters. On the present case, 12.75% of maximum dose is found on the lens. The maximum dose is found onto the eyeball, in the vitreous. The present model represents an advance in simulating and predicting absorbed dose on ocular brachytherapy, incorporating anthropomorphic and anthropometric features of the real eyeball. (author)
Shen, Yan; Tu, Jiasheng
Ophthalmic liposomes of ganciclovir (GCV) were prepared by the reverse phase evaporation method, and their ocular pharmacokinetics in albino rabbits were compared with those obtained after dosing with GCV solution. The in vitro transcorneal permeability of GCV liposomes was found to be 3.9-fold higher than that of the solution. After in vivo instillation in albino rabbits, no difference was found in the precorneal elimination rate of GCV from liposome vs solution dosing. The aqueous humor con...
Iragavarapu, Saradha; Gorin, Michael B
This review is intended to summarize the current knowledge from basic science and clinical medical literature cited within PubMed that pertain to gender-related factors and affect those individuals with hereditary ocular disorders. We consider gender-related biological factors that (a) affect disease onset and progression, (b) gender differences for major X-linked ocular disorders, (c) gender-specific conditions, (d) medications that may influence genetic eye disorders, and finally, (e) gender-related issues that influence the management and quality of life of these patients. Several studies have demonstrated the manner in which sex-related hormones in animal models are capable of influencing cell pathway and survival that are likely to affect hereditary eye disorders. There are very few clinical studies that provide compelling evidence for gender differences in human ocular conditions, other than for a number of X-linked disorders. Disease expression for X-linked disorders may be impacted by genetic mechanisms such as lyonization or uniparental disomy. Clinical evidence regarding the impact of gender-related medical conditions and therapies on eye conditions is extremely limited and primarily based on anecdotal evidence. Gender-specific factors may play a major role in the underlying biological pathways that influence the onset, rate of progression, and clinical findings associated with ocular genetic conditions. Clinicians need to be aware of the variable phenotypes observed in female carriers of X-linked disorders of gender specific issues, many of which are inadequately addressed in the current literature. Clinicians need to be sensitive to gender differences in social, cultural, and religious systems and they should also be aware of how their own gender biases may influence how they counsel patients. Finally, it is clear that the lack of effective clinical studies in this area creates an opportunity for future research that will have real benefits for these
Full Text Available Toxoplasma gondii is a protozoan parasite that infects up to a third of the world′s population. Infection is mainly acquired by ingestion of food that is contaminated with oocysts. We report an outbreak of ocular toxoplasmosis, which is an acute acquired type rather than reactivation of congenital toxoplasmosis. Our preliminary investigation points to municipal water contamination. This outbreak only proves the need of an effective public health system and health education in curtailing any outbreak.
Moon, Sunghyuk; Lim, Su-Ho
Background Blank cartridge guns are generally regarded as being harmless and relative safe. However recent published articles demonstrated that the gas pressure from the exploding propellant of blank cartridge is powerful enough to penetrate the thoracic wall, abdominal muscle, small intestine and the skull. And there has been a limited number of case reports of ocular trauma associated with blank cartridge injury. In addition, no report on case with split extraocular muscle injury with traum...
Shen, Yan; Tu, Jiasheng
Ophthalmic liposomes of ganciclovir (GCV) were prepared by the reverse phase evaporation method, and their ocular pharmacokinetics in albino rabbits were compared with those obtained after dosing with GCV solution. The in vitro transcorneal permeability of GCV liposomes was found to be 3.9-fold higher than that of the solution. After in vivo instillation in albino rabbits, no difference was found in the precorneal elimination rate of GCV from liposome vs solution dosing. The aqueous humor concentration-time profiles of both liposomes and solution were well described by 2-compartmental pharmacokinetics with first-order absorption. The area under the curve of the aqueous humor concentration-time profiles of GCV liposomes was found to be 1.7-fold higher than that of GCV solution. Ocular tissue distribution of GCV from liposomes was 2 to 10 times higher in the sclera, cornea, iris, lens, and vitreous humor when compared with those observed after solution dosing. These results suggested that liposomes may hold some promise in ocular GCV delivery.
Ishikawa, H; Liebmann, J M; Uji, Y; Ritch, R
To develop a uniform file format of ocular imaging data, including, but not limited to, ultrasound biomicroscopy, optical coherence tomography, and nerve fiber analyzer, capable of being transmitted via Internet or intranet for collaborative research and telemedicine use. File filters were developed as dynamic link libraries (DLLs). These can read the original raw data format of each ocular imaging device. A data file format was also designed to describe these raw data uniformly in three different types of compression: noncompressed, run length compression, and differential pulse code modulation (DPCM). These three file formats were then tested in the following aspects: file size, speed of reading, and speed of writing. Run length compression failed to compress raw data, while DPCM compressed raw data successfully (DPCM. However, the actual time of reading and writing was fast enough (<0.6 s) for daily work regardless of file compression methods. The format designed has robust potential to be the standard file format for transmission of any ocular imaging raw data.
Rua Martinez, Raul; Perez Garcia, Diley; Alemanny Rubio, Ernesto
The choroidal osteoma is a benign bony tumor described for the first time in 1978 by Gass and collaborators. It is generally unilateral, with juxtapapillary localization and more frequent in young adult females. It presents unknown etiology, but it is associated to different factors as inflammatory processes, congenital malformations, hormonal alterations and ocular traumas among others. The patient was a 54 year-old woman with a personal history of rheumatic fibromyalgia (osteoarthrosis and osteoporosis) and hypertension. Her ophthalmological antecedent showed myopia and arteriolosclerotic retinopathy. At the beginning of the year, she suffered a traffic accident and was injured in her limbs and periocular region. After this, she began feeling blurred vision of the right eye and she went to our service 6 months later. She was performed an ophthalmologic exam. It was found that the right eye had visual acuity of 0.4, and after correction it reached 1.0. Funduscopy revealed vascular thinness, incomplete posterior vitreous detachment, and a white-orange lesion of 3 papillary diameters that involved inferior temporary arcade with well-defined borders. An angiography was performed, which showed sustained hyperfluorescence and non neovascularization; and the optic coherence tomography revealed a halo of serous retinal detachment. Additionally, the ocular ultrasound yielded a high reflectivity echogenic image that involves choroids with posterior acoustic shadow. It is for this reason that we affirm the traumatic etiology of the lesion. This is a rare pathology that should be diagnosed by imaging techniques. Notably, it is secondary to an ocular trauma
Full Text Available Normal tension glaucoma (NTG is known as a multifactorial optic neuropathy characterized by progressive retinal ganglion cell death and glaucomatous visual field loss, even though the intraocular pressure (IOP does not exceed the normal range. The pathophysiology of NTG remains largely undetermined. It is hypothesized that the abnormal ocular blood flow is involved in the pathogenesis of this disease. A number of evidences suggested that the vascular factors played a significant role in the development of NTG. In recent years, the new imaging techniques, fluorescein angiography, color Doppler imaging (CDI, magnetic resonance imaging (MRI, and laser speckle flowgraphy (LSFG, have been used to evaluate the ocular blood flow and blood vessels, and the impaired vascular autoregulation was found in patients with NTG. Previous studies showed that NTG was associated with a variety of systemic diseases, including migraine, Alzheimer’s disease, primary vascular dysregulation, and Flammer syndrome. The vascular factors were involved in these diseases. The mechanisms underlying the abnormal ocular blood flow in NTG are still not clear, but the risk factors for glaucomatous optic neuropathy likely included oxidative stress, vasospasm, and endothelial dysfunction.
Rosa María Naranjo Fernández
Full Text Available La miastenia grave es una enfermedad caracterizada por debilidad y fatiga de los músculos voluntarios debido a una trasmisión anómala a nivel de la unión neuromuscular. La prevalencia es aproximadamente de 5 casos/100 000 personas. La miastenia grave puede ser bulbar, ocular o generalizada.Existen formas clínicas en la infancia como son la miastenia neonatal transitoria, la miastenia congénita y la miastenia juvenil. Los músculos oculares, faciales y bulbares son los más frecuentes afectados por la enfermedad. Cuando los síntomas se limitan a la musculatura cercana al ojo se denomina miastenia grave ocular. Una vez el oftalmólogo diagnostica o sospecha la miastenia grave, un neurólogo generalmente dirige la comprobación y tratamiento. El papel del oftalmólogo continúa siendo importante, además de chequear la motilidad y disfunción palpebral y proporcionar el alivio sintomático para estos desórdenes, debe estar alerta a la posibilidad de ambliopía.
Full Text Available Purpose: To evaluate the demography, aetiology, type and outcome of paediatric ocular trauma in tertiary centre in Malaysia. Method: We retrospectively studied 118 eyes from 117 patients over a period of 36 months (January 2006 to December 2008. All ocular injuries in patients aged 12 and below seen in the Ophthalmology Department for the first time were included in thisstudy. Results: Mean age of patients was 6.1±3.0 years. 68 cases (58.2% occurred in pre-school children, whereas 49 (41.9% in school-aged children. Boys accounted for 65.8% of cases. There was no predilection for either right or the left eye. 47% of cases (56 patients occurred in Malay. Most of the injuries took place at home when the children were alone (p<0.05. Sharp objects were the commonest cause (45 cases, 38.1%. The majority of cases (103, 87.3% were considered preventable. The frequency of open and closed globe injury was similar. Hyphema was more common in closed globe injury compared to open globe injury (p<0.05. Other associated injuries such as cataract, vitreous hemorrhage and retinal hemorrhage are similar between the two groups. Visual outcome is generally poor with only 34 eyes (28.8% had no visual impairment. Conclusion: Ocular trauma in children is an important cause of visual loss. Most cases occurred at home and were preventable. Prevention through education is the best approach.
Morita, Shinroku; Nakano, Takashi; Gomi, Hiromichi
Seventy MeV Proton beam irradiation (beam range:38 mm in the water) was applied for the treatment of 6 patients of ocular melanoma between October 1985 and July 1986 at National Institute of Radiological Sciences(NIRS). The Proton beam has more localized and uniform dose distributions than the electron beams, leading to increased delivery of the dose to tumors with out excess exposure to adjacent normal tissues. Since the accurate treatment planning was necessary for the Proton beam therapy, various studies concerned with the diagnosis of tumor localization using X-CT, MRI or ultrasonography and with the methods for fixation of the body or target using holder or plastic shell were performed. The diagnosis of ocular melanoma was established in the all cases through clinical examinations, such as indirect ophthalmoscopy, fundus photography, fluorescein angiography, ultrasonography and so on. The narrow horizontal Proton beam(10 ∼ 24 mm diameter) was straightly irradiated to the tumor, through the several thicked bolus, avoiding an exposure to the lens. The dose of 30 ∼ 60 Gy/3 ∼ 5 fractions/3 ∼ 5 weeks (TDF 90 ∼ 150) was prescribed. Although the follow up studies in order to estimate the tumor response and the complications are not enough to long to evaluate the results, we believe that Proton beam irradiation is considered to be an excellent therapy for the management of ocular melanomas, alternative to enucleation of affected eye. (author)
Bosch, Jacobus J; Heindl, Ludwig M
Background Malignant melanoma is the most common cancer of the eye in adults that originates either in the intra-ocular uveal tract or extra-ocular conjunctiva. Although the primary tumor can be treated successfully, no effective therapy for both metastatic conjunctival and uveal melanoma currently exits. Tumor-associated lymphangiogenesis and immune cell infiltration play a pivotal role in the development and therapeutic targeting of metastases. Project description Here, we provide an overview of current translational research on lymphangiogenesis and its therapeutic inhibition as well as modulation of immune cell infiltration by passive and active immunotherapy in melanoma of the eye. Specifically, our previous and ongoing work on lymphangiogenesis and immune cells in ocular melanoma within the clinical research unit FOR 2240 "(Lymph)Angiogenesis and Cellular Immunity in Inflammatory Diseases of the Eye" is summarized. Conclusions Translational research on the modulation of tumor-associated lymphangiogenesis and immune cell infiltration could provide novel targets for adjuvant therapy in melanoma of the eye. Georg Thieme Verlag KG Stuttgart · New York.
Full Text Available Ocular inflammation is one of the leading causes of blindness and loss of vision. Human uveitis is a complex and heterogeneous group of diseases characterized by inflammation of intraocular tissues. The eye may be the only organ involved, or uveitis may be part of a systemic disease. A significant number of cases are of unknown etiology and are labeled idiopathic. Animal models have been developed to the study of the physiopathogenesis of autoimmune uveitis due to the difﬁculty in obtaining human eye inflamed tissues for experiments. Most of those models are induced by injection of speciﬁc photoreceptors proteins (e.g., S-antigen, interphotoreceptor retinoid-binding protein, rhodopsin, recoverin, phosducin. Non-retinal antigens, including melanin-associated proteins and myelin basic protein, are also good inducers of uveitis in animals. Understanding the basic mechanisms and pathogenesis of autoimmune ocular diseases are essential for the development of new treatment approaches and therapeutic agents. The present review describes the main experimental models of autoimmune ocular inflammatory diseases.
Weber, Konrad P; Bockisch, Christopher J; Olasagasti, Itsaso; Straumann, Dominik
On close inspection, it can be seen that most saccadic trajectories are not straight but curve slightly; in other words, they are not single-axis ocular rotations. The authors asked whether saccade curvatures are systematically influenced by static ocular counterroll (OCR). OCR was elicited by static whole-body roll position. Eight healthy human subjects performed horizontal and vertical saccades (10 degrees amplitude; 0 degrees and 10 degrees eccentricity; head-fixed coordinate system) in upright and ear-down whole-body roll positions (45 degrees right, 45 degrees left). Three-dimensional eye movements were recorded with modified dual-search coils at 1000 Hz. Saccade curvature was systematically modulated by OCR depending on saccade direction. In the horizontal-vertical plane, primarily vertical saccades were modulated with downward saccades curving toward the upper ear and upward saccades curving toward the lower ear. Modulation of saccade curvature in the torsional direction correlated significantly with OCR only in abducting saccades. No universal mechanism, such as visual-motor coordinate transformation or kinematic characteristics of the saccadic burst generator, alone could explain the complex modulation pattern of saccade curvature. OCR-induced changes of the ocular motor plant, including transient force imbalances between agonist eye muscles (vertical rectus and oblique muscles) and shifting eye muscle pulleys, are suitable to explain the found direction-dependent modulation pattern.
Mansour, A M; Bitar, F F; Traboulsi, E I; Kassak, K M; Obeid, M Y; Megarbane, A; Salti, H I
To describe the ocular findings in subjects with congenital heart disease (CHD). In a prospective study, the same observer examined 240 consecutive patients with CHD admitted to the medical centre. Two independent geneticists performed identification of syndromes. The commonest anatomic cardiac anomalies were ventricular or atrial septal defects (62), tetralogy of Fallot (39), pulmonary stenosis (25), and transposition of the great arteries (24). The heart lesions were divided physiologically into volume overload (90), cyanotic (87), and obstructive (63). In all, 105 syndromic subjects included the velocardiofacial syndrome (18), Down's syndrome (17), CHARGE association (6), DiGeorge syndrome (5), Williams syndrome (3), Edwards syndrome (3), Noonan syndrome (3), VACTERL association (2), and Patau syndrome (trisomy 13) (2). The paediatric team recognized 51 patients as syndromic. Two independent geneticists recognized additional 54 patients as syndromic. Positive eye findings were present in 55% (132) and included retinal vascular tortuosity (46), optic disc hypoplasia (30), trichomegaly (15), congenital ptosis (12), strabismus (11), retinal haemorrhages (8), prominent eyes (7), and congenital cataract (6). There was a strong correlation between the retinal vascular tortuosity and both a low haematocrit (P=0.000) and a low arterial oxygen saturation (P=0.002). Patients with CHD are at a high risk for ocular pathology and need screening for various ocular abnormalities.
Full Text Available BACKGROUND: Systemic Lupus Erythematosus is one of the common autoimmune diseases seen in young patients, predominantly affecting females. OBJECTIVES: The purpose of this prospective study is to determine ocular presentations in SLE METHODS: In this descriptive, prospective, observational, cross sectional study, all patients who presented to the department of dermatology during this study period of 12 months from January 2010 - December 2010 in Belgaum Institute of Medical Sciences were included . RESULTS: Total number of females in the present study was 19(74%, males in the study was 6 (26%. Mean age of the patients was 26.2 ± 2.8 (SD years, maximum age being 36 years and minimum age being 20 years, number of patients in the age group 20 - 25 years was 14 (56%, 26 - 30 years was 6 (24%, 30 - 35 years was 3 (12%, number of patients in 36 - 40 years was 2 (8% Maximum number of patients was in their middle age between 20 - 25 years. Ocular symptoms in present study scelritis was seen in 8(32% patients, episcelritis was seen i n 10(40% patients, conjunctivitis was seen in 5(20% patients, ANA - positive was seen in 20 (80% patients, episcelritis was seen in maximum number of patients i.e. 10 (40%. Distribution of ocular symptoms in present study between two eyes, scelritis was seen in 6(75% in right eye, was seen in 2(25% in left eye, scelritis was seen in 7(70% in right eye, was seen in 3(30% in left eye, conjunctivitis was seen in scelritis was seen in 2 (40% in right eye, was seen in 3(60% in left eye. Ocular symptoms a nd sex distribution, scelritis was seen in 6 (31.57% patients in females, Episcelritis was seen in 8(42.10% females, Conjunctivitis was seen in 5(26.31% males, and ANA positivity was seen in 18 (72% females. Scelritis was seen in 2 (33.33% patients in males, Episcelritis was seen in 2 (33.33% males, Conjunctivitis was not seen in males, and ANA positivity was seen in 2 (8% males. P value of all ocular symptoms is insignificant. P
Athaide, Helaine Vinche Zampar; Campos, Mauro; Costa, Charles
Aging has various effects on visual system. Vision deteriorate, contrast sensitivity decreases and ocular aberrations apparently make the optical quality worse across the years. To prospective evaluate ocular aberrations along the ages. Three hundred and fifteen patients were examined, 155 were male (39.36%) and 160 were female (60.63%). Ages ranged from 5 to 64 year-old, the study was performed from February to November, 2004. Patients were divided into 4 age-groups according to IBGE (Instituto Brasileiro de Geografia e Estatística) classification: 68 patients from 5 to 14 year-old, 55 patients from 15 to 24 year-old, 116 from 25 to 44 year-old and 76 from 45 to 67 year-old. All patients had the following characteristics: best corrected visual acuity > 20/25, emmetropia or spherical equivalent < 3.50 SD, refractive astigmatism < 1.75 CD on cycloplegic refraction, normal ophthalmologic exam and no previous ocular surgeries. This protocol was approved by Federal University of São Paulo Institutional Review Board. Total optical aberrations were measured by H-S sensor LadarWave Custom Cornea Wavefront System (Alcon Laboratories Inc, Orlando, FLA, USA) and were statistically analysed. Corneal aberrations were calculated using CT-View software Version 6.89 (Sarver and Associates, Celebration, FL, USA). Lens aberrations were calculated by subtraction. High-order (0.32 e 0.48 microm) and ocular spherical aberrations (0.02 e 0.26 microm) increased respectively in child and middle age groups. High order (0.27 microm) and corneal spherical aberrations (0.05 microm) did not show changes with age. Lens showed a statistically significant spherical aberration increase (from -0.02 to 0.22 microm). Vertical (from 0.10 to -0.07 microm) and horizontal coma (from 0.01 to -0.12 microm) presented progressively negative values with aging. High-order and spherical aberrations increased with age due to lens contribution. The cornea did not affect significantly changes observed on ocular
Mercede Majdi; Behrad Y. Milani; Asadolah Movahedan; Lisa Wasielewski; Ali R. Djalilian
With decreasing levels of ozone in the atmosphere, we are being exposed to higher levels of ultraviolet radiation (UVR) than ever before. UVR carries higher energy than visible light, and its effects on tissues include DNA damage, gene mutations, immunosuppression, oxidative stress and inflammatory responses. In the eye, UVR is strongly associated with the development of basal and squamous cell carcinoma of the eyelid, pterygium, photokeratitis, climatic droplet keratopathy, ocular surface sq...
Full Text Available Purpose. To assess the repeatability and reproducibility of ocular biometry and intraocular lens (IOL power measurements obtained by ophthalmology residents using an AL-Scan device, a novel optical biometer. Methods. Two ophthalmology residents were instructed regarding the AL-Scan device. Both performed ocular biometry and IOL power measurements using AL-Scan, three times on each of 128 eyes, independently of one another. Corneal keratometry readings, horizontal iris width, central corneal thickness, anterior chamber depth, pupil size, and axial length values measured by both residents were recorded together with IOL power values calculated on the basis of four different IOL calculation formulas (SRK/T, Holladay, and HofferQ. Repeatability and reproducibility of the measurements obtained were analyzed using the intraclass correlation coefficient (ICC. Results. Repeatability (ICC, 0.872-0.999 for resident 1 versus 0.905-0.999 for resident 2 and reproducibility (ICC, 0.916-0.999 were high for all biometric measurements. Repeatability (ICC, 0.981-0.983 for resident 1 versus 0.995-0.996 for resident 2 and reproducibility were also high for all IOL power measurements (ICC, 0.996 for all. Conclusions. The AL-Scan device exhibits good repeatability and reproducibility in all biometric measurements and IOL power calculations, independent of the operator concerned.
College Planning & Management, 2003
Describes four examples of residence hall design, one renovation and three new residence halls, that exemplify design principles that meet student and institutional requirements. The examples are at (1) the University of Illinois at Chicago; (2) Bowdoin College; (3) Muhlenberg College; and (4) Spring Arbor University. (SLD)
Outlines the author's experience as a dancer and choreographer artist-in-residence with third graders at a public elementary school, providing a cultural arts experience to tie in with a theme study of the rain forest. Details the residency and the insights she gained working with students, teachers, and theme. (SR)
Pokharkar, Varsha; Patil, Vikram; Mandpe, Leenata
Physiologic barriers of the eye, short precorneal drug residence time and poor corneal penetration are the few reasons for reduced ocular bioavailability. This study was aimed to develop novel polymer-surfactant nanoparticles of hydrophilic drug doxycycline hydrochloride (DXY) to improve precorneal residence time and drug penetration. Nanoparticles were formulated using emulsion cross-linking method and the formulation was optimized using factorial design. The prepared formulation was characterized for particle size, ζ potential, encapsulation efficiency, in vitro drug release and ex vivo drug diffusion studies. The antibacterial activity studies were also carried out against Escherichia coli and Staphylococcus aureus using the cup-plate method. In vivo eye irritation study was carried out by a modified Draize test in rabbits. The particle size was found to be in the range of 331-850 nm. About 45-80% of the drug was found to be encapsulated in the nanoparticles. In vitro release demonstrated sustained release profile. Lower flux values in case of nanoparticles as compared to DXY pure drug solution in ex vivo diffusion studies confirmed the sustained release. The nanoparticles were found to be significantly effective (p nanoparticles in both the E. coli and S. aureus strains. The formulation was found to be stable over entire stability period. The developed formulation is safe and suitable for sustained ocular drug delivery.
Reuben, D B
The intense situational and physiologic stresses that accompany postgraduate training may have serious psychosocial ramifications. Although only a small proportion of residents have overt psychiatric illness, virtually all display some psychologic impairment. Contributing factors include life-changes, stresses associated with providing patient care, loss of social support, long working hours, sleep deprivation, and underlying personality traits of residents. The manifestations of this impairment are variable and may be subtle. In response to these problems, residency programs have taken steps to provide psychosocial support. Unfortunately, most programs do not offer formal support groups or seminars to discuss difficulties that accompany residency. Further definition of the psychosocial effects of residency may prompt changes that make the training of physicians a more humane process.
Kim, Joowon; Hwang, Yunji; Kang, Seungheon; Kim, Minhye; Kim, Tae-Shin; Kim, Jay; Seo, Jeongmin; Ahn, Hyojeong; Yoon, Sungjoon; Yun, Jun Pil; Lee, Yae Lim; Ham, Hyunsoo; Yu, Hyeong Gon; Park, Sue K
Smartphone use has dramatically increased in recent years. Smartphones may have adverse health effects, particularly on the eyes, because users stare at the screen for a much longer time than they do with ordinary mobile phones. The objective of this study was to elucidate the relationship between smartphone use and ocular symptoms among adolescents. Information on smartphone use and ocular symptoms (blurring, redness, visual disturbance, secretion, inflammation, lacrimation and dryness) related to eye fatigue and strain from 715 adolescent subjects from three cities in Korea was obtained using a structured questionnaire. Ocular health was scored using number of ocular symptoms. Odds ratios (ORs), 95% confidence intervals (95% CIs) and p-values for ocular symptoms were calculated with binomial and multinomial logistic regression models. Higher prevalence rates for ocular symptoms were observed in groups with greater exposure to smartphones (p smartphone use was associated with a higher likelihood of having multiple ocular symptoms (5-7 symptoms out of 7 symptoms; p = 0.005). Excessive/intermittent use (>2 hours daily and ≤2 hours continuously) and excessive/persistent use (>2 hours daily and >2 hours continuously) compared to shorter use (smartphones was associated with a higher likelihood of having multiple ocular symptoms (OR 3.05, 95% CI 1.51-6.19; p = 0.001). Increasing exposure to smartphones can have a negative impact on ocular health in adolescents.
Hertle, Richard W
The purpose of this report is to summarize an understanding of the ocular motor system in patients with albinism. Other than the association of vertical eccentric gaze null positions and asymmetric, (a) periodic alternating nystagmus in a large percentage of patients, the ocular motor system in human albinism does not contain unique pathology, rather has "typical" types of infantile ocular oscillations and binocular disorders. Both the ocular motor and afferent visual system are affected to varying degrees in patients with albinism, thus, combined treatment of both systems will maximize visual function.
Gregory, Darren G
To describe a new grading system and associated treatment guidelines for the acute ocular manifestations of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Prospective case series. Seventy-nine consecutive patients (158 eyes) evaluated and treated for acute ocular involvement in SJS or TEN during hospitalization. Photographic and chart review of acute ocular findings, interventions received, and outcomes with regard to visual acuity, dry eye symptoms, and scarring sequelae at least 3 months after the acute illness. Visual acuity, dry eye severity, and scarring of the ocular surface and eyelids were assessed after follow-up of at least 3 months. Cases graded as mild or moderate were managed medically. All had best-corrected visual acuity (BCVA) of 20/20, no dry eye symptoms, and no scarring sequelae. Cases graded as severe or extremely severe were treated with urgent amniotic membrane transplantation (AMT) in addition to medical management. Severe cases all had BCVA of 20/20 and mild or no dry eye problems. Five of 28 patients had mild tarsal conjunctival scarring. No other scarring sequelae occurred. Nine of the 10 extremely severe cases had BCVA of 20/20 (1 was 20/30). Three of 10 had moderate scarring of the tarsal conjunctiva and lid margins and also moderate dry eyes with severe photophobia. Seven of 10 had only mild or no dry eye symptoms and scarring sequelae. This grading system facilitates decision making in the evaluation and management of the acute ocular manifestations of SJS and TEN. Mild and moderate cases have a low risk of significant scarring or visual sequelae and may be monitored and treated medically if not worsening. Severe and extremely severe cases should receive urgent AMT to decrease the risk of scarring and visual sequelae. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Jwala, Jwala; Boddu, Sai H S; Shah, Sujay; Sirimulla, Suman; Pal, Dhananjay; Mitra, Ashim K
The objective of this study was to develop and characterize polymeric nanoparticles of appropriate stereoisomeric dipeptide prodrugs of acyclovir (L-valine-L-valine-ACV, L-valine-D-valine-ACV, D-valine-L-valine-ACV, and D-valine-D-valine-ACV) for the treatment of ocular herpes keratitis. Stereoisomeric dipeptide prodrugs of acyclovir (ACV) were screened for bioreversion in various ocular tissues, cell proliferation, and uptake across the rabbit primary corneal epithelial cell line. Docking studies were carried out to examine the affinity of prodrugs to the peptide transporter protein. Prodrugs with optimum characteristics were selected for the preparation of nanoparticles using various grades of poly (lactic-co-glycolic acid) (PLGA). Nanoparticles were characterized for the entrapment efficiency, surface morphology, size distribution, and in vitro release. Further, the effect of thermosensitive gels on the release of prodrugs from nanoparticles was also studied. L-valine-L-valine-ACV and L-valine-D-valine-ACV were considered to be optimum in terms of enzymatic stability, uptake, and cytotoxicity. Docking results indicated that L-valine in the terminal position increases the affinity of the prodrugs to the peptide transporter protein. Entrapment efficiency values of L-valine-L-valine-ACV and L-valine-D-valine-ACV were found to be optimal with PLGA 75:25 and PLGA 65:35 polymers, respectively. In vitro release of prodrugs from nanoparticles exhibited a biphasic release behavior with initial burst phase followed by sustained release. Dispersion of nanoparticles in thermosensitive gels completely eliminated the burst release phase. Novel nanoparticulate systems of dipeptide prodrugs of ACV suspended in thermosensitive gels may provide sustained delivery after topical administration.
Christensen, Mette Krogh; O'Neill, Lotte; Hansen, Dorthe Høgh
Background The majority of studies on prevalence and characteristics of residents in difficulty have been conducted in English-speaking countries and the existing literature may not reflect the prevalence and characteristics of residents in difficulty in other parts of the world such as the Scand......Background The majority of studies on prevalence and characteristics of residents in difficulty have been conducted in English-speaking countries and the existing literature may not reflect the prevalence and characteristics of residents in difficulty in other parts of the world...... such as the Scandinavian countries, where healthcare systems are slightly different. The aim of this study was to examine prevalence and characteristics of residents in difficulty in one out of three postgraduate medical training regions in Denmark, and to produce both a quantifiable overview and in-depth understanding...... of the topic. Methods We performed a mixed methods study. All regional residency program directors (N = 157) were invited to participate in an e-survey about residents in difficulty. Survey data were combined with database data on demographical characteristics of the background population (N = 2399...
Kofoed, Peter Kristian; Munch, Inger Christine; Larsen, Michael
Abstract. Purpose: To report the result of ranibizumab administration in an eye with ocular ischaemic syndrome. Methods: Fluorescein angiography, ocular pneumoplethysmography and retinal vessel calibre measurement. Results: An 85-year-old man with ocular ischaemic syndrome demonstrated vision los...
Parra, Alexander; Mallandrich, Mireia; Clares, Beatriz; Egea, María A; Espina, Marta; García, María L; Calpena, Ana C
This work aimed the design and development of poly(lactic-co-glycolic) acid (PLGA) nanoparticles (NPs) for the ocular delivery of Carprofen (CP) by a central rotatable composite design 2(3)+ star. NPs showed adequate size for ocular administration (189.50 ± 1.67 nm), low polydispersity (0.01 ± 0.01), negative charge surface (-22.80 ± 0.66 mV) and optimal entrapment efficiency (74.70 ± 0.95%). Physicochemical analysis confirmed that CP was dispersed inside the NPs. The drug release followed a first order kinetic model providing greater sustained CP release after lyophilization. Ex vivo permeation analysis through isolated rabbit cornea revealed that a sufficient amount of CP was retained in the tissue avoiding excessive permeation and thus, potential systemic levels. Ex vivo ocular tolerance results showed no signs of ocular irritancy, which was also confirmed by in vivo Draize test. In vivo ocular anti-inflammatory efficacy test confirmed an optimal efficacy of NPs and its potential application in eye surgery. Copyright © 2015 Elsevier B.V. All rights reserved.
Marilita M. Moschos
Full Text Available The aim of this manuscript is to review the action and adverse effects of combined oral contraceptives (COCs on ocular tissues. The percentage of unwanted pregnancies and the subsequent abortions make contraception crucial worldwide. Over 100 million women around the world use common contraceptive methods, including intrauterine devices, combined estrogen and progestin oral contraceptives, as well as progestin only preparations (oral contraceptives, implants or injections. COCs are widely used for contraception, but they are also indicated in menorrhagia, endometriosis, acne and hirsutism, fibroid uterus and premenstrual syndrome. However, they have been associated with high rates of cardiovascular events, venous thromboembolic disease, ischemic strokes and breast cancer. The incidence of COCs-related ocular complications is estimated to be 1 in 230 000, including dry eye symptoms, corneal edema, lens opacities and retinal neuro-ophthalmologic or vascular complications. We may infer that the serious ocular complications of COCs can be prevented by eliminating the estrogen dosage and choosing third-generation progestins. In any case, doctors should take into consideration the systemic and ocular history of the patients before selecting any method of contraception.
Enéias Bezerra Gouveia
Full Text Available A gestação pode causar várias alterações no funcionamento do olho humano, tanto nas condições sistêmicas quanto em doenças oculares, sendo seus efeitos divididos em três categorias: alterações fisiológicas, mudanças em doenças oculares pré-existentes e alterações patológicas. O presente texto propõe uma revisão bibliográfica sobre o tema. Os autores pesquisaram os bancos de dados do PubMed (MEDLINE e LILACS.Pregnancy can cause several alterations in human eye function in healthy condition as well in ocular disease; these effects on the eyes are divided into three categories: physiologic alterations, ocular diseases changes already existing before the pregnancy, and pathological alterations. The present text proposes a bibliographical revision on the theme. The authors researched PubMed (MEDLINE and LILACS databases.
Marta Lucía Muñoz Cardona; Dionis Magnary Vallejo Mesa; José David Paulo Trujillo; Rodrigo Alberto Isaza Bermúdez
The most frequent primary headaches, including migraine variants, and intrinsic optic nerve disorders that produce headache, are reviewed. The latter are often accompanied by autonomic nervous system alterations which lead to vasomotor changes, frequently present in neuralgic processes known as headaches with disautonomic involvement. Epidemiological, semiological, clinical, and therapeutical aspects of different cranial, facial and ocular diseases that produce headache are included. Some phy...
Eduardo Ariel Ramos Gómez
Full Text Available La rehabilitación en oftalmología tiene como función fundamental lograr el máximo aprovechamiento posible del resto visual. El traumatismo ocular es considerado una de las entidades nosológicas frecuentes que conllevan a una rehabilitación visual. Las causas que provocan este tipo de trauma son variadas y dentro de estas, las agresiones con intención de provocar daños con secuelas son muy frecuentes. Es objetivo de esta revisión puntualizar la importancia de la rehabilitación en pacientes con traumatismo ocular e incentivar el buen accionar de todos los oftalmólogos en cuanto a su atención.The main goal of rehabilitation in ophthalmology is to use as much as possible the residual vision. Ocular trauma is considered one of the common diseases that imply visual rehabilitation. The causes of eye injuries are varied; among them assaults with intent to cause damage are the most common. The objective of this article was to point out the importance of rehabilitation in patients with ocular trauma and to encourage all the ophthalmologists to act accordingly.
Laties, A M; Fraunfelder, F T
To date, sildenafil citrate (Viagra) gives every evidence of being a safe drug for the eye despite a series of expressed concerns. A review of how its ocular safety profile has been identified offers insights into the strengths and weaknesses of present systems and resources for judging the ocular safety of Viagra or, for that matter, of any new drug. Such insights include: The great value of careful, informed assessment of preclinical information gleaned from laboratory experiments. By and large, such assessments point the way toward appropriate clinical evaluation. For Viagra, early in its development it was noted that besides exerting a major inhibitory effect on the intended target, the vascular-associated enzyme phosphodiesterase 5 (PDE5), the drug also exerts a lesser but definite inhibitory effect on the closely related PDE6, located in the retina. For this reason, preclinical evaluation of the drug included electroretinography plus postmortem histology. In addition, an extended eye examination was incorporated into clinical protocols. The often chaotic but invaluable information stream that becomes available once marketing approval has been gained and large populations begin to use a drug. False alarms, misattribution, and erroneous information are the order of the day. Nevertheless, as information accumulates, patterns of response clarify and the true nature of special susceptibility for subpopulations, if any, becomes apparent. A role for the astute clinician remains: Subtle changes or unusual risks for subpopulations can be missed entirely for long periods of time. A manifest need for improvement in evaluation of postmarketing side-effects. This need has led to the establishment of a new discipline: pharmacoepidemiology. In ophthalmology, the National Registry of Drug Induced Ocular Side-Effects maintains a constant and invaluable surveillance. Examples are supplied to illustrate each of these major points: Our presentation will include data gleaned from
Ravi Kumar Diddigam
Full Text Available BACKGROUND Worldwide, ocular trauma is an important cause of eye morbidity and a leading cause of non-congenital monocular blindness among children. In general, children are more susceptible to eye injuries because of their immature motor skills, limited common sense, tendency to imitate adult behaviour without evaluating risks, lessened emotional control, relative ignorance, and natural curiosity. Adult supervision is extremely important in preventing accidents. 1 PATIENTS AND METHODS The material for this study consisted of paediatric patients below 15 years of age who presented with history of different types of ocular injuries during the period from March 2007 to February 2010. In all cases, a thorough history was obtained from patients and their parents regarding the circumstances leading to the injury, the exact nature of the event and the object causing the injury. All the patients were also subjected to complete ophthalmic examination and followed up for 6 months. RESULTS 34 (68% were males and 16 (32% were females. The average age was 10.9 years (range 1-15 years. The highest incidence of blunt injuries was seen in age group of 11-15 years (58%. 20 (40% injuries occurred during domestic and leisure activities, 7(14% injuries occurred at work, 13 (26% during sports, 6 (12% were due to assault and 4 (8% from RTAs. CONCLUSION Blunt trauma to the eye causes a wide variety of damage to ocular tissues. Anterior or posterior segments are preferentially involved. Males were observed to be at increased risk for an eye injury necessitating admission to hospital.
Nagra, Manbir; Gilmartin, Bernard; Logan, Nicola S
To determine which biometric parameters provide optimum predictive power for ocular volume. Sixty-seven adult subjects were scanned with a Siemens 3-T MRI scanner. Mean spherical error (MSE) (D) was measured with a Shin-Nippon autorefractor and a Zeiss IOLMaster used to measure (mm) axial length (AL), anterior chamber depth (ACD) and corneal radius (CR). Total ocular volume (TOV) was calculated from T2-weighted MRIs (voxel size 1.0 mm(3)) using an automatic voxel counting and shading algorithm. Each MR slice was subsequently edited manually in the axial, sagittal and coronal plane, the latter enabling location of the posterior pole of the crystalline lens and partitioning of TOV into anterior (AV) and posterior volume (PV) regions. Mean values (±SD) for MSE (D), AL (mm), ACD (mm) and CR (mm) were -2.62±3.83, 24.51±1.47, 3.55±0.34 and 7.75±0.28, respectively. Mean values (±SD) for TOV, AV and PV (mm(3)) were 8168.21±1141.86, 1099.40±139.24 and 7068.82±1134.05, respectively. TOV showed significant correlation with MSE, AL, PV (all p<0.001), CR (p=0.043) and ACD (p=0.024). Bar CR, the correlations were shown to be wholly attributable to variation in PV. Multiple linear regression indicated that the combination of AL and CR provided optimum R(2) values of 79.4% for TOV. Clinically useful estimations of ocular volume can be obtained from measurement of AL and CR. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Leal Fernando Antônio de Macedo
Full Text Available OBJETIVO: Estudar a ocorrência de trauma ocular provocado por corpos estranhos superficiais durante a realização de atividades ocupacionais. MÉTODOS: Estudo prospectivo de pacientes portadores de trauma ocular ocupacional atendidos no serviço de urgência do Hospital Getúlio Vargas (HGV / Universidade Federal do Piauí (UFPI, no período de outubro de 1997 a março de 1999. Os seguintes dados foram coletados: idade, sexo, profissão, olho afetado, atividade realizada durante o trauma, natureza do corpo estranho, localização do mesmo e doença ocorrida. RESULTADOS: Foram estudados 713 pacientes, sendo 686 (96,21% do sexo masculino e 27 (3,79% do sexo feminino. Os pacientes foram acometidos principalmente na terceira década de vida, correspondendo a um total de 312 pacientes (43,75%. Com relação à atividade desenvolvida durante o trauma, 158 pacientes (22,16% eram metalúrgicos, 153 (21,46% serralheiros e 126 (17,67% mecânicos. No tocante ao corpo estranho, 489 (68,58% eram ferro e 47 (6,59% outros metais. Referente a localização, 587 corpos estranhos (81,64% estavam localizados na córnea, 75 (10,43% na conjuntiva tarsal e 49 (6,81% na conjuntiva bulbar. Além dos corpos estranhos 361 (48,39% dos pacientes apresentaram abrasão córneo-conjuntival. CONCLUSÃO: O corpo estranho superficial é importante causa de trauma ocular ocupacional. A atividade desenvolvida principalmente por indivíduos do sexo masculino na metalurgia, serralheria e mecânica foi a principal causa do trauma, sendo o ferro e outros metais os mais freqüentes corpos estranhos encontrados.
Shahid, Khadija; Kolomeyer, Anton M; Nayak, Natasha V; Salameh, Nura; Pelaez, Gina; Khouri, Albert S; Eck, Thomas T; Szirth, Ben
The current U.S. economic recession has resulted in a loss of income, housing, and healthcare coverage. Our major goal in this socioeconomic setting was to provide ophthalmic remote health screenings for urban soup kitchen and homeless populations in order to identify and refer undetected vision-threatening disease (VTD). We assessed visual acuity, blood pressure, pulse/oxygen saturation, body mass index, and intraocular pressure for 341 participants at soup kitchens as part of the homeless outreach program in Newark, NJ. History of diabetes, hypertension, and smoking, last ocular examination, and ocular history were noted. Imaging was performed with an 8.2 megapixel non-mydriatic retinal camera with high-speed Internet ready for off-site second opinion image evaluation. Positive VTD findings were identified in 105 participants (31%) (mean age, 53.6 years), of whom 78% were African American, 73% males, and 62% smokers. We detected glaucoma in 34 participants (32%), significant cataract in 22 (21%), diabetic retinopathy in 5 (5%), optic atrophy in 1 (1%), age-related macular degeneration in 1 (1%), and other retinal findings in 43 (41%). The incidence of VTDs was higher among this cohort than among study groups in previous screenings (31% vs. 12%). This finding shows an increase in ocular morbidity in a younger, at-risk population with elevated rates of hypertension, diabetes, and smoking. Functional visual impairment was 2.5 times higher than the national average (16% vs. 6.4%). Comprehensive, community-based screenings can provide more sensitive detection of VTDs in high-risk groups with low access to ophthalmic care and can be an integral part of recession solutions for improving healthcare.
Liu, Bing; Ding, Li; Xu, Xiaowen; Lin, Hongda; Sun, Chenglong; You, Linjun
Lidocaine hydrochloride ophthalmic gel is a novel ophthalmic preparation for topical ocular anesthesia. The study is aimed at evaluating the ocular and systemic pharmacokinetics of lidocaine hydrochloride 3.5 % ophthalmic gel in rabbits after ocular topical administration. Thirty-six rabbits were randomly placed in 12 groups (3 rabbits per group). The rabbits were quickly killed according to their groups at 0 (predose), 0.0833, 0.167, 0.333, 0.667, 1, 1.5, 2, 3, 4, 6, and 8 h postdose and then the ocular tissue and plasma samples were collected. All the samples were analyzed by a validated LC-MS/MS method. The test result showed that the maximum concentration (C max) of lidocaine in different ocular tissues and plasma were all achieved within 20 min after drug administration, and the data of C max were (2,987 ± 1814) μg/g, (44.67 ± 12.91) μg/g, (26.26 ± 7.19) μg/g, (11,046 ± 2,734) ng/mL, and (160.3 ± 61.0) ng/mL for tear fluid, cornea, conjunctiva, aqueous humor, and plasma, respectively. The data of the elimination half-life in these tissues were 1.5, 3.2, 3.5, 1.9, and 1.7 h for tear fluid, cornea, conjunctiva, aqueous humor, and plasma, respectively. The intraocular lidocaine levels were significantly higher than that in plasma, and the elimination half-life of lidocaine in cornea, conjunctiva, and aqueous humor was relatively longer than that in tear fluid and plasma. The high intraocular penetration, low systemic exposure, and long duration in the ocular tissues suggested lidocaine hydrochloride 3.5 % ophthalmic gel as an effective local anesthetic for ocular anesthesia during ophthalmic procedures.
Full Text Available Subramaniam Suresh1, Saidin Nor-Masniwati1, Muhd Nor Nor-Idahriani1, Wan-Hitam Wan-Hazabbah1, Mohamed Zeehaida2, Embong Zunaina11Department of Ophthalmology, 2Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, MalaysiaBackground: The purpose of this study was to evaluate the immunoglobulin (Ig G avidity of serological toxoplasmosis testing in patients with ocular inflammation and to determine the clinical manifestations of ocular toxoplasmosis.Methods: A retrospective review of all patients presenting with ocular inflammation to the Hospital Universiti Sains Malaysia, Kelantan, Malaysia between 2005 and 2009 was undertaken. Visual acuity, clinical manifestations at presentation, toxoplasmosis antibody testing, and treatment records were analyzed.Results: A total of 130 patients with ocular inflammation were reviewed retrospectively. The patients had a mean age of 38.41 (standard deviation 19.24, range 6–83 years. Seventy-one patients (54.6% were found to be seropositive, of whom five (3.8% were both IgG and IgM positive (suggestive of recently acquired ocular toxoplasmosis while one (0.8% showed IgG avidity ≤40% (suggestive of recently acquired ocular toxoplasmosis and 65 patients (50.0% showed IgG avidity >40% (suggestive of reactivation of toxoplasmosis infection. Chorioretinal scarring as an ocular manifestation was significantly more common in patients with seropositive toxoplasmosis (P = 0.036. Eighteen patients (13.8% were diagnosed as having recent and/or active ocular toxoplasmosis based on clinical manifestations and serological testing.Conclusion: Ocular toxoplasmosis is a clinical diagnosis, but specific toxoplasmosis antibody testing helps to support the diagnosis and to differentiate between reactivation of infection and recently acquired ocular toxoplasmosis.Keywords: ocular toxoplasmosis, chorioretinal scar, toxoplasmosis antibody, IgG avidity test
Eda, I.; Takashima, S.; Kitahara, T.; Ohno, K.; Takeshita, K.
Unusual computed tomographic findings were observed in four patients with congenital ocular motor apraxia (COMA). These (CT) findings were characteristic in the posterior cranial fossa, with a dilated or deformed shape and size of the fourth ventricle, particularly its upper portion. One case revealed partial agenesis of the cerebellar vermis. It was suggested that the four patients subjected to CT showed abnormal topography of the cerebellar vermis or the brain stem. We postulate that these CT findings in COMA may have an important role in its pathogenesis.
Jasper, Smitha; Vedula, Satyanarayana S; John, Sheeja S; Horo, Saban; Sepah, Yasir J; Nguyen, Quan Dong
Ocular infection caused by Toxoplasma gondii, a parasite, may result in inflammation in the retina, choroid, and uvea, and consequently lead to complications such as glaucoma, cataract, and posterior synechiae. The objective of this systematic review was to assess the effects of adjunctive use of corticosteroids to anti-parasitic therapy versus anti-parasitic therapy alone for ocular toxoplasmosis. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register (2016; Issue 11)), MEDLINE Ovid, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, MEDLINE Ovid Daily (January 1946 to December 2016), Embase (January 1980 to December 2016), Latin American and Caribbean Literature on Health Sciences (LILACS (January 1982 to December 2016)), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP; www.who.int/ictrp/search/en). We used no date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 7 December 2016. We had planned to include randomized and quasi-randomized controlled trials. Eligible trials would have enrolled participants of any age who were immunocompetent and were diagnosed with acute ocular toxoplasmosis. Included trials would have compared anti-parasitic therapy plus corticosteroids versus anti-parasitic therapy alone, different doses or times of initiation of corticosteroids. Two authors independently screened titles and abstracts retrieved through the electronic searches. We retrieved full-text reports of studies categorized as 'unsure' or 'include' after we reviewed the abstracts. Two authors independently reviewed each full-text report for eligibility. Discrepancies were resolved through discussion. We identified no completed or ongoing trial that was eligible for this Cochrane review. Although research has identified a wide
Manzari, L; Burgess, A M; Curthoys, I S
Previous evidence shows that the n10 component of the ocular vestibular evoked myogenic potential indicates utricular function, while the p13 component of the cervical vestibular evoked myogenic potential indicates saccular function. This study aimed to assess the possibility of differential utricular and saccular function testing in the clinic, and whether loss of saccular function affects utricular response. Following vibration conduction from the mid-forehead at the hairline, the ocular n10 component was recorded by surface electromyograph electrodes beneath both eyes, while the cervical p13-n23 component was recorded by surface electrodes over the tensed sternocleidomastoid muscles. Fifty-nine patients were diagnosed with probable inferior vestibular neuritis, as their cervical p13-n23 component was asymmetrical (i.e. reduced or absent on the ipsilesional side), while their ocular n10 component was symmetrical (i.e. normal beneath the contralesional eye). The sense organ responsible for the cervical and the ocular vestibular evoked myogenic potentials cannot be the same, as one response was normal while the other was not. Reduced or absent saccular function has no detectable effect on the ocular n10 component. On vibration stimulation, the ocular n10 component indicates utricular function and the cervical p13-n23 component indicates saccular function.
Full Text Available Objective To evaluate the predictive value of ocular trauma score(OTS in mechanical ocular injuries occurring in military forces,and compare the difference of OTS application between ocular injury caused by military training and non-military training.Methods The data of 633 inpatients from armed forces suffering from injury of 665 eyes were retrospectively reviewed.Of the 665 injured eyes,326 were injured during military training and 339 during non-military training.The likelihood of final visual acuity(VA calculated with the OTS score was compared with that by the present OTS study,and the correlation between the score and final VA was then analyzed.Results Compared with the distribution of final VA in standard OTS score,the ratio in category 1 was statistically different in present study(P 0.05.There were significant differences in ratio of category 3 between eyes injured by military and non-military training(P < 0.05,and both ratios in category 1 were significantly different compared with those in standard OTS(P < 0.01,e.g.the ratio of NLP was lower(50% vs 73%,P < 0.01;43% vs 73%,P < 0.01;and the ratio in category 2 was significantly different between the eyes injured by non-military training and standard OTS(P < 0.05.However,the OTS showed positive correlation with final VA in present study(P < 0.0001.Conclusion OTS calculated at initial examination may primarily provide a piece of prognostic information of mechanical ocular injuries,and is of special benefit for deciding a prompt management or for evacuation decision for severe ocular injuries caused by military training.
Discusses the necessity for incorporating current technology in today's college residence halls to meet the more diverse and continued activities of its students. Technology addressed covers data networking and telecommunications, heating and cooling systems, and fire-safety systems. (GR)
Ten researches that may represent the progress in Chinese ocular trauma related studies were selected through voting by specialists from Chinese Ocular Trauma Society. These researches focused on the following fields: new strategies for the treatment of ocular trauma, study of vitreoretinal surgery and new technique application for severe ocular trauma, establishment of animal modal for basic research of ocular trauma, prevention of infectious endophthalmitis, clinical and basic study of ocular chemical burn, establishment of the public service and research platform of ocular trauma. These studies represented the level and influence of Chinese ocular trauma specialists in the international academic community and they were the landmark studies of our areas of expertise.
Tan, Li Li; Sanjay, Srinivasan; Morgan, Philip B
To investigate the inter-image, inter-occasion and inter-examiner repeatability of NEC infrared thermo-tracer TH 9260 in assessing healthy and dry eyes. Ocular surface temperature (OST) was recorded using NEC infrared thermo-tracer TH 9260 on 21 healthy and 15 dry eyes. Data from the right eyes were analyzed. Marking of the ocular surface and OST acquisition was performed using a new 'diamond' demarcation method. Twelve OST indices were obtained at three different time points following a blink: 0s, 5s and 10s. Inter-image, inter-occasion and inter-examiner repeatability of the infrared ocular thermography was evaluated by calculating coefficients of repeatability (COR). Ten out of the twelve tested OST indices had good repeatability with small inter-image variability (%COR: 0.2-0.9), inter-occasion variability (%COR: 2.1-3.7) and inter-examiner variability (%COR: 1.5-3.7) for the three studied time points. Two of the OST indices (temperature standard deviation of the region of interest and radial temperature difference) had poor repeatability with much larger inter-image variability (%COR: 8.9-140.7), inter-occasion variability (%COR: 47.5-153.5) and inter-examiner variability (%COR: 54.7-142.0) for the three studied time points. Most of the metrics adopted in this assessment can be considered to be highly repeatable. Copyright © 2016 British Contact Lens Association. All rights reserved.
can occurs in low‑speed (10–30 mph) collisions.[5,6] They may affect any ocular structure. Blunt ocular trauma may result from the mechanical force of a rapidly deployed airbag directly. Intermediary hard objects such as eyeglasses and pipes may cause penetrating eye injuries.[8‑11] Chemical burns may result from the.
Department of Ophthalmology, Pravara Institute of Medical Sciences and Rural Medical College, Loni, Maharashtra, India .... Inclusion criteria. (1) The patients with suspected posterior segment pathology having an opaque ocular media. (2) The patients with clear ocular media in whom .... Financial support and sponsorship.
Desirée C Murray
Full Text Available Ocular trauma is a significant cause of unilateral blindness in the Caribbean in both adults and children. In Trinidad and Tobago, blunt ocular injury will typically account for around a third of all referrals from the Accident and Emergency department to the ophthalmology unit.
Vernal disease was the commonest ocular morbidity seen constituting 349 cases (40.3%), ocular trauma 152 (17.6%), infective conjunctivitis 106 (12.3%) and refractive errors 89 (10.2%). The location of industries (rice mills, sawmills, cement factory) away from residential areas, availability of antiallergic drugs must be ...
Ocular health is one of the most important but most neglected and underestimated Public Health unit. Visual impairment as a result of ocular health problems play very complex roles in the life of affected persons, its effects include reduced productivity, anxiety and depression, poor learning and development abilities, higher ...
Objective: To report a case of an unusual ocular injury following a road traffic accident. Materials and Methods: A case report of a sixty – year – old female patient seen by the authors. The literature on ocular injures following facial trauma is reviewed. Results: An eye globe initially confirmed missing from its socket on clinical ...
Kijlstra, A.; Pedersen, E.
Despite large advances in the field of ocular toxoplasmosis, large gaps still exist in our knowledge concerning the epidemiology and pathophysiology of this potentially blinding infectious disease. Although ocular toxoplasmosis is considered to have a high health burden, still little is known about
Objective: To determine the optimal time and mode of administration of postoperative analgesics following ocular surgery. Background: Most elective ocular surgery are said to be accompanied by onlymild pain. This knowledge, however, is not available to the prospective patientand this usually results in undue fear of eye ...
This is a prospective study of all cases of motorcycle related accidents with involvement of the eyes seen at the Irrua Specialist Teaching Hospital from January 2005 to December 2005. The study was conducted to assess the severity of ocular trauma, ocular structures mostly affected and initial effect on visual acuity in such ...
Meenken, C.; Assies, J.; van Nieuwenhuizen, O.; Holwerda-van der Maat, W. G.; van Schooneveld, M. J.; Delleman, W. J.; Kinds, G.; Rothova, A.
This study was set up to determine the long term ocular and systemic sequelae in patients with severe congenital toxoplasmosis. Cross sectional and retrospective study of 17 patients with severe congenital toxoplasmosis. In addition to chorioretinitis (100%), the most common abnormal ocular features
Background. A positive Hutchinsonfs sign indicates an increased risk of ocular involvement in herpes zoster ophthalmicus (HZO). We examined the sensitivity of Hutchinsonfs sign as an indicator of ocular involvement in a consecutive series of patients presenting with HZO. Methods. We conducted a descriptive ...
The prevalence of ocular hazards in ophthalmic dispensing industry in south east Nigeria was carried out using 70 subjects drawn from different towns in the region. Tables were used to analyze the data obtained from his study. Results showed that ocular hazards are involved in ophthalmic dispensing depending on the ...
in the elderly. Both hospital and population-based studies indicate a large preponderance of injuries affecting males. (3, 6-8). Various studies show that there is .... and causes of ocular injuries, Grarbet Hospital, Nov. 2009-Oct. 2010. Types of ocular injuries. Sources/ Causes. Tools/ metal. Sharp object. Blunt object. Fall.
Results: Only 103 (26.4%) patients knew the type of diabetes mellitus they were suffering from. Knowledge on ocular effects of diabetes mellitus was low and only 15 (3.8%) knew that it could affect the ocular refraction with no patient mentioning that diabetes mellitus could cause cataract or diabetic retinopathy. Attitude to ...
Background: The work environment of cocoa farmers exposes them to several ocular hazards that predispose them to eye diseases and injuries. However, the extent of ocular injuries and health seeking patterns following these injuries are unknown among cocoa farmers in Ghana. Objectives: To determine the prevalence ...
Abstract. Background: The work environment of cocoa farmers exposes them to several ocular hazards that predispose them to eye diseases and injuries. However, the extent of ocular injuries and health seeking patterns following these injuries are unknown among cocoa farmers in Ghana. Objectives: To determine the ...
Background: Head injuries with ocular involvement are of great importance due to the visual morbidity and mortality which may result. Objective: To determine the pattern of ocular complications among cases of head injury seen in Memphys Hospital for Neurosurgery, Enugu, in south-eastern Nigeria. Patients and Methods: ...
Dr Chijioke Onyeknowu
SUMMARY. Objective: To ascertain the number, types and frequencies of ocular surgeries done at Ebonyi State University Teaching. Hospital (EBSUTH), Abakaliki, with a view to improving the overall surgical uptake. Methods: A retrospective review of ocular surgeries done at. EBSUTH between January 2003 and April ...
Jul 26, 2017 ... Background/Introduction: Macrophthalmia and microphthalmia are cardinal signs of many orbito-ocular and systemic diseases which are seen in northern Nigeria. Some cases of refractive error may also be directly related to the ocular axial length (AL). The need for an imaging parameter that will aid their ...
HIV/AIDS seen at the Sexually Transmitted. Infections/ Human Immunodeficiency Virus. (STI/HIV) clinic during this period was done. Of this number, 125 patients had ocular complications of. HIV/AIDS. The type of ocular manifestation was recorded and investigations/treatment offered noted. Most of these patients were seen ...
Injuries to the face and ocular structures could occur at the war front not only to the enemies, but also to unsuspecting friends of the security agents. We report here a case of ocular injury involving an air force personnel (lance corporal) who was mistakenly hit on the face by the back blast of a rocket‑propelled grenade shot ...
Results: The respondents' reported refraining from interacting with persons afflicted with ocular cancers along these lines: eating together 261/669 (39%), hugging 149/668 (22%), shaking hands 106/561 (19%), laying on the same bed 328/560 (59%), and contracting marriage 462/558 (83%) with ocular cancer patients.
Sabermoghaddam, Ali A; Zarei-Ghanavati, Siamak; Abrishami, Mojtaba
The goal of this study was to compare higher-order aberrations before and after upper lid chalazion excision. Fourteen eyes from 12 patients (8 females, mean age: 28.7 ± 2.7 years) with upper lid chalazion were enrolled in this prospective interventional case series. Chalazia were excised by standard transconjunctival vertical incision. Ocular aberrations were evaluated by aberrometry (ZyWave) before and 2 months after chalazion excision. Root mean square of total higher-order aberrations decreased from 0.67 ± 0.12 to 0.43 ± 0.15 μm (P = 0.012) after excision. The root mean square of Zernike orders in the vertical and horizontal trefoil and horizontal coma were decreased after excision. Orbscan IIz tomography showed a statistically significant decrease in 5 mm zone irregularity (P = 0.027) and an increase in minimum simulated keratometry after surgery (P = 0.046). Chalazion increases higher-order aberrations, as measured by the Hartmann-Shack aberrometer, which could affect the preoperative evaluation and results of refractive surgery, especially wavefront-guided approaches. Chalazion excision could reduce ocular aberrations and is recommended before refractive surgeries.
Full Text Available AIM: To investigatethe relation between axial length(AL, age and ocular parameters.METHODS: A total of 360 subjects(360 eyeswith emmetropia or myopia were recruited. Refraction, center corneal thickness(CCT, AL, intraocular pressure(IOPwere measured by automatic-refractor, Pachymeter, A-mode ultrasound and non-contact tonometer, respectively. Corneal curvature(CC, anterior chamber depth(ACDand white-to-white distance(WWDwere measured by Orbscan II. Three dimensional frequency domain coherent optical tomography(3D-OCTwas used to examine the retinal nerve fiber layer thickness(RNFLT. The Pearson correlation coefficient(rand multiple regression analysis were performed to evaluate the relationship between AL, age and ocular parameters.RESULTS: The average AL was 24.15±1.26mm. With elongation of the AL, spherical equivalent(SE(r=-0.742,Pr=-0.395, Pr=-0.374, Pr=0.411, Pr=0.099, P=0.060and WWD(r=0.061, P=0.252. There was also a significant correlation between AL and age(P=0.001, SE(PPPCONCLUSION: In longer eyes, there is a tendency toward myopia, a flatter cornea, a deeper ACD and a thinner RNFLT. Age is an influencing factor for the AL as well.
Holland, G.N.; O' Connor, G.R.; Diaz, R.F.; Minasi, P.; Wara, W.M.
To investigate the role of cellular immunodeficiency in recurrent toxoplasmic retinochoroiditis, six Cynomolgus monkeys (Macaca fascicularis) with healed toxoplasmic lesions of the retina were immunosuppressed by total lymphoid irradiation. Three months prior to irradiation 30,000 Toxoplasma gondii organisms of the Beverley strain had been inoculated onto the macula of eye in each monkey via a pars plana approach. Toxoplasmic retinochoroiditis developed in each animal, and lesions were allowed to heal without treatment. During total lymphoid irradiation animals received 2000 centigrays (cGy) over a 7-week period. Irradiation resulted in an immediate drop in total lymphocyte counts and decreased ability to stimulate lymphocytes by phytohemagglutinin. Weekly ophthalmoscopic examinations following irradiation failed to show evidence of recurrent ocular disease despite persistent immunodeficiency. Four months after irradiation live organisms were reinoculated onto the nasal retina of the same eye in each animal. Retinochoroidal lesions identical to those seen in primary disease developed in five of six animals. Toxoplasma organisms therefore were able to proliferate in ocular tissue following the administration of immunosuppressive therapy. This study fails to support the hypothesis that cellular immunodeficiency alone will initiate recurrent toxoplasmic retinochoroiditis. Results suggest that reactivation of disease from encysted organisms involves factors other than suppression of Toxoplasma proliferation. If reactivation occurs by other mechanisms, however, cellular immunodeficiency then may allow development of extensive disease.
Holland, G.N.; O'Connor, G.R.; Diaz, R.F.; Minasi, P.; Wara, W.M.
To investigate the role of cellular immunodeficiency in recurrent toxoplasmic retinochoroiditis, six Cynomolgus monkeys (Macaca fascicularis) with healed toxoplasmic lesions of the retina were immunosuppressed by total lymphoid irradiation. Three months prior to irradiation 30,000 Toxoplasma gondii organisms of the Beverley strain had been inoculated onto the macula of eye in each monkey via a pars plana approach. Toxoplasmic retinochoroiditis developed in each animal, and lesions were allowed to heal without treatment. During total lymphoid irradiation animals received 2000 centigrays (cGy) over a 7-week period. Irradiation resulted in an immediate drop in total lymphocyte counts and decreased ability to stimulate lymphocytes by phytohemagglutinin. Weekly ophthalmoscopic examinations following irradiation failed to show evidence of recurrent ocular disease despite persistent immunodeficiency. Four months after irradiation live organisms were reinoculated onto the nasal retina of the same eye in each animal. Retinochoroidal lesions identical to those seen in primary disease developed in five of six animals. Toxoplasma organisms therefore were able to proliferate in ocular tissue following the administration of immunosuppressive therapy. This study fails to support the hypothesis that cellular immunodeficiency alone will initiate recurrent toxoplasmic retinochoroiditis. Results suggest that reactivation of disease from encysted organisms involves factors other than suppression of Toxoplasma proliferation. If reactivation occurs by other mechanisms, however, cellular immunodeficiency then may allow development of extensive disease
Justus G Garweg
Full Text Available Although parasite-mediated host cell lysis is deemed to be an important cause of tissue destruction in ocular toxoplasmosis (OT, the severity of the disease is probably correlated with hypersensitivity and inflammation. Notwithstanding, the mechanisms that regulate the inflammatory process in recurrent OT are poorly understood. Recent evidence has identified interleukin (IL 17 as a marker for disease severity. The ocular and cerebral presence of this cytokine is generally associated with the induction of autoimmune responses in the brain and the eye. Indeed, there are indications that autoimmunity may contribute to clinical variability in the activity of OT. IL-23, which induces the proliferation of IL-17-producing cells and IL-27, which is a counterplayer to IL-17, may regulate T(H-1-cell-mediated responses in OT. The importance of these cytokines in experimental models of uveitis and encephalitis has been recently reported. CD25(+ regulatory T-cells may control the local inflammatory response and protect the host against collateral inflammatory tissue damage. The responses of these cells to OT may be suitably tailored to cope with either an acquired or a congenital aetiology. Knowledge relating to immunoreactivity in OT has grown impressively during the past few years. Its characteristic and variable features have been identified and the potential relevance of autoimmunity has been assessed. In light of this knowledge, potential future treatment options have been considered.
Frane, S L; Sholtz, R I; Lin, W K; Mutti, D O
Acquired nonaccommodative esotropia describes the sudden onset of a constant, comitant strabismus of idiopathic origin in children >6 months of age. We present a case of acquired nonaccommodative esotropia at 20 months of age in a subject participating in the Berkeley Infant Biometry Study, a longitudinal study of emmetropization and ocular component development in infants between 3 months and 3 years of age. Ocular components for this child were normal before the onset of strabismus (within 2 SD's of the mean for orthotropic study participants) for refractive error, corneal power, lens radii, lens power, and ocular axial dimensions. Refractive error postsurgically was significantly more hyperopic and crystalline lens power lower than average at +2.38 D and 37.2 D, respectively. The lack of abnormal ocular parameters is consistent with the idiopathic etiology of acute onset esotropia. This case suggests that ocular component values may not be useful for assessing the risk of acquired nonaccommodative esotropia.
VanDenBerg, C; Murphy, J E
The level of work satisfaction among pharmacists in ASHP-accredited residencies was studied. In March 1996 a questionnaire designed to measure residency satisfaction was mailed to 697 individuals in ASHP-accredited pharmacy practice and specialty practice residencies. Subjects responded to 16 statements relating to intrinsic and extrinsic determinants of work satisfaction on a scale of 1 to 5, where 1 = strongly disagree and 5 = strongly agree. Questionnaires were returned by 413 (59%) of the residents. The respondents were predominantly women (76%), and most (86%) had at least a Pharm. D. degree. Hospitals were the primary work setting (88%). Of the 413 residents, 305 were in pharmacy practice residencies and 108 were in specialized residencies. None of the mean scores indicated disagreement (scores 3) with the negatively worded statements. The median and mode were equal to 2 (disagree) for the three negatively worded items and 4 (agree) for all but three positively worded items. Only 8% of the residents indicated that they would not accept the residency again if given the chance. Specialized residents tended to rate positively worded statements higher and negatively worded statements lower than pharmacy practice residents. Female residents indicated greater satisfaction than male residents. Pay and benefits were rated slightly better than neutral. Pharmacy residents appeared generally satisfied with their residencies. Specialized pharmacy residents were more satisfied than pharmacy practice residents, and women were more satisfied than men.
Full Text Available AIM: To describe the clinical features and microstructural characteristics assessed by in vivo confocal microscopy (IVCM in patients with ocular cicatricial pemphigoid (OCP. METHODS: A descriptive, uncontrolled case series study. Patients diagnosed with OCP were examined by clinical history, slit-lamp biomicroscopy features and IVCM images. The results of direct immunofluorescence (DIF biopsies and indirect immunofluorescence (IIF were also recorded. Local and systemic immunosuppressive therapy were administered and adjusted according to response. RESULTS: A total of 12 consecutive OCP patients (7 male, 5 female; mean age 60.42±10.39y were recruited. All patients exhibited bilateral progressive conjunctival scarring and recurrent chronic conjunctivitis was the most frequent clinical pattern. The mean duration of symptoms prior to diagnosis of OCP was 2.95±2.85y (range: 5mo to 10y. The Foster classification varied from stage I to IV and 20 eyes (83% were within or greater than Foster stage Ⅲ on presentation. Two of the 12 patients (17% demonstrated positive DIF; 3 of the 12 (25% patients reported positive IIF. The mean duration of the follow-up period was 20.17±11.88mo (range: 6 to 48mo. IVCM showed variable degrees of abnormality in the conjuctiva-cornea and conjuctival scarring was detected in all the involved eyes. Corneal stromal cell activation and dendritic cell infiltration presented as ocular surface inflammation, ocular surface keratinization along with the destroyed Vogt palisades was noted in eyes with potential limbal stem cell deficiency. After treatment, remission of ocular surface inflammation was achieved in all the patients, 18 eyes (75% remained stable, 6 eyes (25% had recurrent conjunctivitis and cicatrization in 2 eyes (8% was progressing. CONCLUSION: As an autoimmune disease, OCP manifests as variable degrees of clinical and laboratory abnormalities with both local and systemic immunosuppressive treatment playing
Biondi, Flávia; Dornbusch, Peterson T; Sampaio, Manuella; Montiani-Ferreira, Fabiano
Infrared thermography was used to measure temperature differences of the corneal surface between nasal and temporal limbus regions and central cornea of normal dogs and dogs with keratoconjunctivitis sicca (KCS), in order to establish temperature values in normal canine eyes and in patients with decreased Schirmer tear tests (STT) values. Dogs investigated were all either patients seen at the Veterinary Teaching Hospital of Federal University of Paraná or normal dogs that belonged to the same institution. STT were performed in all eyes. A total of 40 control eyes (STT ≥15 mm/min) and 20 eyes with low STT values (STT ≤14 mm/min) were examined. The mean STT value for eyes with normal STT values was 22.9 ± 3.9 mm/min (mean ± standard deviation), and the mean STT value for eyes with low STT value was 7.2 ± 4.8 mm/min. The mean corneal temperature was significantly lower in eyes with low STT values than in control eyes (P Thermography is a method that can differentiate between eyes with normal and abnormal STT values. In the future, thermography might be incorporated as part of the ophthalmic examination and perhaps become a popular ancillary test for the diagnoses of ocular surface disorders. © 2013 American College of Veterinary Ophthalmologists.
Full Text Available Background: Although ocular trauma is preventable public health problem throughout the world it is still one of the common causes of ophthalmic morbidity and monocular blindness. There are no published studies on pattern and severity of ocular trauma in Uttarakhand. The present study analyzes the pattern and visual outcome of ocular trauma in this region. Methods: Study design: Prospective hospital-based study. Settings: Patients of ocular trauma presenting to Ophthalmology OPD and emergency department of Himalayan Institute of Medical Sciences, Dehradun. Participants: All ocular injury patients seen for the first time during the period January to December 2008. Results: A total of 88 patients, and 103 eyes, were studied. Men had two fold higher rate of ocular injury than women. The mean age of presentation was 31.2 + 13.6 years (range: 6 - 80 years. The predominant age group of patients was 21-40 years, 55.29 % (n = 47. Eye injuries related to road traffic accident were seen in 37.86% of eyes. Industrial workers were more frequently involved in ocular trauma (23.86%. Closed globe injuries were noted in 55 eyes (53.39% and open globe injuries were noted in 40 eyes (38.83%. Eight eyes (7.76% suffered from chemical injuries. The initial presenting visual acuity of patients with blunt ocular trauma was better than penetrating injury. Eye with better visual acuity at presentation had better visual prognosis at 6 months. Conclusion: Ocular injuries were common in young males. Road traffic accidents related eye injuries were noted in significant number of cases. Strict implementation of traffic rules, health education and preventive strategies may help to decrease the occurrence of ocular injuries.
Tzelikis Patrick Frensel de Moraes
Full Text Available OBJETIVO: Avaliar e comparar com a literatura o perfil dos pacientes portadores de colobomas oculares, bem como verificar a acuidade visual, alterações oculares associadas e alterações sistêmicas apresentadas pelos mesmos. MÉTODOS: Foram estudados retrospectivamente 18 pacientes com diagnóstico de coloboma ocular matriculados no serviço de Visão Subnormal do Hospital São Geraldo da Universidade Federal de Minas Gerais (HSG - HCUFMG. Foram avaliados: sexo, idade, raça, história familiar de anomalias oculares, história gestacional, tipo de coloboma, localização, bilateralidade, presença de microftalmia ou anoftalmia, alterações oculares concomitantes, e associação com doenças sistêmicas e acuidade visual. RESULTADO: Dez (55,6% pacientes eram do sexo feminino, 15 (83,3% eram leucodérmicos. A idade variou de 4 a 57 anos, com média de 9,5 anos. Apenas 3 (16,7% apresentavam história familiar para coloboma. Todos apresentavam história gestacional negativa para qualquer intercorrência. Houve acometimento bilateral em 100% dos casos, com microftalmia presente em 6 (33,3% casos. O coloboma foi típico em 14 (77,8% pacientes, sendo o coloboma mais comum o retinocoroidal ocorrendo em 16 (88,9% pacientes. 50% dos pacientes apresentavam o coloboma como achado isolado, e a outra metade associado a alguma doença sistêmica. Em 14 (77,8% pacientes foi encontrado algum tipo de alteração ocular além do coloboma. CONCLUSÃO: O exame oftalmológico completo é muito importante tanto no diagnóstico quanto no prognóstico de pacientes com coloboma, visto que este pode estar associado a uma baixa visual importante, além de poder estar relacionados a diferentes anomalias ou síndromes.
Turgut, Namigar; Karacalar, Serap; Polat, Cengiz; Kıran, Özlem; Gültop, Fethi; Kalyon, Seray Türkmen; Sinoğlu, Betül; Zincirci, Mehmet; Kaya, Ender
The aim of this study is identified the degree of Burnout Syndrome (BOS) and find out its correlation with years of recidency and sociodemograpfic chareacteristics, training, sleeping habits, such as smoking and alcohol consumption. After approval from the Hospital Ethics Committee and obtaining informed consent, First, second, third, fourth and fifth year of recidency staff (n=127) working in our hospital were involved in this study. The standardized Maslach Burnout Inventory (MBI) was used in this study. Fifty six male (44.1%) and seventy one female (55.9%) residents were enroled in this study (Coranbach Alfa(α)=0.873). 57% of the first year residents smokes cigaret and 54% of them use alcohol. 2% of them gets one day off after hospital night shift, 61% of them suffers from disturbed sleep. 60% of them had been stated that they willingly selected their profession. 61% of them prefers talking to friends and 32% of them prefers shopping to overcome stress. There were statistical difference acording to years of recidency in MBI, Emotional Burnout (EB) and desensitisation scale (DS) points. EB scale points of the second year of residency group was statisticaly higher than fourth year of residency group. DS points of second year of residency group was also statisticaly higher than the third and fourth year of residency group. There was no statistical difference between any groups in Personal Success. BOS is a frequent problem during residency in anaesthesia. Appropriate definition and awareness are the first important steps to prevent this syndrome. Further administrative approaches should be evaluated with regard to their effects.
Yamamoto, Satoshi; Tanaka, Pedro; Madsen, Matias Vested
Our goal in this study was to examine Accreditation Council for Graduate Medical Education case logs for Stanford anesthesia residents graduating in 2013 (25 residents) and 2014 (26 residents). The resident with the fewest recorded patients in 2013 had 43% the number of patients compared with the...
Ng, Victor K; Burke, Clarissa A; Narula, Archna
To examine Canadian family medicine residents' perspectives surrounding teaching opportunities and mentorship in teaching. A 16-question online survey. Canadian family medicine residency programs. Between May and June 2011, all first- and second-year family medicine residents registered in 1 of the 17 Canadian residency programs as of September 2010 were invited to participate. A total of 568 of 2266 residents responded. Demographic characteristics, teaching opportunities during residency, and resident perceptions about teaching. A total of 77.7% of family medicine residents indicated that they were either interested or highly interested in teaching as part of their future careers, and 78.9% of family medicine residents had had opportunities to teach in various settings. However, only 60.1% of respondents were aware of programs within residency intended to support residents as teachers, and 33.0% of residents had been observed during teaching encounters. It appears that most Canadian family medicine residents have the opportunity to teach during their residency training. Many are interested in integrating teaching as part of their future career goals. Family medicine residencies should strongly consider programs to support and further develop resident teaching skills.
Alejandro Arias Díaz
Full Text Available Se realizó una descripción de los aspectos clínicos y el manejo terapéutico del trauma ocular en edades pediátricas. Se identifican las particularidades a abordar en estos pacientes con presencia de cataratas traumáticas y/o heridas penetrantes corneales, por las diferencias en el manejo de las mismas en estas edades y en la adultez. Se hace énfasis en el hifema traumático.The clinical aspects and the treatment management of the ocular trauma at pediatric ages were described. Those particularities to be taken into account when approaching these patients who suffer traumatic cataracts and/or penetrating corneal injuries were indentified, on the account of the differences in the management of this disease between children and adults. Emphasis was made on the description of traumatic hyphema.
Sílvia Ligório Fialho
Full Text Available O método mais comum de administração de drogas no olho é por meio de colírios. Entretanto, por este método, não é possível atingir a concentração terapêutica nos fluidos e tecidos posteriores do olho. A administração sistêmica apresenta reduzido acesso ao segmento posterior do olho devido à presença das barreiras oculares. Injeções subconjuntivais e retrobulbares não são capazes de proporcionar níveis adequados da droga, e a injeção intravítrea é método invasivo, inconveniente e que apre-senta riscos de perfuração do bulbo ocular ou descolamento da retina. A iontoforese, no entanto, apresenta-se como alternativa para o transporte de doses terapêuticas de drogas para o segmento posterior do olho. A iontoforese é uma técnica que consiste na administração de drogas para o organismo através dos tecidos, utilizando um campo elétrico. O eletrodo ativo, que se encontra em contato com a droga, é colocado no local a ser tratado, e um segundo eletrodo, com a finalidade de fechar o circuito elétrico, é colocado em outro local do organismo. O campo elétrico facilita o transporte da droga, que deve se encontrar, preferencialmente, na forma ionizada. A iontoforese pode ser considerada como um método seguro e não invasivo de transporte de drogas para locais específicos do olho. Aplicada experimentalmente para o tratamento de doenças oculares, esta técnica tem evoluído muito nos últimos anos e, atualmente, testes clínicos de fase III encontram-se em andamento.The most traditional method of ocular drug delivery is through the use of eyedrops. However, by this method, the therapeutic concentration in deep ocular fluids and tissues can not be efficiently reached. Systemic administration presents poor access to the posterior segment of the eye due to ocular barriers. Subconjuntival and retrobulbar injections are not able to produce adequate levels of the drug, and intravitreal injection is an invasive and problematic
Full Text Available The use of parenteral antibiotic eye drop formulations with non-marketed compositions or concentrations, commonly called fortified antibiotic eye drops, is a common practice in Ophthalmology in the hospital setting. The aim of this study was to evaluate the in vitro ocular toxicity of the main fortified antibiotic eye drops prepared in the Hospital Pharmacy Departments. We have conducted an in vitro experimental study in order to test the toxicity of gentamicin, amikacin, cefazolin, ceftazidime, vancomycin, colistimethate sodium and imipenem-cilastatin eye drops; their cytotoxicity and acute tissue irritation have been evaluated. Cell-based assays were performed on human stromal keratocytes, using a cell-based impedance biosensor system [xCELLigence Real-Time System Cell Analyzer (RTCA], and the Hen’s Egg Test for the ocular irritation tests. All the eye drops, except for vancomycin and imipenem, have shown a cytotoxic effect dependent on concentration and time; higher concentrations and longer exposure times will cause a steeper decline in the population of stromal keratocytes. Vancomycin showed a major initial cytotoxic effect, which was reverted over time; and imipenem appeared as a non-toxic compound for stromal cells. The eye drops with the highest irritating effect on the ocular surface were gentamicin and vancomycin. Those antibiotic eye drops prepared at the Hospital Pharmacy Departments included in this study were considered as compounds potentially cytotoxic for the ocular surface; this toxicity was dependent on the concentration used
Nakano, Satoko; Sugita, Sunao; Tomaru, Yasuhiro; Hono, Ayumi; Nakamuro, Takako; Kubota, Toshiaki; Takase, Hiroshi; Mochizuki, Manabu; Takahashi, Masayo; Shimizu, Norio
To establish and evaluate a new multiplex solid-phase strip polymerase chain reaction (strip PCR) for concurrent detection of common ocular infectious disease pathogens. A new multiplex strip PCR was established to detect 24 common ocular infectious disease pathogens: herpes simplex virus (HSV) 1, HSV2, varicella-zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpes virus (HHV) 6, HHV7, HHV8, human T-cell lymphotropic virus (HTLV)-1, adenovirus, Mycobacterium tuberculosis, Treponema pallidum, Propionibacterium acnes (P. acnes), bacterial 16S ribosomal RNA (rRNA), Candida species (Candida sp.), C. glabrata, C. krusei, Aspergillus, Fusarium, fungal 28S rRNA, Toxoplasma (T. gondii), Toxocara, Chlamydia trachomatis (C. trachomatis), and Acanthamoeba. Strip PCR was tested with a negative control (distilled water) and standard positive control DNA. Cutoffs of quantification cycle (Cq) values were determined with noninfectious ocular samples to avoid false-positives caused by contamination with P. acnes, bacterial 16S, and fungal 28S from reagents and ocular surfaces. A pilot study to evaluate the strip PCR was performed using infectious ocular samples (aqueous humor, vitreous, cornea, and tears) by strip PCR and previously developed capillary-type multiplex PCR and quantitative real-time PCR (qPCR). Strip PCR was verified with negative and positive controls. Strip PCR rapidly detected HSV1, HSV2, VZV, EBV, CMV, HHV6, HHV7, HTLV-1, adenovirus, P. acnes, bacterial 16S, Candida sp., C. glabrata, Aspergillus, fungal 28S, T. gondii, C. trachomatis, and Acanthamoeba in patient samples. The sensitivity was comparable to that of qPCR. Our novel strip PCR assay is a simple, rapid, and high-sensitivity method for detecting ocular infectious disease pathogens.
Marta Lucía Muñoz Cardona
Full Text Available The most frequent primary headaches, including migraine variants, and intrinsic optic nerve disorders that produce headache, are reviewed. The latter are often accompanied by autonomic nervous system alterations which lead to vasomotor changes, frequently present in neuralgic processes known as headaches with disautonomic involvement. Epidemiological, semiological, clinical, and therapeutical aspects of different cranial, facial and ocular diseases that produce headache are included. Some physiopathological elements that may help to analyze painful craniofacial processes are discussed. Secondary headaches and common facial neuralgias, on the other hand, are also considered because they may confuse the differential diagnosis. Se revisan las cefaleas primarias más frecuentes que comprometen las estructuras oculares y vecinas al globo ocular, las variantes de la migraña y las alteraciones propias del nervio óptico que alteran la función visual y que se acompañan no solamente de síntomas dolorosos sino también de trastornos vasomotores debidos a alteraciones del sistema nervioso autónomo que suelen ser comunes en algunos procesos neurálgicos llamados ahora cefaleas con compromiso disautonómico. En este artículo se comentan los elementos epidemiológicos de las diferentes enfermedades craneales, faciales y oculares que cursan con cefalea; las diferencias clínicas entre las mismas y su presentación semiológica, al igual que algunos elementos terapéuticos. Se discuten además algunos elementos fisiopatológicos de gran utilidad en el análisis de los procesos dolorosos craneofaciales y el perfil temporal de los mismos; también se comentan algunas cefaleas secundarias que comparten con las primarias elementos que se prestan a confusión en la clínica. Finalmente, se hace un análisis de las neuralgias faciales comunes.
Aggarwal, Himanshi; Kumar, Pradeep; Singh, Raghuwar Dayal
When an enucleation or exenteration procedure removes the entire orbital contents but not the eyelids, an abnormally large orbital socket is created that would require an equally sized volume enhancing, flush fitting ocular prosthesis. The solid acrylic prosthesis would rest on or in the lower fornix and owing to its weight, causes distortion of the lower eyelid and/or asymmetrical alignment of the entire palpebral fissure. The aim of this article was to describe a method of fabricating a pne...
Otermat, J.E.; Wikoff, W.O.; Kovach, J.L.
The residence time calculations of ASME AG-1 Code, Section FC, currently specify a screen surface area method, that is technically incorrect. Test data has been obtained on Type II adsorber trays of different configurations to establish residence time in the adsorber trays. These data indicate that the air volume/carbon volume ratio or the average screen area are more appropriate for the calculation of the residence time calculation than the currently used, smallest screen area basis.
Otermat, J.E.; Wikoff, W.O.; Kovach, J.L.
The residence time calculations of ASME AG-1 Code, Section FC, currently specify a screen surface area method, that is technically incorrect. Test data has been obtained on Type II adsorber trays of different configurations to establish residence time in the adsorber trays. These data indicate that the air volume/carbon volume ratio or the average screen area are more appropriate for the calculation of the residence time calculation than the currently used, smallest screen area basis
Li, Mengshuang; Xin, Meng; Guo, Chuanlong; Lin, Guiming; Wu, Xianggen
A stable topical ophthalmic curcumin formulation with high solubility, stability, and efficacy is needed for pharmaceutical use in clinics. The objective of this article was to describe a novel curcumin containing a nanomicelle formulation using a polyvinyl caprolactam-polyvinyl acetate-polyethylene glycol (PVCL-PVA-PEG) graft copolymer. Nanomicelle curcumin was formulated and optimized and then further evaluated for in vitro cytotoxicity/in vivo ocular irritation, in vitro cellular uptake/in vivo corneal permeation, and in vitro antioxidant activity/in vivo anti-inflammatory efficacy. The solubility, chemical stability, and antioxidant activity were greatly improved after the encapsulation of the PVCL-PVA-PEG nanomicelles. The nanomicelle curcumin ophthalmic solution was simple to prepare and the nanomicelles are stable to the storage conditions, and it had good cellular tolerance. Nanomicelle curcumin also had excellent ocular tolerance in rabbits. The use of nanomicelles significantly improved in vitro cellular uptake and in vivo corneal permeation as well as improved anti-inflammatory efficacy when compared with a free curcumin solution. These findings indicate that nanomicelles could be promising topical delivery systems for the ocular administration of curcumin.
Little, Julie-Anne; McCullough, Sara J; Breslin, Karen M M; Saunders, Kathryn J
The interaction between higher order ocular aberrations (HOA) and refractive error is not yet fully understood. This study investigated HOA in relation to refractive error and ocular biometric parameters in a population with a high prevalence of ametropia. The HOA were investigated in two cohorts of Caucasian children aged 9 to 10 and 15 to 16 years (n = 313). These aberrations were measured for a 5-mm pupil with the IRX3 aberrometer. Cycloplegic refractive error and ocular biometry measures, including axial length and corneal curvature, also were assessed with the Shin-Nippon SRW-5000 auto-refractor and Zeiss IOLMaster, respectively. Participants were divided into refractive groups for analysis of HOA. The magnitude of total HOA was higher in this population at 0.27 μm (interquartile range [IQR], 0.22-0.32 μm) than other HOA reported in the literature. The profile of HOA was not significantly different across the two age cohorts or across refractive groups, nor did spherical aberration differ significantly with age (Z₄⁰ = 0.07 μm for both cohorts). Multivariate linear regression analysis demonstrated spherical aberration was significantly related to axial length (but not refractive grouping), with longer eyes having less positive values of fourth order and root mean square (RMS) spherical aberration. This study found no significant difference in HOA across refractive groups. The current study also highlights the importance of knowledge of axial length when analyzing HOA. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.