Добірка наукової літератури з теми "Conjunctival impression"

Introduction:It is known that the computer users develop the features of dry eye. Objective: To study the cytological changes in the conjunctiva using conjunctival impression cytology in computer users and a control group. Materials and methods: Fifteen eyes of computer users who had used computers for more than one year and ten eyes of an age-and-sex matched control group (those who had not used computers) were studied by conjunctival impression cytology. Results: Conjunctival impression cytology (CIC) results in the control group were of stage 0 and stage I while the computer user group showed CIC results between stages II to stage IV. Among the computer users, the majority ( > 90 %) showed stage III and stage IV changes. Conclusion: We found that those who used computers daily for long hours developed more CIC changes than those who worked at the computer for a shorter daily duration. Nepal J Ophthalmol 2013; 5(9):33-37 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7819

In order to establish a method usable in the field for diagnosis of pre-clinical vitamin A deficiency, conjunctival impression cytology with transfer (CICT) was used in 200normal slum children aged 6−120 months in Chandigarh, India. Conjunctival impressions taken on cellulose acetate paper were transferred to glass slides which were fixed in ethanol and stained with alcian blue and carbol fuchsin. Sixty samples of cellulose acetate paper were preserved after transfer of impression and were stained later. Transfer was complete in forty-eight samples and in the other twelve it was incomplete. Conjunctival impressions on paper and slide of these twelve cases were comparable. At a plasma retinol concentration of <0·70 pmol/l measured by HPLC the sensitivity, specificity and positive predictive values of CICT were 90·5%, 100% and 100% respectively. Compared with conventional conjunctival impression cytology, CICT is less time consuming, cheaper and comparable in validity. It is thus more suitable than the conventional method for mass screening

We report a case of conjunctival intraepithelial neoplasia (CIN) in a patient presenting with the pigmented conjunctival lesion.<b><i></i></b>This study involved a 56-year-old woman that presented with right eye irritation for 1 month. She noticed brownish pigmentation arising from her right nasal conjunctiva and growing slowly over time. Biomicroscopic examination showed a gelatinous pigmented conjunctival mass with feeder vessels. Conjunctival impression cytology (CIC) was done and reported as CIN. Treatment was started with 0.02% mitomycin-C eye drops. The conjunctival lesion responded well to medication. This report shows that CIN can manifest as a pigmented tumor, resembling melanoma. CIC plays a role in the diagnosis of this condition. This tumor responded well with 0.02% mitomycin-C eye drops.

Purpose: To assess the alterations in conjunctival impression cytology following 23-gauge transconjunctival sutureless versus conventional pars plana vitrectomy. Patients and Methods: Sixty consecutive patients were enrolled in the study. Conjunctival impression cytology was performed on 30 eyes (of 30 subjects) with 23-gauge transconjunctival sutureless vitrectomy and on 30 eyes (of 30 subjects) with conventional vitrectomy. Conjunctival impression cytology was performed preoperatively on the 1st day and in the 3rd month after the surgery. Impression cytology specimens of each group were graded and scored using a range of 0-3 according to Nelson's method. Results: In the conventional pars plana vitrectomy group, statistically significant alterations in the conjunctival impression cytology were detected on the 1st postoperative day (p = 0.001) and in the 3rd postoperative month (p = 0.001), whereas in the 23-gauge transconjunctival sutureless pars plana vitrectomy group, statistically significant changes were observed on the 1st postoperative day. However, no significant changes were observed in the following 3 postoperative months (p = 0.08). Conclusion: The properties of impression cytology were altered in the early postoperative period after sutureless and conventional vitrectomy. These changes were improved in the sutureless vitrectomy group only. Sutureless vitrectomy also had an advantageous effect on the conjunctival cytological changes and conjunctival structure.

Abstract The principle of Impression Cytology (IC) utilizes a non-invasive technique to remove superficial layers of the ocular surface. The application of a filter to the surface of the bulbar conjunctiva allows for repeated collection of superficial cells for the analysis of ocular surface disorders. Evidence suggests expression of the HLA-DR antigen on the surface of conjunctival epithelial cells is associated with allergic conjunctivitis and dry eye syndrome. Performance characteristics of HLA-DR was evaluated through intra, inter and stability assays. Evaluation of the reproducibility and overall performance of the novel methodology would be useful in understanding the tolerance level of the assay. Utilizing established techniques, IC specimens were obtained from 12 donors and assayed over multiple days and timepoints. Conjunctival epithelial cells were extracted and assayed based on differential immunostaining of both conjunctival epithelial cells and leukocytes. The reproducibility across donors over time was consistent, demonstrating conjunctival cells maintained their integrity of cell surface expression of HLA-DR. In conclusion, the studies met all validation criteria, and support the utilization of HLA-DR inflammatory measurements in impression cytology specimens. Utilization of a flow cytometric platform to examine the expression of HLA-DR antigen may help predict clinical outcome, evaluate disease progression, and monitor the effects of treatment.

Purpose : To compare the levels of conjunctival transforming growth factor beta (TGF-β) between glaucoma and control patients and to determine conjunctival TGF-β levels before and 3 months after augmented primary trabeculectomy. Methods : Patients with primary open angle glaucoma (POAG) or primary angle closure glaucoma (PACG) admitted for mitomycin (MMC) augmented primary trabeculectomy due to failure in achieving target pressure after maximum medical therapy were selected. Age-matched non-glaucoma patients were controls. Impression cytology of the conjunctiva was obtained twice from glaucoma patients (1 week before augmented primary trabeculectomy and 3 months after surgery) and once from controls. Conjunctival cells were tagged with an anti-TGF-β antibody and analyzed by flow cytometry. Results : Eighteen patients (11 POAG and 7 PACG patients) and 18 age-matched control patients were included. Conjunctival TGF-β levels were significantly different between glaucoma (35.21% ± 14.12%) and control patients (14.96% ± 6.34%) (p = 0.001). There was a significant reduction in conjunctival TGF-β levels after augmented trabeculectomy (23.0% ± 13.8%) (p < 0.001). A significantly greater reduction in conjunctival TGF-β levels (61.6% ± 17.9%) was associated with complete success of trabeculectomy at 3 months (83.3%) after surgical intervention (p = 0.029). Conclusion : The reduction of TGF-β on the conjunctival post primary augmented trabeculectomy may suggest TGF-β as potential predicting marker of short term trabeculectomy success. However, the result may be affected by site of impression, topical pressure lowering drugs and small sample size.

Subclinical vitamin A deficiency was assessed in 65 Hispanic children attending four migrant Head Start programs in Utah. Subjects aged 2 to 6 years (median 3 years 10 months) were examined for evidence of vitamin A deficiency by conjunctival impression cytology. Biochemical indices for serum vitamin A, retinol-binding protein, zinc, and iron were performed. Of eight children (12.5%) with subclinical vitamin A deficiency, one child had a marginal serum vitamin A of 11 μg/dl. Retinol-binding protein concentrations were significantly lower in two subjects with abnormal conjunctival impression cytology. Serum zinc, which when low can mimic signs of ocular vitamin A lesions, was normal for all 65 subjects. Fifteen children (23%) had iron-deficiency anemia. Logistic regression was the central method of analysis used in this study. The results of the statistical analyses indicated there was a correlation value (0.31) between abnormal conjunctival impression cytology and serum vitamin A, which supports the hypothesis that abnormal conjunctiva! impression cytology is concurrent with decreased serum vitamin A. Assessment of vitamin A status of Hispanic migrant children by impression cytology was effective in identifying children at risk for hypovitaminosis A. Beyond vitamin A's role in vision and maintenance of epithelium, it is also required for growth and hematopoiesis. The children of migrant workers may be suffering physiologically important consequences of vitamin A and iron deficiency that can be prevented by screening with biochemical and histological testing. Nutrition intervention for deficient children is warranted.

Up to fifty percent of contact lens wearers discontinue from lens wear as a result of symptoms of dry eye. Using a high power confocal microscope specially adapted for examining the eye, the candidate observed that contact lens wear is associated with a reduction in the number of mucus-secreting conjunctival goblet cells, which means that the eye is less well lubricated, leading to discomfort during blinking. This discovery may pave the way towards developing strategies to avoid lens-induced discomfort, leading to more satisfied patients and saving the contact lens industry hundreds of millions of dollars each year.

Le dupilumab a prouvé son efficacité dans le traitement de la dermatite atopique (DA) modérée à sévère. Cependant, la survenue d'événements indésirables oculaires (Ocular Adverse Events, OAE) a été rapporté. Les objectifs de ce travail étaient de décrire l'incidence et la nature des OAE induits par le dupilumab, d'évaluer les facteurs prédisposants potentiels et d'en comprendre les bases moléculaires. Nous avons mené une première étude monocentrique, prospective, en vie réelle, chez des patients adultes atteints de DA traités par dupilumab, qui ont été systématiquement examinés par un ophtalmologiste avant et pendant le traitement. Nous avons inclus 46 patients avec un score clinique de sévérité (SCORing initial médian de DA (SCORAD)) de 46,0 (interquartile : 34,5-55,5). 34,8 % des patients ont présentés des OAE, souvent légers à modérés, mais aboutissant à une interruption du dupilumab pour deux patients. La majorité des patients ont développé ou aggravé une sécheresse oculaire. Six patients (13%) ont développé une conjonctivite, de novo. Les OAE induits par le dupilumab étaient associés à une kératite ponctuée superficielle initiale (Odds ratio (OR) = 6,3 ; intervalle de confiance (IC) à 95% : [1,3-31,6]), un eczéma des paupières (OR = 8,7 ; IC à 95 % : [1,8-40,6]), un antécédent d'allergie alimentaire (OR = 3,8 ; IC à 95 % : [1,002-14, 070]) et/ou des taux sériques d'IgE > 1 000 kU/L (OR = 10,6 ; IC à 95 % : [1,2-91,3]). Nous avons ensuite participé à une étude nationale multicentrique qui a inclus 181 patients. Trente-quatre patients (18,7 %) présentaient une blépharoconjonctivite induite par le dupilumab : soit de novo (n=32 ; 17,6%), soit par aggravation d'une préexistante (n=2 ; 1,1%). La plupart des événements (27/34 ; 79,4 %) étaient modérés. Une analyse multivariée a montré que la DA avec atteinte de la tête et du cou (OR = 7,254 ; IC à 95 % : [1,938-30,07] ; p= 0,004), l'érythrodermie (OR = 5,635 ; IC à 95 % : [1,635-21,50] ; p = 0,007) et la présence d'un syndrome de sec avant le traitement (OR = 3,51 ; IC à 95 % : [3,158-13,90] ; p = 0,031) étaient des facteurs indépendants associés à la blépharoconjonctivite induite par le dupilumab. Le SCORAD ou la réponse au traitement (% d'amélioration du SCORAD à S16), un antécédent de conjonctivite allergique, d'asthme ou de rhinite n'étaient également pas corrélés significativement à la survenue d'OAE. Enfin, nous avons mené une étude bi-centrique, comparant le transcriptome (analysé par biopuces et RT-qPCR) et l'expression de la chimiokine CCL20 (par ELISA) sur des cellules conjonctivales, collectées par empreintes conjonctivales, de patients atteints de DA, avant (M0) et 4 mois après le début du traitement au dupilumab (M4). Trente-six patients ont été inclus et répartis en deux groupes selon leur statut ophtalmologique à M4 : un groupe de 12 ayant développé des OAE (OAE+) et un groupe de 24 qui n'en ont pas développé (OAE-). En analyse multiple transcriptomique, nous avons identifié 52 gènes différentiellement exprimés entre OAE+/M0 et OAE-/M0, 113 entre OAE+/M4 et OAE-/M4, deux entre OAE+/M0 et OAE+/M4, et aucun entre OAE-/M0 et OAE-/M4. L'analyse en IPA (Ingenuity Pathway Analysis) avec un intérêt particulier pour les maladies, a mis en évidence principalement une signature "psoriasis". Parmi les 15 gènes différentiellement exprimés sélectionnés pour la validation par RT-qPCR, seuls 7 étaient significatifs : CCL20, IL-19, NOX1, NOS2, SLC26A4, S100A12 étaient régulés positivement et MUC-7 était régulé négativement entre M0 et M4 chez les patients présentant des OAE (OAE+/M4 vs OAE-/M4). La quantification de la protéine CCL20 par ELISA a confirmé une surexpression entre M0 et M4 pour les deux groupes. En conclusion, le traitement par dupilumab des patients atteints de DA qui présentent des OAE, semble accentuer un profil immunologique orienté Th17, voie particulièrement impliquée dans le psoriasis
Dupilumab has proven its efficacy in the treatment of moderate to severe atopic dermatitis (AD). However, the occurrence of ocular adverse events (OAEs) has been reported. The objectives of this work were to describe the incidence and nature of OAEs induced by dupilumab in AD patients, to evaluate potential predisposing factors, and to understand their molecular bases. We conducted a first single-center, prospective, real-life study in adult AD patients treated with dupilumab, who were systematically examined by an ophthalmologist before and during treatment. We included 46 patients with a median initial SCORing of AD (SCORAD) of 46.0 (interquartile range: 34.5-55.5). 34.8% of patients experienced OAEs, often mild to moderate, but leading to interruption of dupilumab for two patients. The majority of patients developed or worsened dry eye. Six patients (13%) developed conjunctivitis de novo. Dupilumab-induced OAEs were associated with dry eye with superficial punctuate keratitis (Odds ratio (OR) = 6.3 95% confidence interval (CI): [1.3-31.6]), eyelid eczema (OR= 8.7; 95% CI: [1.8-40.6]), a history of food allergy (OR = 3.8; 95% CI: [1.002-14.070]) and/or serum IgE levels > 1.000 kU/L (OR = 10.6; 95% CI: [1.2-91.3]). We then participated to a national multicenter study which included 181 patients. Thirty-four patients (18.7%) presented blepharoconjunctivitis induced by dupilumab: either de novo (n=32; 17.6%) or by worsening of a pre-existing condition (n=2; 1.1%). Most events (27/34; 79.4%) were moderate. Multivariate analysis showed that AD with head and neck involvement (OR = 7.254; 95% CI [1.938-30.07]; p = 0.004), erythroderma (OR = 5.635; 95% CI [1.635] -21.50]; p = 0.007) and the presence of dry eye syndrome before treatment (OR = 3.51; 95% CI [3.158-13.90]; p = 0.031) were independent factors associated with dupilumab-induced blepharoconjunctivitis. The SCORAD or the response to treatment (% improvement in SCORAD at W16), a history of allergic conjunctivitis, asthma or rhinitis were also not significantly associated with the occurrence of OAE. Finally, we conducted a bicentric study, comparing the transcriptome (analyzed by DNA microarrays and RT-qPCR) and the expression of the chemokine CCL20 (by ELISA) of conjunctival cells, collected by conjunctival impression, on AD patients before (M0) and 4 months after dupilumab beginning (M4). Thirty-six patients were included and divided in two groups, according their ophthalmological status at M4: one group of 12 who developed OAE (OAE+) and another group of 24 who did not (OAE-). In multiple analysis of the full transcriptome, we found 52 differentially expressed genes (DEG) between OAE+/M0 and OAE-/M0, 113 DEG between OAE+/M4 and OAE-/M4, two DEG between OAE+/M0 and OAE+/M4, and none DEG between OAE-/M0 and OAE-/M4. Ingenuity Pathway Analysis enrichment with a special interest in diseases, mainly indicated a psoriasis signature. Among the 15 DEG selected for RT-qPCR validation, only 7 were significant: CCL20, IL-19, NOX1, NOS2, SLC26A4 and S100A12 were up-regulated, whereas MUC-7 was downregulated in OAE+/M4 vs OAE-/M4 patients. CCL20 protein quantification by ELISA confirmed an over-expression between M0 and M4 for the two groups. In conclusion, most cases of dupilumab-induced blepharoconjunctivitis are de novo. Pre-existing factors (dry eye syndrome, AD with eyelid, head and neck) are associated with an increased risk of OAE. Dupilumab seems to switch AD immunological profile of OAE patients from Th2 to Th17, particularly involved in psoriasis

Mucin deficiency is a possible cause of tear film instability. The important sources of mucin are the conjunctival goblet cells and the non-goblet conjunctiva! epithelial cells where the mucin-like glycoproteins are stored in the mucous secretory vesicles. This thesis addresses the relationship between the quantity of the mucin sources and tear film physiology in a group of normal to marginal dry eye Chinese subjects. Chinese subjects were used in this study because they were found to have a lower tear break-up time than Caucasians (Cho and Brown, 1993). Impression cytology techniques were used to obtain conjunctiva! cells and goblet cells from the bulbar conjunctiva! of 61 subjects in order to study the relationship of the goblet cell density and tear film stability. The tear function tests included subjective dry eye symptoms, non-invasive tear break-up time, phenol red thread test and tear break-up time. A second source of mucin supply and tear film stability was also studied. This mucin supply comes from the mucous secretory vesicles of the conjunctival epithelial cells. To study the anatomical structure, the ultrastructure of the conjunctiva! epithelial cells was investigated under the transmission electron microscope. The findings revealed that goblet cell density did not show any correlation with severity of dry eye symptoms, non-invasive tear break-up time, phenol red thread test or tear break-up time test. There are three possibilities for this finding: Deficiency in goblet cell density is not associated with mucin deficiency but mucin de2. Mucin deficiency is not associated with low tear stability but deficiency in goblet cell density remains associated with mucin deficiency. 3. Deficiency in goblet cell density is not associated with mucin deficiency and mucin deficiency is not associated with low tear stability.ficiency remains associated with low tear stability. The negative finding could also be due to the relatively normal and healthy subjects used in the present study. They did not show a great reduction in goblet cell density that could cause an impact on the result. In the counting of goblet cell density using the impression cytology technique, the imprints of the goblet cells might be obtained instead of the whole goblet cells. There was also no significant correlation between dry eye symptoms and tear function tests such as the non-invasive tear break-up time, phenol red thread test and tear break-up time test. This study also found that the gender of the age group between 18 to 28, and contact lens wear of up to three years, would not affect goblet cell density, dry eye symptoms, non-invasive tear break-up time, phenol red thread test and tear break-up time. There was no significant difference in the number of mucous secretory vesicles, microvilli and cell invaginations in the conjunctiva} epithelial cells of subjects with high and low tear stabilities. Therefore, the tear film function may not be associated with the presence of the number of mucous vesicles, microvilli and cells invaginations. On the other hand, the finding could also be due to a small subject sample and the inter-group difference in tear stability might be too small to reflect a difference in the assessment of the ultrastructures. However, a new technique of cell processing for transmission electron microscopy work was also developed for specimens obtained using the impression cytology technique.

OBJETIVOS: Avaliar as alterações clínicas da superfície ocular, citologia de impressão (CI) e sintomas de olho seco (OS) dos pacientes com Espondilite Anquilosante (EA) e Artrite Reumatoide (AR). Classificar a intensidade de OS. Avaliar prospectivamente os parâmetros clínicos, laboratoriais e da superfície ocular dos pacientes com EA e AR submetidos a tratamento com drogas anti-TNF. MÉTODOS: Estudo prospectivo envolvendo inicialmente (pré-tratamento) 36 pacientes com EA e 20 pacientes com AR comparados com grupo controle de 39 voluntários saudáveis para o grupo de EA e 24 voluntários saudáveis para o grupo de AR. Do total inicial, 14 pacientes consecutivos com EA e 20 pacientes consecutivos com AR foram submetidos a terapia anti-TNF. Foram realizados os seguintes exames: teste de Schirmer I, tempo de rompimento do filme lacrimal, tingimento com corantes vitais e questionário dos sintomas de OS (Ocular Surface Disease Index-OSDI), citologia de impressão (CI) conjuntival, avaliação laboratorial inflamatória: velocidade de hemossedimentação e proteína C reativa (VHS e PCR) e atividade da doença pelas medidas de Bath Ankylosing Spondylitis Activity Index e Bath Ankylosing Spondylitis Functional Index (BASDAI e BASFI respectivamente) na EA e Disease Activity Score 28 (DAS 28) para AR. Além disso, avaliou-se a qualidade de vida pelo Health Assessment Questionnaire (HAQ) para ambas as doenças. As avaliações foram realizadas pré-tratamento e repetidas aos 3 meses (3M) e 12 meses (12M) após o início da terapia. RESULTADOS: Na avaliação pré-tratamento com drogas anti-TNF, os pacientes com EA apresentaram OS de intensidade leve a moderada (80,5% versus 43,6%, p=0,01) e maior escore de alteração da CI (55% versus 12,8%, p=0,007) associados a provas de atividade inflamatórias elevadas (p < 0,001) quando comparados com controles saudáveis. A avaliação longitudinal do tratamento com terapia anti-TNF demonstrou melhora da produção aquosa lacrimal (pré-tratamento: 13,7 ? 11,3 mm, aos 3M: 18,3 +- 11,1 mm e aos 12M: 19,3 +- 9,0 mm, p=0,04) assim como da CI conjuntival (pré-tratamento: 78,6% alterada, aos 3M: 57,1%, e aos 12M: 35,7%, p=0,03). Houve, paralelamente, melhora dos parâmetros inflamatórios e da atividade da doença (p < 0,05). No grupo de pacientes com AR, no momento pré-tratamento com drogas anti-TNF, foram observados maior frequência (75% versus 4%, p < 0,001) e intensidade leve de OS (65% versus 4%, p < 0,001) associados a sintomas moderados (escore OSDI 24,0 +- 17,6 versus 7,5 +- 14,3, p=0,001) quando comparados com controles saudáveis. Esses pacientes também apresentaram maior frequência de disfunção das glândulas de meibômio (55,0% versus 8,3%, p=0,001), maior escore de alteração da CI conjuntival (1,0 +- 0,6 versus 0.0 +- 0,2, p=0,001) e menor densidade de células caliciformes (431,3 +- 209,5 células/mm2 versus 804,8 +- 383,2 células/mm2, p < 0,001) quando comparados com o grupo controle. A análise prospectiva dos pacientes com AR tratados com drogas anti-TNF mostrou um aumento dos valores do teste de Schirmer (prétratamento: 11,8 +- 6,7 mm, aos 3M: 21,0 +- 10,4 mm, e aos 12M: 23,0 +- 9,7mm, p < 0,001), melhora da CI conjuntival (pré-tratamento: 1,0 +- 0,6, aos 3M: 0,8 +- 0,6, e aos 12M: 0,5 +- 0,5, p=0,005) e da densidade de células caliciformes (pré-tratamento: 429 +- 211,7 células/mm2, aos 3M: 908 +- 291,4 células/mm2, e aos 12M: 1265,4 +- 430,6 células/mm2, p=0,001). Os marcadores de atividade inflamatória sistêmicos (VHS e PCR) também melhoraram ao longo do tratamento (p=0,005 e p=0,006, respectivamente). CONCLUSÃO: Os pacientes com EA e AR avaliados nesse estudo apresentaram prevalência elevada de OS de intensidade leve a moderada associada à alteração da citologia conjuntival. A recuperação precoce e manutenção de longo prazo na produção aquosa da lágrima e na CI conjuntival, em especial, das células caliciformes, nos pacientes submetidos a terapia anti-TNF, pode refletir a melhora da condição inflamatória. Esse resultado histológico pode ter influência como biomarcador da inflamação na superfície ocular
OBJECTIVES: Evaluate ocular surface parameters, impression cytology (IC) and dry eye (DE) symptoms of patients with Ankylosing Spondylitis (AS) and Rheumatoid Arthritis (RA). Classify DE severity grade. Analyse prospectively clinical and laboratory, as well as ocular surface parameters of AS and RA patients, submitted to anti-TNF therapy. METHODS: This prospective study initially (baseline) enrolled 36 AS patients and 20 RA patients who were compared to a control group of 39 and 24 healthy volunteers for the AS group and RA group, respectively. From the initial group, 14 consecutive AS and 20 consecutive RA patients received anti-TNF therapy. They underwent the following exams: Schirmer I test, tear break-up time, vital dyes staining of the ocular surface, a questionnaire for dry eye symptoms- Ocular Surface Disease Index (OSDI), and conjunctival IC. Laboratory tests for inflammatory activity were assessed by erythrocyte sedimentation rate and C- reactive protein (ESR and CRP). The Bath Ankylosing Spondylitis Activity Index and Bath Ankylosing Spondylitis Functional Index (BASDAI and BASFI, respectively) in AS and Disease Activity Score 28 (DAS 28) in RA analyzed disease activity parameters. Besides, the Health Assessment Questionnaire evaluated the quality of life in both group of diseases. These measurements were taken at baseline (BL) and repeated at 3 months and 12 months (3M and 12M, respectively) after the beginning of anti-TNF therapy. RESULTS: At the baseline moment, AS patients presented mild to moderate DE (80.5% vs 43.6%, p=0.01) and a higher score of altered IC (55% vs 12.8%, p=0.007) associated with the systemic inflammatory activity (ESR and CRP, p < 0.001) when compared to healthy volunteers. The longitudinal evaluation of anti- TNF treatment showed an improvement of aqueous tear production (BL: 13.7 +- 11.3 mm, 3M: 18.3 +- 11.1 mm and 12M: 19.3 +- 9,0 mm, p=0.04). The IC also improved (BL: 78.6% altered IC, 3M: 57.1% and 12M: 35.7%, p=0.03). There was a parallel amelioration of systemic inflammatory markers and disease activity (p < 0.05). Concerning the RA group of patients, at the baseline moment, there was a higher frequency of DE (75% vs 4%, p < 0.001) as well as mild DE severity grade (65% vs 4%, p < 0,001) associated with moderate symptoms of DE (OSDI score: 24.0 +- 17.6 vs 7.5 +- 14.3, p=0.001) when compared to healthy volunteers. This group of patients also presented higher frequency of meibomian gland dysfunction (55% vs 8.3%, p=0.001), a worse score of IC (1.0 +- 0.6 vs 0.0 ? 0.2, p=0.001) and lower goblet cells count (431.3 +- 209.5 cells/mm2 vs 804.8 +- 383.2 cells/mm2, p< 0.001) when compared to the control group. The prospective analysis of RA patients treated with anti-TNF drugs demonstrated an increase of Schirmer\'s test (BL: 11.8 +- 6.7, 3M: 21.0 +- 10.4, 12M: 23.0 +- 9.7, p < 0.001) and an improvement of cytological grade (BL: 1.0 +- 0.6, 3M: 0.8 +- 0.6, 12M: 0.5 +- 0.5, p=0.005) and goblet cells density (BL: 429,0 +- 211.7 cells/mm2, 3M: 908,0 +- 291.4 cells/mm2, 12M: 1265.4 +- 430.6 cells/mm2, p=0.001). The systemic inflammatory markers (ESR and CRP) also improved throughout the treatment period (p=0.005 and p=0.006, respectively). CONCLUSION: Patients with AS and RA enrolled in this study presented a higher prevalence of mild to moderate DE associated with altered IC. The prompt and maintained aqueous tear and conjunctival cytology recovery, especially the goblet cells, in patients submitted to anti-TNF therapy seem to represent the improvement of inflammatory condition. This histological outcome may have an influence as a biomarker of ocular surface inflammation

碩士
高雄醫學大學
醫學研究所
99
Thyroid orbitopathy (TO), an autoimmune disease, is complicated with ocular surface disorder leading to discomforts of patients. Dry eye is highly prevalent in TO patients. Although previous studies have proposed factors of increased corneal exposure predisposing to dry eye disease in TO, inflammation in ocular surface may be another main contribution. Recent studies have focused on the inflammatory process to explain pathogenesis of dry eye and certain evidences have discovered. Since TO is a disorder of autoimmune origin, its association with dry eye is highly speculated to be inflammation-related. Inflammation of ocular surface has never been well studied in such cases of TO with dry eye. So far, no extensive study has been published in this aspect and hypothesis. In this study we will assay cellular inflammation in ocular surface and cytokines profiles in patients of TO combined with dry eye. Conjunctival impression cytology (CIC) will be studied with immunofluorescent assay (IFA). TO and dry eye patients were diagnosed with Schirmer test, tear break-up time, thyroid function and clinical signs. Conjunctival impression cytology (CIC) was combined with immunological stain of Interleukin-1???n?vIL-1???w, IL-1???nand IL-6?|?nThe grading of the immunological impression cytology (IC) was compared to clinical activity score of TO. All the markers of IL-1???z?nIL-1?? and IL-6 were highly positive in patients of TO with dry eyes. However, in normal control group, IL-1?? was similarly highly positive. A slight parallel trend was observed between clinical inflammatory score and grading of immunological IC. This study is the first to delineate the immunological IC of TO patients with dry eyes. The prospect of this study is to investigate the pathogenesis of dry eye occurring in TO. Our findings suggest that conjunctival cytokines IL-1α, IL-1β and IL-6 may play a role. This model of study is promising for further experiment of more inflammatory cytokines, and can be used as an outcome for investigation of treatment, such as anti-cytokine or immuno-suppression therapy, in such patients or other ocular surface inflammatory disorders.

碩士
高雄醫學大學
醫學研究所碩士班
103
Thyroid-associated Orbitopathy (TAO or TO) or Graves’ Orbitopathy (GO) is an autoimmune inflammatory eye disease associated with thyroid disorders, which clinical manifestation occurr as a combination of inflammation, increase of orbital fat and extra ocular muscle volume within the orbital space. The incidence rate of this disease is 16 women and 3 men per 100,000 populations. Autoantibodies to both TSHr (Thyroid stimulating hormone-receptor) and IGF-1r (insulin-like growth factor 1 receptor) displayed in the orbital fibroblast contributed in the development of the orbital changes in TO. In this study, we described the inflammation in TO patient’s ocular surface by morphological and immunological impression cytology of conjunctival epithelium cells layer. We also evaluated the eyelid changes in TO including eyelid retraction and swelling using an ultrasound biomicroscopy (UBM) imaging features. This enables us to observe the correlation of eyelid’s structure thickness and the pathology of the aforementioned changes. We found the morphological changes of conjunctival epithelial cells including low quality of cell-to-cell adhesion, increased nucleo-cytoplasmic ratio of cells and absence of mucus and goblet cells. The positivity of pro-inflammatory cytokines-released from the cells (IL-1α, IL-1β and ICAM) was also observed in immunostaining examination. Ultrasound Biomicroscopy (UBM) measurement gave a significant different thickness of eyelid and levator aponeurosis (LA) layer in TO compare to normal subject, but LA thickness was less correlated with the clinically upper eyelid retraction. Since its causes are multifactorial, eyelid retraction could be seen as a restrictive problem where lid retractors (LPS and Muller muscle) may also become inflamed and subsequent fibrosis, scarring to the adjacent connective tissue might cause retraction. Eyelid swelling could not be clearly imaged by UBM, because eyelid skin (thin epidermis and dermis with subcutaneous tissue) was observed as an echo-dense line at the water cup medium-upper eyelid interface. We emphasized the inflammation of ocular surface in TO patient by using impression cytology method and the clinical use of UBM in eyelid structure study related to TO clinical finding. This model of study support the anti-inflammatory drug application for TO patients with severe dry eye and UBM study provides information about anatomy of TO eyelid.

Abstract By now the reader may have gathered that Tamil initiatory and ritual experiences mostly serve to dissociate people from social and personal identities. We have had ample warrant for such an impression. The camis visions of the goddess led them to withdraw from mainstream society and their families. Many of them, in turn, were quick to prescribe “funerals ” of debilitating relationships for their clientele. While the ultimate objective of exorcisms may be seen to reunite “possessed ” women with their husbands, these reconciliations actually entailed suppressing or “beheading ” an inner personality. And while possession by one’s untimely dead does not call for any kind of “removal. ” this is because a more finite separationdeath-has already happened. No wonder it can appear that Tamil religious practices lean toward effecting what Luc de Heusch calls “disjunctions ” (1981). But this is only one side of the Tamil cosmological picture and its mechanisms and motivations. Its other “face ” is expressed through rituals that incorporate participants into a generational sequence and network of forebears, descendants, and relatives. This body of “conjunctive ” rites stands in isomorphic opposition to diagnostic seances, “removals, ” and exorcisms. A mirrored symbolic vocabulary and identical patterning of actions here are employed to forge a continuity of experience and identity instead of the reverse. Yet, at every crucial step the overlaps and repetitions in these ritual processes are consistent with my deeper conclusion that, above all, Tamil religion works to transform the “inner ” self. The difference is that whereas disjunctive practices objectify the “healthy ” person as separated from unrelated others (be they “commanding ” or alien personalities) conjunctive rituals “prescribe ” mingling or even expanding the self into other connected selves. Before entering this new world of ritual transactions, I might set the tone for the chapters to come by recounting one more diagnostic seance by a recruit of the goddess-a seance of some contrast to those we have witnessed before. It was performed by one of those specialists who could “see ” and embody the spirits of her clients’ dead relatives.1 While this female practitioner did not actually carry out the “fruits ” she recommended.

The many and often disfiguring features of a typical patient with Graves’ ophthalmopathy are obvious at first glance (Fig. 3.3.10.1). The changed appearance of the patient has a profound effect on their emotional and social status. The various signs and symptoms can be described according to the NO SPECS classification (1) (Box 3.3.10.1). Class 1 signs can be present in any patient with thyrotoxicosis regardless of its cause. Upper eyelid retraction causes stare and lid lag on downward gaze (the latter is the well-known von Graefe’s sign). Soft tissue involvement (class 2) comprises swelling and redness of eyelids, conjunctiva, and caruncle. Symptoms are a gritty sandy sensation in the eyes, retrobulbar pressure, lacrimation, photophobia, and blurring of vision. Proptosis (class 3) can be quite marked. Upper eyelid retraction by itself may already give the impression of exophthalmos. Extraocular muscle involvement (class 4) may result in aberrant position of the globe, or fixation of the globe in extreme cases. More common is limitation of eye muscle movements in certain directions of gaze, especially in upward gaze; it is usually associated with diplopia. Diplopia will not occur if the vision of one eye is very low (e.g. in amblyopia), or if the impairment of eye muscle motility is strictly symmetrical. Patients may correct for double vision by tilting the head, usually backwards and sideways; the ocular torticollis often leads to neck pain and headache. Corneal involvement (class 5) occurs through overexposure of the cornea due to lid lag, lid retraction, and exophthalmos, easily leading to dry eyes and keratitis. Lagophthalmos is often noted first by the patient’s partner because of incomplete closure of the eyelids during sleep. Sight loss (class 6) due to optic nerve involvement is the most serious feature, often referred to as dysthyroid optic neuropathy (DON). Besides the decrease of visual acuity, there may be loss of colour vision and visual field defects. Visual blurring may disappear after blinking (caused by alteration of the tear film on the surface of the cornea due to lacrimation or dry eyes) or after closing one eye (attributable to eye muscle imbalance). Visual blurring that persists is of great concern as it may indicate optic neuropathy (2).