Expression of cell adhesion molecules in the salivary and lacrimal glands of Sjogren's syndrome

We attempted to determine whether cell adhesion molecules, including vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and E-selectin (endothelial-leukocyte adhesion molecule-1; ELAM-1), are involved in the lymphoid cell infiltration of the salivary and lacrimal glands in Sjogren's syndrome (SS) patients. Both immunohistochemical analysis and the reverse-transcripts polymerase chain reaction (RT-PCR) were used to analyze the expression of VCAM-1, ICAM-1, ELAM-1, very late antigen 4 (VLA-4 [alpha 4,beta 1]), lymphocyte function-associated antigen-1 (LFA-1), interferon-gamma (IFN-gamma), tumor necrosis factor (TNF), and interleukin-1 beta (IL-1 beta). Immunohistochemical analysis of salivary gland biopsies from SS patients showed a marked expression of VCAM-1 and ICAM-1 in the venules surrounded by infiltrated CD4+ CD45RO+ T cells. E-selectin was expressed on vascular endothelium with weak intensity. Increased levels of VCAM-1, ICAM-1, IFN-gamma, and IL-1 beta mRNA were demonstrated by RT-PCR, whereas E-selectin mRNA were weakly expressed in SS lacrimal and salivary gland tissues. This is in contrast with strong expression of ELAM-1 in IL-1 beta-stimulated human umbilical vascular endothelial cells (HUVEC) in vitro. Cytokine-mediated up-regulation of VCAM-1 and ICAM-1 that facilitates the recruitment of VLA-4 and LFA-1 expressing T cells might contribute to lymphoid cell infiltration in the salivary and lacrimal glands in SS.

Aldose reductase inhibition and the phosphorus-31 profile of the intact diabetic rat lens

Diabetic metabolic change and response to aldose reductase inhibition in the Wistar rat lens were examined with phosphorus-31 (31P) nuclear magnetic resonance (NMR) spectroscopy. To avoid artifacts in sample preparation, we used freshly excised lenses and acquired NMR data for 20 min immediately after lens extraction. The results showed a diabetes-induced time-dependent loss of ATP and phosphorylcholine (PC), an increase in alpha-glycerophosphate (alpha-GP) and inorganic phosphate and the appearance of sorbitol-3-phosphate (S-3-P) and fructose-3-phosphate (F-3-P). Oral but not topical dosing of an aldose reductase inhibitor, 5-(3-ethoxy-4-pentyloxyphenyl)-2,4- thiazolidinedione, resulted in a positive dose-response correlation characterized by a restoration of PC, S-3-P and F-3-P to the prediabetic level; however, alpha-GP and ATP were only partially normalized. The significance of the 31P change was further discussed.

Distribution of autofluorescence in the rabbit corneal epithelium

Autofluorescence from reduced pyridine nucleotides (PN) and oxidized flavoproteins (Fp) was measured in order to detect the difference in redox states in rabbit corneal epithelium. The enucleated rabbit eye was mounted in an eye bank eye container with McCarey-Kaufman medium, and the autofluorescence was measured using ocular redox fluorometry as a function of depth. The PN signal distributed evenly whereas the Fp signal was greater in the posterior epithelial region than in the anterior region (p < 0.05). The PN/Fp ratio, a sensitive indicator of tissue redox state, was less in the posterior region. After the application of 1 mM of potassium cyanide in the medium, the ratio increased significantly in each layer (p < 0.001), and the difference between anterior and posterior region diminished. These results indicate that ocular redox fluorometry has the potential to resolve the redox states of the various layers of the corneal epithelium. The posterior region of the epithelium is more active in mitochondrial respiration than the anterior region.

Metabolic and morphologic changes in the corneal endothelium. The effects of potassium cyanide, iodoacetamide, and ouabain

The metabolic pathways of glycolysis and mitochondrial respiration in the corneal endothelial cell are the primary sources of the adenosine triphosphate (ATP) necessary to maintain endothelial structure and pump fluid to maintain the corneal stroma in its normally dehydrated and transparent state. The correlation between endothelial metabolism and morphology in rabbits was studied for 7 days after the application of three different agents: (1) iodoacetamide, used to inhibit ATP synthesis from both glycolysis and respiration; (2) potassium cyanide (KCN), used to inhibit ATP synthesis from respiration only; and (3) ouabain, used to inhibit fluid pumping but not ATP synthesis. After application of each of these three drugs to the corneal endothelium, changes in endothelial morphology were measured. The greatest change resulted from the use of iodoacetamide. Specular microscopic examination of the endothelium after the application of iodoacetamide showed progressive degradation of the integrity of the cellular structure; after 6 hr, there were no discernible cell borders. In those corneas treated with either KCN or ouabain, only minor changes in the endothelium were seen during the full 7 days of the investigation. Computer-assisted morphometric analysis showed an increase in the coefficient of variation of both cell area and perimeter in all cases. This increase was greater in the corneas treated with ouabain than those treated with either iodoacetamide or KCN. Redox fluorometry showed that the metabolic ratio (autofluorescence of reduced pyridine nucleotides divided by that of oxidized flavoproteins) decreased significantly in the iodoacetamide-treated corneas, increased significantly in the KCN group, and showed no significant change in the corneas in the ouabain group, all compared with a control group. The results showed that (1) when ATP produced by both glycolysis and respiration was inhibited by 0.1 mmol/l iodoacetamide, the endothelial cells could not survive, but (2) when ATP synthesis produced by respiration alone was inhibited by 1.0 mmol/l KCN, the cells could survive for at least 1 wk on the ATP produced by anaerobic glycolysis. Furthermore, the polymegathism seen after application of ouabain, a drug that is not believed to affect ATP synthesis but inhibits the endothelial pump function, is greater than that seen as a result of reduced pump function caused by inhibited respiration produced by 1.0 mmol/l KCN. Combining specular microscopy, computer-assisted morphometric analysis, redox fluorometry, and corneal pachymetry allowed correlations between corneal endothelial metabolism, pump function, and morphology to be studied.

Oxiradical-dependent photoemission induced by a phacoemulsification probe

Oxygen free radical formation by conventional phacoemulsification devices has been postulated as a possible mechanism of corneal endothelial damage during surgery. To test this hypothesis, phacoemulsification probe-induced free radical production was visualized using a single photon-counting camera and an O(2-)-sensitive luciferin derivative, 2-methyl-6-[p-methoxyphenyl-3,7-dihydroimidazo [1,2-a]pyrazin-3-one (MCLA), which allows the visualization of spatial and temporal alterations in free radical production. Within 1 min after starting ultrasound emission, MCLA-dependent chemiluminescence was increased significantly, the intensity of which was maximal at the tip of the probe and tapered along a gradient toward distal portions. The chemiluminescence was suppressed significantly by adding either superoxide dismutase (300 U/ml) or sodium azide (20 mmol/l). By adding deuterium to the medium, MCLA-dependent chemiluminescence significantly increased, suggesting the involvement of singlet oxygen in the reaction.

Tear evaporation from the ocular surface

A simple method was developed to measure tear evaporation. A sensor was inserted into a chamber covering the eye. The humidity inside each chamber then was measured every 10 sec for 2 min with both eyes either closed or open but allowing normal blinking. The difference between these conditions represented evaporation from the ocular surface. Using this method, the tear evaporation rate at 40% ambient humidity (TEROS 40) was calculated. The average TEROS 40 in normal subjects (n = 43) was 15.6 +/- 3.8 x 10(-7) g/sec. It was 9.5 +/- 5.6 x 10(-7) g/sec in patients with dry eye symptoms (n = 72, P less than 0.001). The insertion of lacrimal collagen implants in one group of such patients (n = 10) increased the TEROS 40 from 10.2 +/- 5.5 x 10(-7) g/sec to 18.2 +/- 4.8 x 10(-7) g/sec (P less than 0.01). The instillation of eye drops increased the TEROS 40 significantly in patients with dry eye symptoms for at least 1 min (n = 10, P less than 0.01); a continued effect depended on the type of eye drop. Increased TEROS 40 still was observed 5 min after instillation of viscous eye drops (0.1% and 0.3% sodium hyaluronic acid); the TEROS 40 returned to original levels within 5 min after instillation of artificial tears of normal viscosity with or without 0.05% sodium hyaluronate. In all cases, TEROS 40 returned to original levels within 10 min. This was a quick reliable method for measuring tear evaporation from the ocular surface, and it can be applied to evaluate tear dynamics and subclassifications of dry eyes.

Cytologic evaluation of conjunctival epithelium after cataract surgery

Although numerous studies have examined corneal epithelial wound healing, few reports describe conjunctival wound healing. Thus, we evaluated the conjunctival epithelium by brush cytology, in which a miniature brush was used to collect many cells relatively noninvasively. The temporal and superior conjunctivae were examined before and after cataract extraction on the first, third, seventh, and fourteenth days and then the first, second, and third months postoperatively, in a group of 20 patients (9 men and 11 women with a mean age of 69 years 3 months +/- 10 years). The cells collected were stained by the Papanicolaou method. Each postoperative specimen contained keratinized, polygonal, round, columnar, elongated, and inflammatory cells, as well as cells with nuclear alterations. No keratinized, elongated, or inflammatory cells were observed preoperatively. In contrast, columnar cells, which were present preoperatively, decreased during the wound healing process. Such nuclear changes as chromatin formation or the appearance of snake-like figures were observed in several patients postoperatively. These cellular changes may represent altered differentiation during the healing process. However, the conjunctival epithelium returned to normal within 2 months postoperatively in all patients.

Comparison of diagnosis and treatment of Sjögren's syndrome in Japan and United States

Today, as with western countries, diagnosis and treatment of Sjögren's syndrome (SS) patients in Japan are carried out by a team effort. The clinical manifestations of Japanese SS patients are quite similar also. There are, however, several minor modifications in the diagnosis and treatment of SS patients in Japan, which are presented in this article.

Corneal epithelial alterations induced by disposable contact lens wear

PURPOSE

To study the effect of disposable extended-wear soft contact lenses on the corneal epithelium.

METHODS

Thirteen healthy patients (1 male, 12 females; average age, 26.3 +/- 7.6 years) with or without histories of previous contact lens use were recruited for this study. Specular microscopic pictures of the corneal epithelium and endothelium were taken with the help of a specular contact lens, before and after 3 months of contact lens use. The pictures were analyzed by means of a computer-assisted morphometric analysis system.

RESULTS

The mean cell area and coefficient of variation (CV) of the mean cell area of the corneal epithelium before contact lens use were 639.4 +/- 84.0 microns 2 and 29.1 +/- 13.2, respectively. After lens wear, the mean cell area increased to 819.7 +/- 99.2 microns 2 (P less than 0.01), whereas the CV decreased to 20.0 +/- 6.1 (P less than 0.05). The corresponding values for the endothelium were 300.8 +/- 22.5 microns 2 and 36.4 +/- 7.3 before contact lens use, and remained at 322.3 +/- 27.8 microns 2 and 32.8 +/- 3.7 after contact lens use, respectively (P greater than 0.05).

CONCLUSIONS

Based on the 3-month results, disposable extended-wear soft contact lenses caused similar enlargement of the mean cell area of the superficial corneal epithelium, as has been reported previously. It would appear that disposable lenses may cause the same metabolic and physiologic changes in the corneal epithelium as do conventional extended-wear soft contact lenses.

[Metabolic analysis of the diseased human corneal endothelium]

Redox states of the corneal endothelium in 42 recipient corneas obtained at the penetrating keratoplasty were measured non-invasively using ocular redox fluorometry. Autofluorescence from reduced pyridine nucleotides (PN) and oxidized flavoproteins (Fp) were measured, and the PN/Fp ratio was used as an indicator of the redox state. Endothelial damage was graded as normal, mildly damaged, moderately damaged, and severely damaged, based on the histopathological findings. Mildly damaged endothelium showed a significantly higher PN/Fp ratio than the that in normal endothelium whereas the ratio was significantly lower in the severely damaged endothelium. These changes in the redox state may represent compensation and decompensation processes of the endothelial metabolism. Ocular redox fluorometry was shown to be useful for the evaluation of the metabolic state in the human corneal endothelium.

Presence of bar-shaped nuclear chromatin in cell samples from the conjunctiva

A study was performed on 60 patients, of whom 20 had the dry eye syndrome, 20 had had cataract surgery and 20 belonged to a control group. Twenty percent of the dry eye group and 45% of the post-cataract surgery group had cells with so-called bar-shaped nuclear chromatin (bar-chromatin cells) with a morphology basically akin to those of Anitschkow nuclear changes found in cardiac tissue. Bar-chromatin cells were found in scrapings from different parts of the conjunctiva, mostly in intermediate squamous cells and rarely in goblet cells. However, these nuclear changes were infrequent in the control group. Since the bar-chromatin cells were much more frequent in patients with diseased eyes, we concluded that the findings were possibly of a regenerative nature.

Metabolic changes in the corneal epithelium resulting from hard contact lens wear

The metabolic state of rabbit corneas was monitored in vivo using the noninvasive method of corneal redox fluorometry. The autofluorescence signals of reduced pyridine nucleotides (PN) and oxidized flavoproteins (Fp) were measured in the corneal epithelium with and without contact lens wear. The PN/Fp ratio, which is related to the metabolic status of the tissue, was then calculated for each of these conditions. After application of polymethylmethacrylate (PMMA) contact lenses having an oxygen transmissibility (Dk) of less than 0.1, the PN signal increased and the Fp signal decreased. The PN/Fp ratio, generally a more precise indicator of metabolic state than either of these two quantities alone, was 1.93 +/- 0.78 without contact lenses, and increased to 2.78 +/- 0.86 (p less than 0.0001) with contact lenses. When oxygen-permeable silicon contact lenses (Dk = 12.5) were placed on the corneas, the PN/Fp ratio was found to increase slightly, but not as much as with the PMMA lenses. Newly developed highly oxygen-permeable contact lenses (Dk = 58.8) did not increase this ratio. Our findings indicate that redox fluorometry can be valuable in determining the effects of contact lens wear on corneal metabolism.

Efficacy of nine heat and moisture exchangers for intraoperative airway heat conservation

The performance of heat and moisture exchangers (HMEs) were clinically evaluated for the effectiveness of intraoperative heat conservation. Ten groups of patients were studied, nine groups with commercially available HMEs (Gibeck Humidvent 1, Terumo Brethaid, Portex Thermovent 600, NMI Pneumoist 2, Pall HME15-22, Gambro Engström Edith 1000, Gambro Engström Edith 1500, Gambro Engström Edith Flex and Siemens Servo Humidifier 153) and a control group with no HMEs. Deep temperature of the forehead (107 patients) and heat and humidity at the airway (55 patients) were measured. The temperature decrease in one hour, the total body heat loss, the temperature and absolute humidity of inspired gas and the heat loss from the airway were much better for all groups with HMEs than for the group with no HMEs, and the nine HMEs had different efficiency. There were significant correlations between the index values of body temperature and the index values of heat and humidity at the airway. In conclusion, HMEs were useful devices for preventing heat loss from the airway and maintaining body temperature.

[Noninvasive metabolic analysis of the diabetic cornea and lens: in vivo measurement]

In vivo measurement of metabolic changes in diabetic cornea and lens were performed using redox fluorometry in nonobese diabetic (NOD) mice. Autofluorescence from reduced pyridine nucleotides (PN) and oxidized flavoproteins (Fp) were measured, and the PN/Fp ratio was used as a tissue metabolism indicator. The PN/Fp ratios were significantly higher in the diabetic corneal endothelium. Morphometric analysis of the corneal endothelium using specular microscopy revealed no significant differences between the two groups. These results indicate that redox fluorometry is able to detect early metabolic changes in the corneal endothelium and lens epithelium, which are induced by diabetes mellitus. Activation of the polyol pathway may be responsible for the change. Corneal epithelia may be less susceptible to diabetic changes than the corneal endothelium and lens epithelium.

Specular microscopic observation of normal human corneal epithelium

The authors analyzed the specular microscopic appearance of normal corneal epithelium, with particular regard to four cell patterns previously identified in pathologic corneas. Corneal epithelia of 75 normal eyes were examined by specular microscopy using a special compound contact lens. There were no elongated or extra large cells, whereas 44.0% and 35.7% of the corneas showed central epithelial nuclei and irregular patterns, respectively. The mean epithelial cell area and corresponding mean coefficient of variation (CV) for each of the corneas were 595.6 +/- 98.8 microns 2 and 30.3 +/- 15.3%, respectively. The values for the endothelium were 325.7 +/- 48.4 microns 2 and 33.6 +/- 6.3%, respectively. Although there was a significant Pearson correlation (r = 0.50, P less than 0.01) between mean endothelial cell area and age, none existed (r = 0.19, P greater than 0.05) between mean epithelial cell area and age, even though there was a relationship (r = 0.35, P less than 0.01) between the mean cell areas themselves. There were no significant relationships among the CV of the epithelium, that of the endothelium, and age. This study presents a powerful new technique and baseline data by which to assess normal corneal epithelium and any aberration.

Detection by brush cytology of mast cells and eosinophils in allergic and vernal conjunctivitis

The presence of eosinophils in the conjunctival epithelium is indicative of allergies, and detection is currently performed by cotton swab scrapings. Although mast cells are thought to be chemotactic for eosinophils and thus presage their accumulation, the former's use as early indicators of allergy has heretofore been hindered by poor detection methods. The recent development of a special brush now makes it possible to collect many cells with less disturbance of the conjunctival epithelium. In the present study, we have used this brush for conjunctival scraping in 18 patients with vernal and allergic conjunctivitis, and 10 patients serving as controls. The superior and inferior tarsal conjunctiva in both eyes were examined, and the specimens were stained using Hansel's method. Mast cells were observed in at least one of the tarsal conjunctivae in all cases of vernal and allergic conjunctivitis, whereas eosinophils were so observed in only eight cases (44.4%). Neither mast cells nor eosinophils were present in the conjunctivae of the normal group. Although treatment by mast cell stabilizers produced clinical remissions, they induced disappearance of mast cells in only 10 cases (55.6%), whereas in six cases (33.3%) the mast cells increased, and in two cases they were unchanged (11.1%). Six cases (33.3%) each showed disappearance of, increase in, and no change in eosinophils, reflecting even less of a response of these allergic cells to the treatment. The presence of mast cells and eosinophils, as determined by our cytologic method, was found to be correlated with the early detection, but not the clinical severity, of allergic conjunctivitis.

Corneal epithelium following intraepikeratophakia

The corneal epithelium in eight patients was surveyed by biomicroscopy and specular microscopy before and after the intraepikeratophakia procedure. Autografting of the epithelium was also examined by electron microscopy. Although the superficial layer of the epithelium was damaged, the wing cell layer remained intact, contributing to the epithelialization of the cornea. Epithelialization of the cornea after surgery was completed in three days in all cases. The epithelium was stained with fluorescein, revealing abnormalities in the superficial layer. This stained superficial epithelium was replaced with new epithelium within seven days, but the new, unstained epithelium exhibited an abnormal pattern when observed under the specular microscope. Abnormally shaped cells, cells with nuclei, and white cells were observed, and normal maturation of the epithelial cells was disrupted. These abnormalities lasted more than eight months in three patients. Patient selection and careful follow-up is advised because of the abnormalities of the epithelium.

Corneal epithelium in diabetic patients

The corneal epithelia of phakic control (n = 13), aphakic control (n = 10), diabetic phakic (n = 10), and diabetic aphakic patients (n = 13) were surveyed under a wide-field specular microscope with a special contact lens. In control patients, the corneal epithelium showed relatively hexagonal cells, which we divided into three groups: bright cells, medium-bright cells, and dark cells. These epithelial cells displayed a smooth-surface configuration. In diabetic phakic patients, the epithelium seemed almost normal, with slightly more irregularity. In diabetic aphakic patients, the epithelium appeared larger. The cells were irregular and easy to distinguish from normal cells. Morphometric analysis showed that the mean cell areas of phakic control, aphakic control, diabetic phakic, and diabetic aphakic patients were 648 +/- 152, 643 +/- 125, 658 +/- 146, and 821 +/- 203 microns 2, respectively. The increase in the average cell area in diabetic aphakic patients was statistically significant. Although no apparent changes of the epithelium could be detected in the diabetic corneal epithelium under biomicroscopy, abnormalities that could be evaluated by specular microscopic images and morphometric analysis were observed.

Specular microscopic observation of human corneal epithelial abnormalities

The diameter of the cone lens of the specular microscope was enlarged from its original size of 3.5 mm to 6.0 mm. This modification enabled the authors to take clear pictures of the corneal epithelium with a specular microscope (SM) contact lens, because tears could be excluded from the photographic field by exerting even pressure on the cornea. The normal corneal epithelium showed three kinds of cells with no abnormally shaped or reflex cells. As spindle-shaped cells were mainly observed in keratoconus patients, post-penetrating keratoplasty patients, and postepikeratophakia patients, this suggests that these cells may be an indicator of wound healing. Large cells were observed in diabetic aphakic patients, aphakic extended-wear soft contact lens wearers, and aphakic patients using 0.5% indomethacin eye drops; thus, the presence of large cells may indicate suppressed metabolism and mitosis. Colonies of small cells were observed in keratoconjunctivitis patients. Cells with nuclei and irregular cell patterns were observed in all diseased conditions. There are several common abnormal patterns in the corneal epithelium that are observable under the specular microscope. Modified specular microscopic observation can detect these subtle alterations at the cellular level.

Cytological evaluation of adenoviral follicular conjunctivitis by cytobrush

Conjunctival brush samples from 38 patients with acute conjunctivitis were examined to determine whether cellular features could be utilized for cytodiagnosis. Of all cases, 32 (84%) patients showed a characteristic cell pattern for adenoviral follicular conjunctivitis (AFC) and in the remaining 6 (16%) patients herpetic infection was suggested cytologically. The background of the conjunctival smears from patients with AFC was characterized by the predominance of lymphocytes with little fibrinous discharge. In addition, two types of nuclear alterations were demonstrated i.e. intranuclear inclusions and a so-called ground-glass nuclear appearance. Ground-glass nuclei occurred more frequently than intranuclear inclusions in patients with AFC. However, the presence of lymphocytes in conjunctival smears was a useful criterion for making the differential diagnosis between herpetic and adenoviral infections. Thus, in the absence of these three cellular changes, i.e. ground-glass nuclei, intranuclear inclusions and lymphocytic background, infectious conditions other than AFC may be considered, regardless of the numbers of conjunctival cells present. Emphasis is placed on the value of conjunctival brush cytology for the rapid diagnosis of cases of suspected AFC.

[Measurement of tear evaporation from ocular surface]

A new method for measuring tear evaporation from the ocular surface is developed. The change of humidity in the closed chamber around the eye was recorded, with eyes open and eyes closed. Theoretical equations were used for data analysis, and the evaporation coefficient K, the tear evaporation volume at the environmental humidity of 40% were calculated. We examined 28 normal eyes and 58 eyes of dry eye patients. Evaporation coefficient K (x 10(-4)/sec) were 32.4 +/- 9.2 in normal and 16.5 +/- 11.3 in dry eyes (p less than 0.001). Tear evaporation volume at the environmental humidity of 40% (x 10(-7) g/sec.eye) were 16.2 +/- 4.7 in normal and 8.4 +/- 5.7 in dry eyes (p less than 0.001). This method is so simple and non-invasive that it could be used as a new examination for dry eye.

Metabolic studies of galactosemic cataract

Experimental diabetic and galactosemic animal models are widely used to study diabetes-induced complications. Galactose feeding can rapidly produce cataract, retinopathy and nephropathy; it is therefore favored over the diabetic model. Although the common feature for both models is the activation of aldose reductase, there are substantial differences between the two--not only does the rate of cataract progression differ but the metabolic patterns are far more complex than for polyol production alone. We here present the result of a comparison between diabetic and galactosemic lenses and show the differences in phosphorus and aldose metabolism, cell integrity and osmotic environment.

Specular microscopic observation of eye-bank corneal endothelium using the clinical specular microscope

A special holder for endothelial evaluation of eye-bank corneas using the clinical specular microscope was developed. Using this holder, pictures of the corneal endothelium can be taken without the eye-bank specular microscope.

Conjunctival brush cytology

In order to collect conjunctival cells efficiently, we developed a special brush that is a modification of the Cytobrush used in cervical cytology. The conjunctival brush is small and made of nylon bristles. Cells collected by these brushes were rinsed into a buffered solution, from which filter preparations were made. This technique produced adequately cellular samples from temporal bulbar conjunctiva; these preparations stained well with the Papanicolaou stain. Under normal conditions, three cell types were observed in the brushing samples; one was the polygonal epithelial cell, the second type was a small rounded cell, and the third type was a mucus-secreting goblet cell. Samples from dry-eyed patients contained keratinized cells with or without a decrease in goblet cells. Elongated cells were seen in samples from postirradiation and postoperative patients. Irritation caused by the brushing was of the same intensity as irritation caused by collecting cytologic specimens by impression or by the use of cotton swabs. These findings suggest that brushing cytology of the conjunctiva is a relatively noninvasive technique and can provide valuable information for evaluation of conjunctival conditions.

[Brush cytology for the evaluation of dry-eye]

A special brush was developed for collection of conjunctival cells with better integrity of the harvested specimens. Using this brush, cells were collected from temporal bulbar conjunctiva of 20 normal eyes and 40 eyes with dry-eye, and were stained by the modified Papanicolau method, Keratinized cells (K) and goblet cells (G) were classified into 5 categories, from (-) to ( ) according to the numbers of the cells observed. Normal eyes were categorized as K (-):16, K(+/-):4, G (+):2, G(++):18, Eyes with dry-eye were K (-):3, K (+/-):8, K (+) 13, K (++):11, K ( ):5, and G (-):7, G (+/-):7, G (+):22, G (++):4. Clinical severity and the rose Bengal score corresponded to these categories. This technique can detect cytological changes in conjunctival cells in terms of shape and quality of staining. Eyes with dry-eye could be evaluated in relation to the numbers of keratinized cells and goblet cells.

Image analysis of the corneal epithelium

The method for quantifying corneal epithelial images has been examined. When pictures were developed, the images were stored in the memory of the image processing system by video camera. The distribution of the density of the images was analyzed. The density of each pixel of an image was assigned one of 256 grades, from completely black to completely bright. The average (AV), the standard deviation (SD), the coefficient of variation (CV), the skewness (SK) and the sharpness (S) of the density were calculated. Normal epithelium could be differentiated from abnormal by subjectively observing the shapes of the cells, the sizes of the cells and the irregularity of the cell pattern. But there were no statistical differences between the two groups with regard to the AV, SD, CV, SK and S of normal (n = 4) and abnormal (n = 8) corneal epithelial images. Simple analysis of density distribution could not be used as a parameter for the evaluation of the cells.

Application of erbium: YAG laser in ocular ablation

Recent developments in lasers have provided us the possibility of laser ocular surgery. The xenon, argon, neodymium:YAG and dye lasers have been successfully used in out-patient clinics. The excimer laser has been attracting researchers' interest in the new application of laser to cornea and lens. The erbium:YAG laser emits a 2.94-microns beam that can ablate the transparent ocular tissues such as lenses and corneas. The author has applied this laser to the cornea, lens, vitreous and other ocular tissues. The erbium:YAG laser beam was directed through a 1.5-meter-long, 200-microns-diameter fiberoptic guide. The radiant energy measured about 50 mJ at the end of the probe. The laser was emitted as a 400-microsecond pulse. Freshly enucleated rabbit eyes were used in this study. Laser burns were applied to the tissue surface at various energy settings. At minimal power, the tissues were coagulated by the erbium:YAG laser application. At a power of more than 636-954 mJ/mm2, tissue began to evaporate; the tissue loss was observed under a surgical light microscope. Corneal photoablation, lens ablation, iridotomy, trabeculotomy, cutting of the vitreous and retinal ablation were easily performed. Like the excimer laser, the erbium:YAG laser is a potential tool for ocular surgery.

Hard contact lens-induced metabolic changes in rabbit corneas

The biochemistry of contact lens-cornea interaction is not well understood, although previous studies have suggested that corneal metabolic changes may be the underlying factor in morphological alterations. Using a rabbit model, this interaction has been examined with 31P nuclear magnetic resonance (NMR) spectroscopy, which detects signals principally from the epithelium. The examination was supplemented with electron microscopy and histochemistry. Polymethylmethacrylate lenses caused reversible changes, including activation of anaerobic glycolysis and disturbance of membrane metabolite levels. These changes were far more severe than those occurring during prolonged eye closure. There appears to be an association between cellular deterioration and loss of membrane metabolites. On the other hand, oxygen-permeable silicone lenses allowed maintenance of nearly normal metabolic patterns. These results show multifaceted corneal response to hard contact lens wear.

Lens redox fluorometry: pyridine nucleotide fluorescence and analysis of diabetic lens

We performed both ex vivo and in vivo fluorometric analyses of pyridine nucleotides (PN) in rabbit and rat lenses. Rabbit lens PN fluorescence (99% NADH) was found to have an excitation maximum at 366 nm and an emission maximum at 462 nm (366:462). The only other fluorescent chromophore in that region of the spectrum has excitation and emission peaks at 328 and 460 nm, respectively. Anaerobic glycolysis in the lens was stimulated by KCN, a known inhibitor of mitochondrial respiration, after which a time-study of fluorescence intensities was performed. Over the course of a 3.5 hr period following treatment with KCN, the PN signal showed a statistically significant increase relative to that in the control lenses (those treated with KCl). while the 328:460 signal (which may be due to some protein involved in energy transfer with the PN) had a significantly greater decrease. We also found that fluorescence intensity of NADH in solution is linearly proportional to physiologic-range concentration. Moreover, there was a close correlation between fluorescence intensity of rat lens PN as measured on a specular microscope-coupled redox fluorometer capable of in vivo use, and the lens PN levels as determined by the analytical cycling assay technique. This fluorometer was then employed to assess the redox state in rats with streptozotocin-induced diabetes. The normalized ratio of PN to flavoproteins (Fp) in the lens epithelium increased from 0.96 +/- 0.12 in the normal state to 1.48 +/- 0.30 2 weeks after diabetes induction. In contrast, the ratio in the diabetic lens treated with an aldose reductase inhibitor, sorbinil, did not increase. The increase in the PN:Fp ratio therefore reflects activation of the polyol pathway and its associated metabolic activities, which results in an increase in the NADH:NAD ratio in the diabetic rat lenses. Our results indicate that the non-invasive, real-time method of redox fluorometry may be useful in the early detection and evaluation of cataracts and other disorders in lens metabolism, long before opacities occur. It can be used to monitor the disease process and evaluate the efficacy of such drugs as aldose reductase inhibitors on a biochemical level.

Thermal cycling effects on the stored rabbit cornea

Specular microscopy has proven itself a useful tool for evaluation of donor corneas. In many eye banks, corneas are stored at 4 degree C and warmed to room temperature for specular microscopic evaluation. On occasion it would be desirable to put the cornea back into storage provided there were no detrimental effects of the recooling and subsequent rewarming. The effects of repeated cooling and rewarming (thermal cycling) on the corneal endothelium were determined using rabbit corneas stored in M-K medium at 4 degree C. Some corneas were left in the refrigerator for a 7-day storage interval while others were removed daily, warmed to room temperature, evaluated morphologically and biochemically with the specular microscope and the redox fluorometer, respectively, and then placed back in the refrigerator. At the end of the 7-day storage period there were no statistically significant differences in either the biochemical signals or the specular appearance between thermally cycled corneas and corneas that were continuously stored at 4 degrees C for the same period of time. Repeated warming, specular microscopic observation, and cooling of the cornea appear not to be detrimental to the corneal endothelium.

Noninvasive metabolic analysis of preserved rabbit cornea

With the method of corneal redox fluorometry, the autofluorescence of reduced pyridine nucleotides (PN) and oxidized flavoproteins (Fp) in rabbit corneal endothelium was measured as a function of storage time in McCarey-Kaufman (MK) medium and K-Sol medium. Measurements were started immediately after preparation of the corneal button, and the corneas were followed up for up to three weeks of storage. In both media, the PN/Fp ratio of the endothelium initially increased slightly in the first or second day and then began to decrease toward a level lower than baseline. This initial increase is possibly a result of an adaptive mechanism. The PN/Fp ratio maintained itself in the range of baseline values up to one week in MK medium but not in K-Sol medium. With scanning electron microscopy, the surface of the membrane and cell border were maintained for a three-week preservation period, and no apparent differences were found between the corneas stored in the two media. With transmission electron microscopy, the intracellular organelles appeared almost normal through one week of preservation in corneas stored in either media. During weeks 2 and 3, however, intracellular edema with increased endothelial thickness became prominent in the corneas stored in both media. Although no visual difference in the morphological features of the endothelium was apparent between corneas stored in either medium, computer-assisted morphometric analysis showed a statistically significant increase in the coefficient of variation of mean cell area for the corneas preserved in K-Sol medium but not for those preserved in MK medium.

Corneal endothelial changes following minor trauma

The healing processes that occur when corneal endothelial cells are subjected to only mild trauma are not known. To study these processes we have developed a system that enables only a few endothelial cells to be traumatized or destroyed under continuous specular microscopic observation in vitro. Experiments in which a small group of cells were traumatized by gentle wounding with a microglass tip produced an immediate and distinct dark area having the same size as the tip. Using this method we have produced and observed two types of wound by controlling the force of wounding. The first type of wound, produced by a gentle touch, recovered within 1 hr. The second type of wound, produced by moderate touch, took about 24 hr to recover completely from the trauma. In the second type of wound, we observed migration, elongation, coalescence and mitosis during the healing process. Histological examination revealed that in the first type of wound, the cells remained intact with no apparent damage seen by vital staining and light microscopy. For the second type of wound, the cells were completely missing although there was no apparent damage to Descemet's membrane.

Clinical features of a newly recognized type of lattice corneal dystrophy

We examined five patients with an undescribed type of lattice corneal dystrophy. All patients were in the seventh to ninth decades of life and had developed decreasing vision late in life. None of the patients had suffered from recurrent epithelial erosions, there was no overt evidence of systemic amyloidosis, and the lattice lines were much thicker than those usually observed in lattice corneal dystrophy types I and II. Available pedigree data from two families of three patients indicated that the corneal disorder affected several siblings but not the parents or offspring. Two patients had no affected family members. There was no known consanguinity in any of the four families.

Noninvasive measurements of pyridine nucleotide and flavoprotein in the lens

Abnormalities in glucose metabolism are thought to be among the main causes of cataract formation. The authors have made noninvasive biochemical measurements of the lens that provide information concerning glucose metabolism in the lens epithelium. The autofluorescence of reduced pyridine nucleotides (PN) and oxidized flavoproteins (Fp) within the rabbit lens were noninvasively measured as a function of depth using redox fluorometry. The peak of the autofluorescence at 440 nm (excited at 360 nm) and 540 nm (excited at 460 nm) were determined at the lens epithelium. When 8 mM sodium pentobarbital, a known inhibitor of mitochondrial respiration, was applied to the lens, the autofluorescence peak at 440 nm increased and that at 540 nm decreased. The 440 nm autofluorescence is thought to be from reduced pyridine nucleotides, whereas the 540 nm autofluorescence is from the oxidized flavoprotein. Blocking lens respiration with pentobarbital caused an increase in the PN/Fp ratio by a factor of 3 within 3.5 hr after pentobarbital application.

Morphometric analysis of corneal endothelium following radial keratotomy

We performed morphometric analysis of the central corneal endothelium on 24 eyes of 19 patients who had had anterior radial keratotomy. The endothelium was analyzed for a variety of parameters, including cell area, perimeter, side lengths, cell shape, and number of sides. Mean, standard deviation, and coefficient of variation were calculated for each parameter. The mean cell density decreased from 2,835 to 2,677 cells/mm2, mean cell perimeter increased from 71.4 micron to 74.3 micron, and mean side length increased from 11.8 micron to 12.3 micron following surgery. The changes in these three parameters were statistically significant (P less than 0.05). The coefficient of variation of cell area (polymegathism) changed from 0.319 to 0.307, the hexagonality changed from 62.5% to 59.6%, and the cell shape changed from 0.872 to 0.867. The changes in these parameters were not statistically different before and after surgery. The group of patients that had no reported microperforations showed only a small decrease of cell density (1.6%), while the group of patients that had microperforations showed a large decrease of cell density (14.3%). The cell perimeter and side lengths showed a similar pattern. The group of corneas with the optical zone diameter less than 3.5 mm showed a decrease in mean cell density from 2,994 to 2,725 cells/mm2, and the cell shape changed from 0.874 to 0.866 following surgery. The changes in these parameters were statistically significant (P less than 0.05) before and after surgery. Among all factors associated with radial keratotomy, microperforation and a small diameter of central optical zone appear to be the two greatest risk factors.

Lattice dystrophy type 1: a report of 8 families

Eight families with lattice corneal dystrophy are reported. The symptoms and signs are almost identical with the typical lattice corneal dystrophy type 1 in western countries. Lattice corneal dystrophy has been considered to be a rare disease until recently, but it might be a more common disorder. This is the first report of a large series of lattice corneal dystrophy in Japan.

Adenocarcinoma of the ciliary body pigment epithelium in a child

Tumors arising from the pigment epithelium of the ciliary body are rare and most commonly occur in white adults. We describe a tumor that was clinically indistinguishable from a melanoma or medulloepithelioma occurring in a 7-year-old Japanese boy. Three months after initial evaluation, the eye was enucleated because of intractable intraocular pressure elevation and pain. On pathologic examination the tumor was found to fill approximately one third of the anterior chamber. Light microscopic and ultrastructural findings were consistent with an adenocarcinoma of the ciliary body pigment epithelium. To our knowledge, this is the youngest patient described with this tumor.