- Email: [email protected]
Evaluation of Wettability of Diseased Conjunctiva in Superior Limbic Keratoconjunctivitis
TEAR FILM & OCULAR SURFACE EVALUATION OF WETTABILITY OF DISEASED CONJUNCTIVA IN SUPERIOR LIMBIC KERATOCONJUNCTIVITIS. Aoi Komuro,1,2 Norihiko Yokoi, Kunio Maruyama, Shigeru Kinoshita.2 Rakuwakai Marutamachi Hospital, Kyoto, Japan1; Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.2 Purpose. To evaluate wettability of the diseased superior conjunctiva in superior limbic keratoconjunctivitis (SLK) and its recovery after a new operation for SLK to eliminate the conjunctivochalasis of the diseased conjunctiva (Yokoi, et al. AJO 135, 2003). Methods. Nineteen eyes of eleven clinically-diagnosed superior limbic keratoconjunctivitis (SLK) patients [1 male and 10 females; 49.7±11.6 (mean±SD) yrs.] with no aqueous tear deficiency (Schirmer I test > 5mm) were enrolled and they were divided into three groups: A: preoperative group (10 eyes); B: postoperative group (6 eyes), C: pre- and post-operative group (3 eyes). The wettability of the diseased conjunctiva was evaluated by the observation of the fluidity of tear film lipid layer using tear film interferometer DR-1® (Kowa, Japan) at the diseased conjunctiva at the time of upward drawing of the upper lid; and the fluidity was evaluated as good (smooth fluidity assuring wettable surface) or poor (unsmooth fluidity implying unwettable surface). Within the same lesion where the DR-1® observation was performed, impression cytology was done in 8 preoperative eyes (groups B: 5 eyes and C: 3 eyes) and 9 postoperative eyes (groups B: 6 eyes and C: 3 eyes) just after the examination. Results. In 9 out of 10 eyes in group A and all 3 preoperative eyes in group C, the wettability of the diseased conjunctiva was poor, but was good in 5 out of 6 eyes in group B and all 3 postoperative eyes in group C, showing significant difference between those pre- and postoperative eyes (p<0.05). Moreover, in group C, the wettability of the diseased conjunctiva was improved in all 3 eyes after the operation. Also, impression cytology disclosed the loss of goblet cells in all 8 preoperative eyes, in contrast, in 6 eyes out of 9 postoperative eyes, goblet cells were demonstrated (p<0.05) with good wettability of the diseased conjunctiva (p<0.05). Conclusions. From the present study, it was shown that in SLK, the diseased superior conjunctiva showed a decreased wettability, which might be associated with the loss of goblet cells; and a new operation would help in resolving the vicious cycle between tear film and diseased conjunctival epithelium.
INCREASED TEAR FILM LIPID LAYER THICKNESS WITH THE USE OF TWO NOVEL LUBRICATING EYEDROPS. Donald R. Korb,1 Robert C. Scaffidi,2 Jack V. Greiner,2,3 Kenneth R. Kenyon,2,3 John P. Herman,4 Caroline A. Blackie,1 Courtney L. Case,1 Teresa Douglass,1 Victor M. Finnemore.1 Korb Associates, Boston, MA USA;1 Schepens Eye Research Institute, Boston, MA USA;2 Department of Ophthalmology, Harvard Medical School, Boston, MA USA; 3 Pittsfield Eye Associates, Pittsfield, MA USA.4 Purpose. Since tear film lipid layer thickness (LLT) has been correlated to the presence of dry eye symptoms, this study was conducted to determine the maximum increase in LLT with the use of two novel products, Soothe¥ and Systane¥, designed for the lubrication of dry eye. Specifically, the effect of a single eyedrop on the LLT of subjects reporting symptoms indicative of dry eye states was measured. Methods. A double blind, internally paired study was performed. A custom tear film apparatus, enabling characterization of lipid layer interference patterns, was used to quantify the LLT (OU) of eligible subjects. Subjects (n=40) received a single drop of Soothe¥ in one eye and a single drop of Systane¥ in the other eye. Test drops were supplied in masked identical opaque eye dropper bottles. The LLT of all subjects, following the instillation of each test drop, was analyzed. Inclusion criteria included: 1) subjective report confirming dry eye symptoms and 2) LLT < 75 nm, with variability no greater than r 15 nm in each eye or between an individual pair of eyes, over a 15 minute observation period. Results. The mean r standard error baseline LLT findings pre-eyedrop instillation were 72 r 1.6 nm for eyes treated with Soothe¥, and 73 r 1.5 nm for eyes treated with Systane¥. These means were not significantly different (p > 0.5). Post-eyedrop instillation, the mean LLT for eyes treated with Soothe¥ increased to 135 r 1.7 nm, and for Systane¥ to 85 r 1.9 nm. The LLT increase from Soothe¥ was significantly greater than that from Systane¥ (p < 0.0001). Conclusions. In subjects with symptoms indicative of dry eye states and with LLT < 75 nm, one eyedrop of Soothe¥ resulted in a significant increase in LLT when compared to that resulting from Systane¥. Commercial Relationship. Ocular Research of Boston, Inc. (ORB) and Alimera Sciences, Inc. Dr. Korb and Dr. Greiner have a financial interest in ORB, Inc
TIME-DEPENDENT MORPHOLOGIC CHANGES IN THE CONJUNCTIVA AFTER LASIK SURGERY. Keiko Konomi,1 Li-li Chen,1 Rachel S. Tarko,1 Amy Scally,2 Debra Schaumberg,3 Dimitri Azar,2 Darlene A. Dartt.1 Schepens Eye Research Institute and Harvard Medical School, Boston MA USA;1 Massachusetts Eye and Ear Infirmary, Boston MA USA;2 Division of Preventive Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston MA USA.3 Purpose. To investigate the morphologic changes in epithelial cells of the conjunctiva after LASIK surgery and to determine the time-course of this change. Methods. The study consisted of 25 patients who underwent LASIK surgery in one eye. (males: 12, females :13) Ages ranged from 21 to 39 years. Impression cytology from nasal and superior bulbar conjunctiva was performed twice within two weeks before LASIK surgery and at 1, 12, and 36 weeks after surgery. Samples were stained with periodic acidSchiff’s reagent. Mean nucleus-to-cytoplasm ratio of non goblet cells (N/C ratio) and mean goblet cell density (GCD) at each visit were graded using both Nelson’s and Tseng’s classification. Results. At the preoperative visits, the N/C ratio in superior conjunctiva was 0.404 and that in nasal conjunctiva was 0.343. The GCD in superior conjunctiva was 83.6 cells /mm2 and that in nasal conjunctiva was 67.4 cells /mm2. At these visits, the mean Nelson’s grade in superior conjunctiva was 0.50 and that in nasal conjunctiva was 1.01. The mean Tseng’s staging in superior conjunctiva was 0.76 and that from nasal conjunctiva was 1.37. The N/C ratio and the GCD decreased at 1week after LASIK surgery by 13.4% and 61.2% in superior conjunctiva, 9.0% and 59.7% in nasal conjunctiva. These values appeared to recover gradually returning to the preoperative level 36 weeks after surgery. Changes in the N/C ratio and the GCD appeared to be greater in the superior conjunctiva than in the nasal conjunctiva. Conclusions. LASIK surgery changes the morphology of the conjunctival epithelial cells, but these changes appear to return to preoperative levels with time. Commercial Relationship(s): None; Support: DAMD 17-01-2-0032
THE OCULAR SURFACE / JANUARY, 2005, VOL. 3, NO. 1 / SUPPLEMENT
S83
INCREASED TEAR FILM LIPID LAYER THICKNESS WITH THE USE OF TWO NOVEL LUBRICATING EYEDROPS. Donald R. Korb,1 Robert C. Scaffidi,2 Jack V. Greiner,2,3 Kenneth R. Kenyon,2,3 John P. Herman,4 Caroline A. Blackie,1 Courtney L. Case,1 Teresa Douglass,1 Victor M. Finnemore.1 Korb Associates, Boston, MA USA;1 Schepens Eye Research Institute, Boston, MA USA;2 Department of Ophthalmology, Harvard Medical School, Boston, MA USA; 3 Pittsfield Eye Associates, Pittsfield, MA USA.4 Purpose. Since tear film lipid layer thickness (LLT) has been correlated to the presence of dry eye symptoms, this study was conducted to determine the maximum increase in LLT with the use of two novel products, Soothe¥ and Systane¥, designed for the lubrication of dry eye. Specifically, the effect of a single eyedrop on the LLT of subjects reporting symptoms indicative of dry eye states was measured. Methods. A double blind, internally paired study was performed. A custom tear film apparatus, enabling characterization of lipid layer interference patterns, was used to quantify the LLT (OU) of eligible subjects. Subjects (n=40) received a single drop of Soothe¥ in one eye and a single drop of Systane¥ in the other eye. Test drops were supplied in masked identical opaque eye dropper bottles. The LLT of all subjects, following the instillation of each test drop, was analyzed. Inclusion criteria included: 1) subjective report confirming dry eye symptoms and 2) LLT < 75 nm, with variability no greater than r 15 nm in each eye or between an individual pair of eyes, over a 15 minute observation period. Results. The mean r standard error baseline LLT findings pre-eyedrop instillation were 72 r 1.6 nm for eyes treated with Soothe¥, and 73 r 1.5 nm for eyes treated with Systane¥. These means were not significantly different (p > 0.5). Post-eyedrop instillation, the mean LLT for eyes treated with Soothe¥ increased to 135 r 1.7 nm, and for Systane¥ to 85 r 1.9 nm. The LLT increase from Soothe¥ was significantly greater than that from Systane¥ (p < 0.0001). Conclusions. In subjects with symptoms indicative of dry eye states and with LLT < 75 nm, one eyedrop of Soothe¥ resulted in a significant increase in LLT when compared to that resulting from Systane¥. Commercial Relationship. Ocular Research of Boston, Inc. (ORB) and Alimera Sciences, Inc. Dr. Korb and Dr. Greiner have a financial interest in ORB, Inc
TIME-DEPENDENT MORPHOLOGIC CHANGES IN THE CONJUNCTIVA AFTER LASIK SURGERY. Keiko Konomi,1 Li-li Chen,1 Rachel S. Tarko,1 Amy Scally,2 Debra Schaumberg,3 Dimitri Azar,2 Darlene A. Dartt.1 Schepens Eye Research Institute and Harvard Medical School, Boston MA USA;1 Massachusetts Eye and Ear Infirmary, Boston MA USA;2 Division of Preventive Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston MA USA.3 Purpose. To investigate the morphologic changes in epithelial cells of the conjunctiva after LASIK surgery and to determine the time-course of this change. Methods. The study consisted of 25 patients who underwent LASIK surgery in one eye. (males: 12, females :13) Ages ranged from 21 to 39 years. Impression cytology from nasal and superior bulbar conjunctiva was performed twice within two weeks before LASIK surgery and at 1, 12, and 36 weeks after surgery. Samples were stained with periodic acidSchiff’s reagent. Mean nucleus-to-cytoplasm ratio of non goblet cells (N/C ratio) and mean goblet cell density (GCD) at each visit were graded using both Nelson’s and Tseng’s classification. Results. At the preoperative visits, the N/C ratio in superior conjunctiva was 0.404 and that in nasal conjunctiva was 0.343. The GCD in superior conjunctiva was 83.6 cells /mm2 and that in nasal conjunctiva was 67.4 cells /mm2. At these visits, the mean Nelson’s grade in superior conjunctiva was 0.50 and that in nasal conjunctiva was 1.01. The mean Tseng’s staging in superior conjunctiva was 0.76 and that from nasal conjunctiva was 1.37. The N/C ratio and the GCD decreased at 1week after LASIK surgery by 13.4% and 61.2% in superior conjunctiva, 9.0% and 59.7% in nasal conjunctiva. These values appeared to recover gradually returning to the preoperative level 36 weeks after surgery. Changes in the N/C ratio and the GCD appeared to be greater in the superior conjunctiva than in the nasal conjunctiva. Conclusions. LASIK surgery changes the morphology of the conjunctival epithelial cells, but these changes appear to return to preoperative levels with time. Commercial Relationship(s): None; Support: DAMD 17-01-2-0032
THE OCULAR SURFACE / JANUARY, 2005, VOL. 3, NO. 1 / SUPPLEMENT
S83