Prevention and Treatment of Retinal Vein Occlusion: The Role of Diet-A Review

Retinal vein occlusion (RVO) is the second most common retinal disorder. In comparison to diabetic retinopathy or age-related macular degeneration, RVO is usually an unexpected event that carries a greater psychological impact. There is strong evidence to suggest that cardiovascular diseases are the most common risk factors in this pathology and it has long been known that a higher consumption of fish, nuts, fruits, and vegetables has a protective effect against these types of conditions. In the last several years, interest in plant-based diets has grown in both the general population and in the scientific community, to the point to which it has become one of the main dietary patterns adopted in Western countries. The aim of this review is to investigate the potential impact of macro- and micronutrients on retinal vein occlusion.

A Mediterranean Diet May Be Protective in the Development of Diabetic Retinopathy

The Mediterranean diet is recognized as one of the healthiest available dietary patterns. This perception results from its beneficial effects on the cardiovascular system and, also, on hypertension, diabetes, and cancer compared with other diets. Its impact on the course of diabetes is assessed in the available scientific literature; however, little information is available about its impact on diabetic retinopathy. The MD is characterized mainly by the consumption of fish, seafood, foods of plant origin, and fresh fruit and vegetables. It is also recommended to consume legumes, which are a source of folic acid, magnesium, iron, and dietary fiber. High consumption of nuts and unrefined grains is also recommended in the MD. Marine fish provide polyunsaturated acids from the omega-3 group. Olive oil plays a very important role, especially olive oil obtained from mechanical pressing. Additionally, olive oil contains vitamins E, K, and polyphenols. Polyphenols, which are present in a diverse range of vegetables, fruits, and seeds, have the ability to decrease oxidative stress, inflammation, and insulin resistance. Resveratrol is naturally found in grape skins and seeds, as well as in peanuts and berries, and is a constituent of red wine. Resveratrol can inhibit increased vascular leakage and loss of pericytes and regulate the level of VEGF protein in the retina, thus inhibiting the development of DR. Consumption of fruits, vegetables, fish, and olive oil may be correlated with a lower risk of diabetic retinopathy. This paper presents the definition of the Mediterranean diet and its influence on the course of diabetes and diabetic retinopathy.

Current Approach to the Pathogenesis of Diabetic Cataracts

Cataracts remain the first or second leading cause of blindness in all world regions. In the diabetic population, cataracts not only have a 3–5 times higher incidence than in the healthy population but also affect people at a younger age. In patients with type 1 diabetes, cataracts occur on average 20 years earlier than in the non-diabetic population. In addition, the risk of developing cataracts increases with the duration of diabetes and poor metabolic control. A better understanding of the mechanisms leading to the formation of diabetic cataracts enables more effective treatment and a holistic approach to the patient.

Air Pollution, Oxidative Stress, and the Risk of Development of Type 1 Diabetes

Despite multiple studies focusing on environmental factors conducive to the development of type 1 diabetes mellitus (T1DM), knowledge about the involvement of long-term exposure to air pollution seems insufficient. The main focus of epidemiological studies is placed on the relationship between exposure to various concentrations of particulate matter (PM): PM1, PM2.5, PM10, and sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (O3), versus the risk of T1DM development. Although the specific molecular mechanism(s) behind the link between increased air pollution exposure and a higher risk of diabetes and metabolic dysfunction is yet unknown, available data indicate air pollution-induced inflammation and oxidative stress as a significant pathway. The purpose of this paper is to assess recent research examining the association between inhalation exposure to PM and associated metals and the increasing rates of T1DM worldwide. The development of modern and more adequate methods for air quality monitoring is also introduced. A particular emphasis on microsensors, mobile and autonomous measuring platforms, satellites, and innovative approaches of IoT, 5G connections, and Block chain technologies are also presented. Reputable databases, including PubMed, Scopus, and Web of Science, were used to search for relevant literature. Eligibility criteria involved recent publication years, particularly publications within the last five years (except for papers presenting a certain novelty or mechanism for the first time). Population, toxicological and epidemiological studies that focused particularly on fine and ultra-fine PM and associated ambient metals, were preferred, as well as full-text publications.

Assessment of the Refractive Error and Stabilisation of Refraction after Cataract Surgery in Relation to the Length of the Eyeball

The aim of this study was to analyse the changes in refraction, depending on the length of the eyeball, in patients who had undergone cataract surgery using the phacoemulsification method and to assess the stability of refraction. A total of 90 patients (46 to 85 years of age) took part in the study and were divided into three groups: emmetropic, hypermetropic, and myopic. Two types of intraocular lenses were used: Bausch (Akreos AO) and Rayner (C-flex). In conclusion, stabilization of refraction was achieved in the third week in 91% of the emmetropic, 77% of the myopic, and 46% of the hypermetropic patients, respectively. The correct postoperative refraction was achieved using optical biometry and the Barrett Universal II formula to calculate the power of the lens implant.

Significant Decrease in Glycated Hemoglobin, 2h-Post-Load Glucose and High-Sensitivity C-Reactive Protein Levels in Patients with Abnormal Body Mass Index after Therapy with Manual Lymphatic Drainage

The objective of this study was to investigate the effect of manual lymphatic drainage (MLD) on the insulin resistance parameter (HOMA-IR), glycated hemoglobin (HbA1c), C-peptide, insulin, fasting plasma glucose (FPG), 2h-post-loadglucose (2h-PG) and the concentration of high-sensitivity C-reactive protein (hsCRP) in patients with abnormal body mass index. The study involved 30 patients, including patients with normal body weight (as a control group; group I; n = 14), overweight patients (group II; n = 9) and obese patients (group III; n = 7). Each patient underwent 10 sessions of MLD therapy, 3 times a week for 30 min. In addition, we measured body mass index (BMI) and waist-to-hip ratio (WHR) and performed body composition analysis as well as biochemical tests before MLD therapy (stage 0′) and after MLD therapy (stage 1′). A statistically significant correlation was demonstrated between the concentration of C-peptide, BMI, the amount of visceral adipose tissue (r = 0.87, p = 0.003; r = 0.76, p = 0.003, respectively), and the HOMA-IR index, BMI and the amount of visceral adipose tissue (r = 0.86, p = 0.005; r = 0.84, p = 0.042, respectively), before and after MLD therapy. In overweight patients (group II), a statistically significant (p = 0.041) decrease in the hsCRP level by 2.9 mg/L and a significant (p = 0.050) decrease in the 2h-PG level by 12 mg/dL after the MLD therapy was detected. Moreover, in the group of obese patients (group III), a statistically significant (p = 0.013) decrease in HbA1c level by 0.2% after MLD therapy was demonstrated. Our results indicate that MLD may have a positive effect on selected biochemical parameters, with the most favorable changes in overweight patients. Further studies in a larger number of patients are warranted to confirm our findings, to test in-depth their mechanism, and to investigate clinical benefits of this alternative therapy in patients with abnormal body mass index.

The Effect of Hyperlipidemia on the Course of Diabetic Retinopathy—Literature Review

Diabetes mellitus is a very important social issue, and its retinal complications continue to be one of the major causes of blindness worldwide. The effect of glucose level on the development of retinal retinopathy has been the subject of numerous studies and is well understood. Hypertension and hyperlipidemia have been known to be important risk factors in the development of diabetes complications. However, the mechanisms of this effect have not been fully explained and raise a good deal of controversy. The latest research results suggest that some lipoproteins are closely correlated with the incidence of diabetic retinopathy and that by exerting an impact on their level the disease course can be modulated. Moreover, pharmacotherapy which reduces the level of lipids, particularly by means of statins and fibrate, has been shown to alleviate diabetic retinopathy. Therefore, we have decided to review the latest literature on diabetic retinopathy with respect to the impact of hyperlipidemia and possible preventive measures

A Clinical Study of the Impact of Soft Contact Lenses on the Progression of Myopia in Young Patients

PURPOSE

To assess the impact of soft contact lenses on the progression of myopia in young patients.

PATIENTS AND METHODS

The observational study included 102 patients divided into 3 groups: MFCL (multifocal contact lenses) group: 15 girls and 9 boys, aged 8-20 (= 14.12 ± 2.863) with soft multifocal contact lenses with myopia: = -3.12 D ± 1.776 D and mean myopia progression -0.23 ± 0.233D after 2 years; SVCL (single vision contact lenses) group: 30 girls and 5 boys, 11-20 years old (=15.5 ± 2.24) with myopia = -2.88 ± 2.122 D at admission and mean myopia progression -0.54 ± 0.464 D after 2 years; the spectacle (single vision glasses) group: 25 girls and 18 boys, aged 8-18 years ( = 13.65 ± 2.448) with single vision glasses with myopia: = -1.74 ± 1.412 D at admission and mean myopia progression -0.86 ± 0.489D after 2 years. Medical history and physical examination were performed every 6, 12, 18 and 24 months. Refractive error was examined using the autorefractometry after cycloplegia.

RESULTS

The analysis of myopia correction after 2 years showed differences between MFCL and spectacle correction. The change in myopia progression after 2 years was statistically significant for MFCL vs SVCL and MFCL vs spectacle correction when the myopia occured before the period of intensive growth. When myopia occurred during the period of intensive growth, difference was noted for MFCL vs spectacle correction and SVCL vs spectacle correction. When myopia occurred after a period of intensive growth, no significant differences between the groups were observed.

CONCLUSION

1) Multifocal contact lenses and some single vision contact lenses (Biofinity) may be useful in the control of myopia in younger patients, slowing the progression of nearsightedness; therefore, they can be a therapeutic option in inhibiting the progression of myopia. 2) The best effects of using multifocal contact lenses occur if myopia is diagnosed before the period of intensive growth.

Adipose Tissue and Biological Factors. Possible Link between Lymphatic System Dysfunction and Obesity

The World Health Organization (WHO) has recognised obesity as one of the top ten threats to human health. Obesity is not only a state of abnormally increased adipose tissue in the body, but also of an increased release of biologically active metabolites. Moreover, obesity predisposes the development of metabolic syndrome and increases the incidence of type 2 diabetes (T2DM), increases the risk of developing insulin resistance, atherosclerosis, ischemic heart disease, polycystic ovary syndrome, hypertension and cancer. The lymphatic system is a one-directional network of thin-walled capillaries and larger vessels covered by a continuous layer of endothelial cells that provides a unidirectional conduit to return filtered arterial and tissue metabolites towards the venous circulation. Recent studies have shown that obesity can markedly impair lymphatic function. Conversely, dysfunction in the lymphatic system may also be involved in the pathogenesis of obesity. This review highlights the important findings regarding obesity related to lymphatic system dysfunction, including clinical implications and experimental studies. Moreover, we present the role of biological factors in the pathophysiology of the lymphatic system and we propose the possibility of a therapy supporting the function of the lymphatic system in the course of obesity.

Integrins: An Important Link between Angiogenesis, Inflammation and Eye Diseases

Integrins belong to a group of cell adhesion molecules (CAMs) which is a large group of membrane-bound proteins. They are responsible for cell attachment to the extracellular matrix (ECM) and signal transduction from the ECM to the cells. Integrins take part in many other biological activities, such as extravasation, cell-to-cell adhesion, migration, cytokine activation and release, and act as receptors for some viruses, including severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2). They play a pivotal role in cell proliferation, migration, apoptosis, tissue repair and are involved in the processes that are crucial to infection, inflammation and angiogenesis. Integrins have an important part in normal development and tissue homeostasis, and also in the development of pathological processes in the eye. This review presents the available evidence from human and animal research into integrin structure, classification, function and their role in inflammation, infection and angiogenesis in ocular diseases. Integrin receptors and ligands are clinically interesting and may be promising as new therapeutic targets in the treatment of some eye disorders.

Adipokines and Obesity. Potential Link to Metabolic Disorders and Chronic Complications

The World Health Organization (WHO) has recognized obesity as one of the top ten threats to human health. It is estimated that the number of obese and overweight people worldwide exceeds the number of those who are undernourished. Obesity is not only a state of abnormally increased adipose tissue in the body, but also of increased release of biologically active adipokines. Adipokines released into the circulating blood, due to their specific receptors on the surface of target cells, act as classic hormones affecting the metabolism of tissues and organs. What is more, adipokines and cytokines may decrease the insulin sensitivity of tissues and induce inflammation and development of chronic complications. Certainly, it can be stated that in an era of a global obesity pandemic, adipokines may gain more and more importance as regards their use in the diagnostic evaluation and treatment of diseases. An extensive search for materials on the role of white, brown and perivascular fatty tissue and obesity-related metabolic and chronic complications was conducted online using PubMed, the Cochrane database and Embase.

Pro-inflammatory cytokines associated with clinical severity of dry eye disease of patients with depression

PURPOSE

The aim of this study was to assess the correlation of inflammatory cytokines levels in tears with severity of dry eye disease in a cohort of patients with depression.

MATERIAL AND METHODS

Tear fluid samples were collected from 32 patients with depression treated with antidepressants, and 34 healthy subjects. Cytokines were assessed by ELISA. All the subjects completed the Beck Depression Inventory and performed the ophthalmic examination, including dry eye tests.

RESULTS

The tear fluid levels of IL-6, IL-17 and TNF-α in depressive patients were higher than in controls. The clinical severity of dry eye disease correlated significantly with the IL-17 and TNF-α levels.

CONCLUSIONS

Our results suggest a crucial role of inflammatory cytokines, especially IL-17 and TNF-α, in the development of severe dry eye disease in patients with depression. Clarification of the role pro-inflammatory cytokines in the pathogenesis of ocular findings in depressive patients may be useful in establishing immunotherapeutic strategies for this disease.

Neuroretinal Apoptosis as a Vascular Dysfunction in Diabetic Patients

Background

Diabetic retinopathy (DR) is an important complication of diabetes and is considered one of the main causes of blindness in moderate-income and highly-developed countries. As it is a major socioeconomic problem, defining all mechanisms that may lead to DR development is of great importance. In the 21st century diabetic lesions occurring in the retina are well known. However what kind of retinal neuronal damage occurs in the course of diabetes remains unclear.

Results

In this manuscript we present the most recent knowledge about suggested mechanisms of diabetic retinopathy, including neuroretinal apoptosis. Getting a deep insight into the role of apoptosis and degeneration of retinal neurons leading to DR will have vital consequences.

Conclusion

The findings of this review confirm that it is very likely that in the nearest future diabetic retinopathy treatment will be based on administration of neuroprotective agents. The implementation of neuroprotective drugs may slow down retinopathy progression, making it possible to avoid the currently used therapeutic procedures, such as laser photocoagulation, intravitreous injections or posterior vitrectomy, which are not only risky for the healthy part of the retina but also relatively expensive.

Elevated percentage of HLA-DR⁺ and ICAM-1⁺ conjunctival epithelial cells in active Graves' orbitopathy

Background

To evaluate if conjunctival epithelial cells’ expression of HLA-DR and ICAM-1 could be helpful as early topical markers of inflammation in Graves’ orbitopathy (GO).

Methods

The ocular examination evaluated a clinical activity score (CAS) by assessment of clinical features, (e.g., eyelid or conjunctival inflammation, lid width, lid closure, proptosis, ocular motility). Conjunctival epithelial cell specimens for flow-cytometric evaluations of ICAM-I and HLADR expression were collected by impression cytology from ten eyes with active GO (CAS ≥ 4 and duration ≤ 12 months), from 15 eyes with Graves’ disease (GD) without active GO (CAS 0–2) and from 15 normal specimens without any ocular disorders.

Results

The percentage of HLA-DR + conjunctival epithelial cells was significantly elevated in patients with active GO comparing to GD without active GO and healthy controls, 10.7 % (8.5–17.7) and 7.78 % (3.92–10.1) (p < 0.05) vs. control 4.89 % (3.5–5.5) (p < 0.005), respectively. The expression of ICAM − 1+ conjunctival epithelial cells was greater only in patients with GO vs. controls, 5.5 % (4.8–7.03) and 1.46 % (0.69–2.51) (p < 0.005), respectively.

Conclusion

The percentage of HLA-DR⁺ and ICAM-1⁺ conjunctival epithelial cells in patients with the active GO may serve as a topical inflammation marker in Graves’ orbitopathy.

[Evaluate the effectiveness of laser therapy in the treatment of diabetic maculopathy]

Diabetes mellitus concerns a growing number of people in the world. Its complications are an important social problem. Diabetic macular edema (DME) is one of the leading causes of visual loss in the course of the disease. Deterioration of vision is typically the patients with long-standing, poorly controlled diabetes, both type 1 and 2. DME can occur at any stage of the disease. Because structural changes in the macula are reversible in the initial period, it is important to start treatment early. In the treatment of diabetic uses three techniques retinal laser--direct photocoagulation, photocoagulation a "grid" and the panphotocoagulation. The aim of this study was to evaluate the effectiveness of laser therapy in the treatment of diabetic macular edema.

MATERIALS AND METHODS

The study included 90 patients (180 eyes) with DME, 50 women and 40 men aged from 18 to 80 years with a visual acuity of 0.08 to 0.7 with the best corrected on the Snellen chart. 9 people were with type 1 diabetes, 81 with type 2. 86 patients applied insulin, 4 people took drugs. Eye with poor visual acuity was qualified for the treatment. In all patients enrolled in the study visual acuity, anterior segment of the eye in the slit lamp and fundus by indirect ophthalmoscopy with Volk 78D lens were evaluated. DME was diagnosed on the basis of the results of fluorescein angiography and optical coherence tomography. In the patients laser therapy was performed twice: on day 1 after qualification and four months later. Performed two types of laser: the focal photocoagulation and the type of "grid" depending on the severity of DME. Retinal photocoagulation was performed using a diode laser 810 nm Diode Laser Systems OcuLight SL and SLx Iris Medical Models. Patients were monitored at 4 and 8 months after the laser therapy. The results were statistically analyzed.

RESULTS

Duration of diabetes less than 10 years was in 67 patients, over 10 years in 23. In patients with diabetes under 10 years predominated limited type of macular edema (92.65%), in patients over 10--diffuse (72.73%). As a result of the treatment in 34 patients (37.8%) visual acuity was improved. 91.18% of them had limited macular edema. In 47 patients (52.2%) showed the stabilization of vision. These patients had also more limited type of edema (74.47%). In 9 patients (10%) visual impairment were observed and they were mostly patients with diffuse macular edema (66.67%). Average visual acuity in patients with limited macular edema before laser therapy was 0.37 +/- 0.18. In the four months after the laser treatment improved slightly (0.38 +/- .18). After 8 months of treatment the average visual acuity in this group remained at a level of 0.44 +/- 0.16. In patients with diffuse macular edema output type visual acuity was significantly lower and averaged only 0.16 +/- 0.1. In 4 months after the laser was found in this group decreased vision (Vo = 0.13 +/- 0.08). In 8 months after surgery visual acuity averaged 0.15 +/- 0.09. Average visual acuity before laser therapy in this group was 0.36 +/- 0.17, and 8 months after was at the level of 0.43 +/- 0.16. In patients with diabetes more than 10 years laser therapy has not brought the desired effect, and visual acuity were as follows: before treatment--0.18 +/- 0.16 and 8 months after--0.17 +/- 0.14 (p < 0.0001). Average macular thickness before laser therapy in patients with limited edema was 348.14 +/- 33.47 microns. In 4 months after the laser has been observed decreased to 340.29 +/- 31.2 microns, and after 8 months of further withdrawal of edema to an average of 337.88 +/- 32.95 microns. In patients with diffuse type average macular thickness was 394.38 +/- 38.18. After 4 months of laser treatment exacerbation of edema (mean 399 +/- 38.08). After 8 months, the thickness of macula in this group was average 388.95 +/- 32.85.

CONCLUSIONS

Laser therapy is an effective type of treatment for DME. Better results after laser therapy are obtained in patients with a short-term macular edema and good visual acuity. In order to maintain useful visual acuity, patients with DME should undergo laser treatment in the early stages of the disease.

[Refractive errors in patients with cerebral palsy]

Ocular changes are common in patients with cerebral palsy (CP) and they exist in about 50% of cases. The most common are refractive errors and strabismus disease. The aim of the paper was to estimate the relativeness between refractive errors and neurological pathologies in patients with selected types of CP. MATERIAL AND METHODS. The subject of the analysis was showing refractive errors in patients within two groups of CP: diplegia spastica and tetraparesis, with nervous system pathologies taken into account. Results. This study was proven some correlations between refractive errors and type of CP and severity of the CP classified in GMFCS scale.

CONCLUSIONS

Refractive errors were more common in patients with tetraparesis than with diplegia spastica. In the group with diplegia spastica more common were myopia and astigmatism, however in tetraparesis - hyperopia.

[Evaluation of the arterial blood flow parameters in the eye of myopic patients]

Myopia is a common refractive defect. Has a good vision from near and deterioration of vision with increasing distance. The main reason for its occurrence is too long axis of the eyeball. The consequence of elongation of the eyeball is the development of degenerative changes in the retina. Despite much research has failed to clearly identify the causes of degenerative changes in those short-sighted. The aim of the study was to evaluate the maximum and minimum speed in arterial blood vessels of the eye in people with myopia.

MATERIAL AND METHODS

The study included 70 patients (138 eyes), 53 women and 17 men, aged from 18 to 79 years, with myopia of -0.25 to -18.0 Dsph and length of the eyeball from 22.61 to 33.36 mm. Depending on the kind and the degree of the progress of degenerative changes, patients were divided in 4 groups: I - without degenerative changes on the fundus (n=32; K-23, M-9); II- with the short-sighted sickle (n=20; K-14, M-6); Ill - with the structure thinned down of the retina, accompanying the short-sighted sickle (n = 8; K-6, M-2); IV - with extensive choroidal-retina disappearances in the fundus (n = 10; K-7, M-3). In all individuals enrolled underwent Color Doppler ultrasound with apparatus SSA 770A Toshiba Aplio with linear probe frequency 12 MHz, judging maximum (Vmax) and minimum (Vmin) speed in the arteries of the eye: ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (SPCA) located on the nasal and temporal side of the optic disc. The results were statistically analyzed.

RESULTS

No statistically significant relationship between the nature of degenerative changes of the eye, and blood velocity in the OA. There was a increase in Vmax and Vmin blood in OA in Group IV, but these changes were not statistically significant. Statistically significant correlation was observed while in the CRA. With a decrease in Vmax and Vmin of blood flowing through a vessel exacerbation of retinal degeneration. Vmax and Vmin changes in the blood did not correlate significantly SPCA with retinal degeneration, although the results were much worse in the temporal vessels.

CONCLUSIONS

With the deterioration of blood flow parameters of the central retinal artery and short posterior ciliary arteries comes to the severity of the retinal degeneration in myopic patients. More severe impairment of blood circulation in the temporal ciliary explain higher incidence of degenerative changes in the temporal side of the optic disc.

[Blood flow in vessels supplying the eye in persons with degenerative myopia. Part II. Blood flow in the central retinal artery]

PURPOSE

To analyse the blood flow parameters in the central retinal artery (CRA) of myopic patients depending on the severity of the degenerative changes in ocular fundi.

METHODS

70 myopic subjects, aged 18 to 79 years, with the axial ocular length ranging between 22.61 and 33.36 mm (27.9 +/- 5.37) were examined. According to the extent and severity of degenerative lesion progression, patients were divided into 4 groups: I--no degenerative changes on the fundus (n = 32; K--23, M--9), II--myopic crescent (n = 20; K--14, M--6), III-- retinal thinning accompanying the myopic crescent (n = 8; K--6, M--2), IV--extensive chorioretinal atrophy in the fundus (n = 10; K--7, M--3). Blood flow parameters in the central retinal artery were determined using Doppler Color ultrasonography (Aplio SSA, Toshiba), with the 12 MHz probe. The following, standard parameters were analysed: maximum (Vmax), minimum (Vmin) and mean (Vm) velocity at systole, resistive index (RI) and pulsation index (PI). The differences were analysed statistically using the variance analysis and the Spearman's rank correlation coefficient, with the p < 0.05 assumed as statistically significant.

RESULTS

The severity of degenerative retinal changes correlated with the blood flow in CRA. At lowered Vmax, Vmin, Vm acompanying the elevated RI and Pi the lesions progressed rapidly and were considerably more advanced and extensive.

CONCLUSIONS

The extent and severity of degenerative processes within the myopic retina are directly proportional to blood flow deterioration in the central retinal artery. This association can explain the development and progression of myopic retinopathy.

[Dry eye disease in patients treated with antidepressants]

PURPOSE

Dry eye disease is defined as a multifactorial disease of tears and ocular surfaces that causes discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. This study aimed to determine dry eye findings in patients with depression.

MATERIAL AND METHODS

There were 40 patients with depression aged 18-65 years old. A comprehensive ophthalmic examination, including intraocular pressure and dry eye tests, was performed.

RESULTS

Among patients with depression 24 patients (70%) had dry eye syndrome. Compared with patients who did not have dry eye, the patients with dry eye were significantly older than the patients without dry eye (44 years old and 36 years old, respectively). Time in duration of depression in patients with depression and with dry eye lasted over 54 months and time of taking antidepressants was longer than 18 months and was significant, in comparing to the patients without dry eye (36 months and 10 months, respectively).

CONCLUSIONS

Dry eye is frequent disease in patients with depression, especially in older patients, who have longer duration of depression, and taking antidepressant medication for a longer period of time. Using of antidepressant may be cosidered as potential cause of dry eye syndrome.

[Blood flow in vessels supplying the eye in persons with degenerative myopia. Part I. Blood flow in the ophthalmic artery]

BACKGROUND

Mechanism of hemodynamic disturbances of blood circulation within the afferent vessels supplying the retina and the choroid, considered as one of main underlying causes of degenerative changes in myopic patients, is exceptionally likely, although not entirely proven.

PURPOSE

To estimate the blood flow parameters in the ophthalmic artery of myopic subjects, depending on the extent and severity of progression of degenerative lesions observed in ocularfundi.

METHODS

A prospective study included 70 myopic persons, aged from 18 to 79 years (44.9 +/- 18.3) with the mean axial ocular length of 27.9 +/- 5.37 mm. According to the extent and severity of degenerative lesion progression, patients were divided into 4 groups: I - no degenerative changes on the fundus (n = 32; K--23, M--9), II--myopic crescent (n = 20; K--14, M--6), III--retinal thinning accompanying the myopic crescent (n = 8; K - 6, M - 2), IV--extensive chorioretinal atrophy in the fundus (n = 10; K--7, M--3). Using colour Doppler ultrasonography (Aplio SSA Toshiba, frequency of the head of 12 MHz) the following parameters of the blood flow in the opthalmic artery were determined: the maximum (Vmax), minimal (Vmin) and mean (Vm) velocity, resistive index (RI) as well as pulsation index (PI). Differences were analysed statistically (the variance analysis and the Spearman's rank correlation coefficient). P < 0.05 was assumed as statistically significant.

RESULTS

In groups I and II blood flow parameters were comparable. In group III Vmax, Vmin and Vm were lower than in groups I and II. However, an increase in these parameters was shown in group IV. The PI remained on the comparable level, and the RI across all the study groups. The observed differences were not statistically significant.

CONCLUSIONS

The severity of degenerative retinal change progression at different stages of myopia is related to the blood flow in the ophthalmic artery, although these associations are not statistically significant. Blood flow discrepancies between the right and left artery, resulting from anatomical asymmetries, does not seem to be significant for the development of degenerative changes.

[Idiopathic intracranial hypertension and organ of vision]

Idiopathic intracranial hypertension (IIH) is defined as a syndrome of increased intracranial pressure without causative lesions on magnetic resonance imaging. The symptoms of IIH patients are headache, transient visual obscurations, photopsia, retrobulbar pain, diplopia, visual loss and papilledema. Management of intracranial hypertension is initially medical, using a combination of managed weight body reduction and diuretic, non-steroid and steroid therapy. Surgical therapy may be required to stabilize vision.

[Systemic and ophthalmological findings in Cornelia de Lange syndrome]

Cornelia de Lange Syndrome (CdLS, de Lange syndrome, Brachmann-de Lange syndrome), is a relatively rare genetic disorder, characterized by set of clinical abnormalities concerning different organs and systems. Phenotypic diagnosis is based on a specific dysmorphic features seen after the birth. We described a genetic basis, hereditary patterns, characteristic dysmorphic features and the most common clinical findings of patients Cornelia de Lange Syndrome concerning eye and vision, hearing, cardiovascular, respiratory, gastrointestinal, genitourinary, skeletal and psychomotor development.

[Optical coherence tomography in diagnosis of intracranial hypertension in children]

Intracranial hypertension (IH) is important cause of optic disc edema. It is essential to distinguish the primary and secondary causes of IH. Persistent increasement of intracranial pressure over 200-250 mmH2O is caused by impairment of the balance between production and absorption of cerebrospinal fluid. Though the exact mechanism of IH is still unknown.

PURPOSE

Assessment of usefulness of spectral optical coherence tomography with dual beam eye tracking (SLO/OCT) in diagnosis of intracranial hypertension in children.

MATERIALS AND METHODS

4 children (at the age of 3-12 years) with IH underwent an comprehensive ophthalmological examination, including visual acuity testing (Snellen charts), color vision (Ishihara charts), evaluation of anterior and posterior segment of the eye in slit lamp. On SLO/OCT (Spectralis, Heidelberg) scans RNFL profile of the optic disc was assessed at admission day and after 8 weeks of treatment with oral diuretics. In all patients MRI of the central nervous system was performed.

RESULTS

In all children best corrected visual acuity and MRI scans were normal. 3 of 4 patients had secondary IH. Median global RNFL was 273 microm at admission day. In 3 of 4 children remission of optic disc edema was observed after 8 weeks of treatment with diuretics - median global RNFL was 138 microm.

CONCLUSIONS

Diagnosis of intracranial hypertension requires interdisciplinary cooperation. SLO/OCT is useful in monitoring remission of the optic disc edema.

[Concentration assessment of interleukin 8 in serum at children with uveitis]

PURPOSE

Uveitis in children is a visual threatening disease with a complication rate of more than 75%. At the children the uveitis differs in several aspect from adults like: clinical presentation or complication of disease. The etiology of uveitis is still unknown, but T lymphocytes are generally key mediators of the pathogenesis of uveitis. In our study we evaluate IL-8 concentration in serum in uveitis patients.

MATERIAL AND METHODS

Serum sample were collected from 28 uveitis patients and 20 people from control group. The level IL-8 was measured with specific enzyme- linked immunoassays ELISA methods (R & D Systems).

RESULTS

Level of IL-8 in uveitis group was a significant higher (p<0.04) compared with control group.

CONCLUSIONS

Increased levels of interleukin 8 in serum of children with uveitis may suggest innate immune mechanisms in the acute disease.

[Nasolacrimal duct disorders in children. Part II. Treatment]

Congenital nasolacrimal duct obstruction (CLDO) is considered as common and onerous disorder present at infancy. Over 5% of infants have CLDO affecting one or both eyes. The symptoms of CLDO appear shortly after birth or during the first weeks of life. The main symptoms are: epiphora, ropy, mucous discharge in the conjunctival sac. In conservative treatment a lacrimal sac massage is proposed, though it is not always successful. Topical antibiotics are reserved only if secondary conjunctivitis occurs. Fortunately, most cases resolve spontaneously. However, sometimes nasolacrimal duct probing performed under local or general anesthesia is necessary. Prognosis for probing decreases with the increasing number of probings and the age of the patient. In children, who have failed nasolacrimal duct probing, intubation or balloon catheter dilatation of the nasolacrimal system with or without silicone tubing should be considered. In the case of the upper sac obstructions one can use laser endoscopic dacryocystorhynostomy. If it is still not amenable to opening a endonasal endoscopic dacryocystorhinostomy (EESC-DCR), or traditional external dacryocysto-rhinostomy (EXT-DCR), should be performed.

[Ocular findings in hepatitis C patients treated with interferon]

The pathology of the liver is associated with many disorders including the eye. We described ocular changes following hepatitis C. The most common ophthalmic findings in hepatitis C patients treated with interferon--involve keratoconjunctivitis, scleritis, dry eye syndrome, uveitis, retinopathy, retinal hemorrhages, anterior ischemic optic neuropathy, retinal vascular changes and macular oedema, as well as electroretinogram, visual field and OCT abnormalities.

[Treatment of nasolacrimal duct obstruction with probing in children younger than 4 years]

PURPOSE

To evaluate the efficacy of nasolacrimal duct probing as the treatment of nasolacrimal duct obstruction in children younger than 4 years.

MATERIAL AND METHODS

A total amount of 320 eyes in 275 children 4 to 48 months old, receiving nasolacrimal duct probing were enrolled in a retrospective study. The patients were divided into 4 groups depends on age: I group--4-12 months, II group--12-24 months, III group--24-36 months and IV group--36-48 months.

RESULTS

The percentage of efficient duct probing was: in I group--84%, in II group--79%, in III group--78% and in IV group--59%.

CONCLUSIONS

In children 4 to 36 months old, probing is a successful treatment of nasolacrimal duct obstruction with no decline in treatment success with increasing age.

[Estimation of morphology and function of the eye in Usher's syndrome]

PURPOSE

Retinitis pigmentosa (RP) is a set of heterogenous retinal diseases that affect primarily photoreceptors and retinal pigmented epithelium. The Usher's syndrome (RP associated with hearing impairment or loss), is responsible for about 10-20% of all cases. We investigate macular morphology using spectral domain optical coherence tomography in correlation with visual function.

MATERIAL AND METHODS

Two patients with Usher syndrome: a 13 years old girl and her 9 years old sister underwent comprehensive ophthalmological examination including: BCVA testing (Snellen charts), biomicroscopy of the anterior and posterior segment of the eye, electroretinography and SD-OCT scans of the macular region.

RESULTS

BCVA was noticeable decreased in both eyes (Vod = 5/16, Vos = 5/16), of 13 years old patient, while it was slightly diminished in her younger sister (Vod = 5/6, Vos = 5/6). In patient with visual deterioration a blue cone deficiency was found. Central foveal thickness (CFT) and foveal outer segment/pigment epithelium thickness (FOSPET) was significantly reduced in 13 years old patient.

CONCLUSIONS

Spectral optical coherence tomography is a useful method to monitor morphological changes of the macula and their progress in patients with retinitis pigmentosa in Usher's syndrome.

[Nasolacrimal duct disorders in children. Part I. Anatomy, physiology and clinical signs]

Congenital nasolacrimal duct obstruction (CLDO) is considered as common and onerous disorder present at infancy. Over 5% of infants have CLDO affecting one or both eyes. The symptoms of CLDO appear shortly after birth or during the first weeks of life. The main symptoms are: excessive and persistent watering, ropy mucous discharge in the conjunctival sac. In conservative treatment a lacrimal sac massage is proposed, though it is not always successful. Topical antibiotics are reserved only if secondary conjunctivitis occurs. Fortunately, most cases resolve spontaneously. However, sometimes nasolacrimal duct probing performed under local or general anesthesia is necessary.

[Dendritic cells in hypertrophied adenoid at children with otitis media with effusion]

INTRODUCTION

The adenoids are organized as lymphoepithelial structures that play an important role in protecting both the upper respiratory and alimentary tract regions. This functions requires dendritic cells (DC) which are one of the major populations of immune cells. Due to the presence of specific receptors (DC) are able to respond to both intra- and extracellular antigens. Dendritic cells activating immunological response in tonsil contribute formation immunologic competent cells on necessity of rolling inflammatory process in middle ear.

AIM OF STUDY

An investigation was executed in hypertrophied adenoids with or without otitis media with effusion.

METHODS

By flow cytometry percentage of CD11c+ myeloid DC and 123+ plasmacytoid DC in hypertrophied adenoid and hypertrophied adenoid and otitis media with effusion was analyzed.

RESULTS

The percentage of CD11c+ myeloid DC and 123+ plasmacytoid DC was similar in hypertrophied adenoid and otitis media with effusion compored to the control group.

CONCLUSIONS

Our data show that part of dendritic cells has not on course of inflammatory process influence rolling in middle ear.

[Ophthalmologic findings in child in the Cornelia de Lange syndrome]

PURPOSE

Cornelia de Lange syndrome is a rare disease showing characteristic facial appearance, development delay, low birth weight, skeletal anomaly, hirsutism and various ophthalmologic and hearing findings.

MATERIAL AND METHODS

We described ophthalmologic problems in 2-year-old girl.

RESULTS

We have find arched eyebrows, long lashes, epiphora, ptosis, nystagmus, myopia, and fundus eye changes.

CONCLUSIONS

We recommend early ophthalmologic examination in patients with Cornelia de Lange syndrome.

[Estimation of the quality of life 8-year-old child with bilateral anophthalmia]

PURPOSE

The main aim of our work was to estimate the physical and psychomotor development and the arrangement to the daily life for a 8-year-old girl with inborn bilateral anophthalmia.

MATERIAL AND METHODS

The basic ophthalmic, pediatric and neurological examinations were performed with additional genetic and radiological examinations.

RESULTS

The ophthalmic and MRI examination find out the absence of the eyeballs, optic nerves, optic chiasm, optic tracts and optic radiation.

CONCLUSIONS

Anophthalmia limits in a big grade an independent life of the child. However, currently the girl's development indicates for good intellectual abilities what is promising for future independent life and professional work.

[Ergonomics in computerized workplace--an ophthalmological view]

Ergonomics in computerized workplace contributes to create special environmental conditions depending on people's needs and possibilities. Ergonomically created room with accurate type of lighting, temperature and humidity, furniture and location of PC unit and monitor is essential to avoid symptoms of computer stress syndrome.

[Myopia in systemic disorders]

Myopia is the most common refractive error Myopia has been well established as a multifactorial disease with both genetic and environmental etiology. A number of genetic loci have been linked with myopia. We have described the prevalence and the symptoms of systemic disorders associated with myopia, including: Stickler syndrome, Marfan syndrome, Ehlers-Danlos syndrome, Weill-Marchesani syndrome, homocystinuria, McCune-Albright syndrome, Kniest syndrome, Down syndrome, Prader-Willi syndrome, Noonan syndrome, Cohen syndrome, Rubinstein-Taybi syndrome, Cornelia de Lange syndrome and fetal alcohol syndrome.

[Expression Fas and FasL antigen protein of lymphocytes T and B in hypertrophied adenoid in children with otitis media with effusion]

INTRODUCTION

Apoptosis of lymphocytes can be induced by different factors mainly however the activation of antigen Fas (CD95) and his ligand FasL (CD95L) route. Apoptosis induced by Fas-FasL has large significance in elimination of lymphocytes T in final phase immune response designate AICD (activation induced cell death). Lymphocytes B undergo apoptosis induced by Fas-FasL in germinal center, which has special meaning in elimination of cells about low specificity and weak affinity of receptor BCR ( B-cell antigen receptor).

AIM OF STUDY

The aim of this study was evaluation of percentage of apoptotic lymphocytes and expression of Fas and FasL in CD4+, CD8+, CD19+ lymphocytes in hypertrophied adenoid and hypertrophied adenoid and otitis media with effusion.

METHODS

CD4+Fas+, CD8+Fas+, CD19+Fas+CD4+FasL+, CD8+FasL+, CD19+FasL+ cells subpopulation were identified using monoclonal antibodies and flow cytometry method.

RESULTS

The percentage of lymphocytes CD4+ Fas+, CD8+Fas+, CD19+Fas+ was higher in hypertrophied adenoid and otitis media with effusion compored to the control group. Their was no significant difference the percentage CD4+ Fas+, CD8+Fas+, CD19+Fas+CD4+FasL+, CD8+FasL+, CD19+FasL+ in hypertrophied adenoid and otitis media with effusion then the control group. The percentage of apoptotic lymphocytes was higher in hypertrophied adenoid and otitis media with effusion compored to the control group.

CONCLUSIONS

The susceptibility the individual subpopulation of lymphocytes in hypertrophied adenoid seems to influence on change of relations of quantitative lymphocytes and upset the immunological function of tonsils which can influence on course otitis media with effusion at children.

Assessment of visual function in children with foldable intraocular lens implants

PURPOSE

The aim of the current study was to assess the results of cataract surgery involving implantation of foldable intraocular lenses in children.

MATERIAL AND METHODS

Cataract surgery with foldable lenses was performed in 60 children. Postoperative visual acuity, endothelial cell density, corneal pachymetry, postoperative astigmatism and complications were analyzed.

RESULTS

Quick visual recovery was observed in children after surgery. Only a few postoperative complications occurred.

CONCLUSIONS

The foldable intraocular lenses are easy to insert. The surgical procedure with foldable lens implantation is a useful and safe method of treatment.

[Mutations in mitochondrial DNA in ocular diseases--Leher's hereditary optic neuropathy and Kearns' syndrome]

Mitochondrial diseases are caused by mitochondrial structure aberrations and function deficiency. The clinical heterogeneity of mitochondrial diseases is associated with the type of causing mutations (de novo or maternally transmitted mutations), and several aspects of mitochondrial genetics and inheritance, including heteroplasmy. In this paper, we explain the basics of mitochondrial genetics and inheritance as well as genetic background of mitochondrial related disorders: Leber's hereditary optic neuropathy and Kearns' syndrome.

Impression cytology of the conjunctival epithelial cells in patients with cystic fibrosis

PURPOSE

Cystic fibrosis (CF) is the most frequent lethal autosomal recessive hereditary disorder. The disease affects all secretory epithelia, including the eye, and belongs to the group of ocular surface epithelial diseases, termed keratoconjunctivitis sicca or dry eye syndrome. The aim of this study was to evaluate goblet cell population and conjunctival epithelial morphology in patients with CF.

METHODS

A total of 20 CF patients and 20 controls underwent conjunctival impression cytology.

RESULTS

Impression cytology showed conjunctival squamous metaplasia and goblet cell loss in patients with CF.

CONCLUSION

Reduced goblet cell numbers and squamous metaplasia may be indicative of a higher degree of epithelial damage of conjunctival epithelial cells in CF patients, and the presence of neutrophils is a strong sign for an inflammatory background of this disease.In view of the simple, noninvasive nature of impression cytology, this technique may prove to be an important tool for the diagnosis and monitoring of dry eye changes in CF patients.

[The evaluation of the efficacy of treatment in glaucoma associated with Sturge-Weber syndrome]

PURPOSE

To estimate the efficiency of glaucoma treatment in Sturge-Weber syndrome.

MATERIAL AND METHODS

4 patients with Sturge-Weber syndrome and the consecutive glaucoma seen at the Department of Ophthalmology in Bialystok between the years 1999-20005, were reviewed. Glaucoma associated with Sturge-Weber syndrome was diagnosed at the age of 6 months in 1 patient, of 10-11 years in 2 patients and of 14 years in 1 patients. All patients underwent surgery. 2 eyes underwent trabeculectomy and 2 eyes had nonpenetrating deep sclerectomy with SKGel implant.

RESULTS

Before the surgery the intraocular pressure was 35.2 mmHg (range from 25 to 48 mmHg). All patients required anti-glaucoma medications after surgery to keep intraocular pressure less than 22 mmHg. After surgery the mean intraocular pressure was 26.25 mmHg (range from 22 to 32 mmHg). 2 patients required 2 medications: Betoptic, and/or Trusopt, and/or Xalatan and 2 patients required 1 medication. After antiglaucoma medications mean IOP was 15.2 mmHg (range from 12 to 18 mmHg).

CONCLUSION

The results of therapy for glaucoma associated with the Sturge-Weber syndrome are often disappointing.

[The role of chemokines in ocular diseases. Part II. Participation of chemokines in ocular diseases]

The chemokines are family of ca. 50 chemotactic cytokines produced by leucocytes and tissue cells, which regulate and stimulate leucocytes migration. Dysregulation of this process is apparent in chronic inflammation, allergic eye disease, corneal graft rejection, proliferative vitreoretinopathies and age-related macular degeneration. Antagonists of chemokine receptors have demonstrated anti-inflammatory and antiviral activity and may represent new generations of therapeutic agents.

[The role of apoptosis in induction ocular changes in patients with cystic fibrosis]

PURPOSE

To evaluate the concentration of sFas in tear film of cystic fibrosis patients.

MATERIAL AND METHODS

Tear samples were collected from 20 patients with cystic fibrosis and 20 patients from control group. The sFas levels were determined by immunoenzymatic assay ELISA.

RESULTS

We found statistically increased levels of sFas in tear film of patients with cystic fibrosis compared with control group.

CONCLUSIONS

Apoptosis may play role in the pathogenesis of ocular changes in cystic fibrosis patients. The above results are important for the choice of the treatment of dry eye syndrome in patients with cystic fibrosis.

[Assessment of sFas concentration in serum of uveitis patients]

PURPOSE

To evaluate the concentration of sFas in serum of uveitis patients.

MATERIAL AND METHODS

Serum samples were collected from 13 patients with uveitis and 12 controls. All patients have underwent ophthalmic and laboratory examinations. The sFas levels were determined by immunoenzymatic assay ELISA.

RESULTS

We found statistically increased levels of sFas in serum of patients with uveitis compared with controls.

CONCLUSIONS

Our results suggest a systemic nature of uveitis with persistent activation of the immune system. Apoptosis may play regulatory role in ocular inflammation of patients with uveitis.

[An analysis of the fundus changes in families with high myopia]

PURPOSE

Of this study is to present fundus changes in members of families with high myopia.

MATERIAL AND METHODS

Detailed clinical examination of the enrolled subjects have been performed in the high myopia families. Both affected (presented with high myopia) and unaffected individuals (without high myopia) are given an ophthalmologic examination: best-corrected visual acuity testing, intraocular pressure examination, fundoscopy, axial length determination (using ultrasonography), refractometry.

RESULTS

In the 19 high myopia families, 152 individuals were carefully examined. In 11 individuals retinal detachment have been observed. Additionally, myopic degeneration of the central retina (15 cases), degeneration of the peripherial retina (20 subjects), AMD (4 subjects), hypertrophy of the RPE (2 subjects), CNV (1 case), striae medullares (1 case) and macular foramen (1 case), have been identified.

CONCLUSIONS

In the affected individuals (presented with high myopia) changes of the eye fundus and retinal detachment were more frequently observed comparing to unaffected members of the families without high myopia. In unaffected individuals genetic factor seems to play insignificant role in apperance of fundus. Changes within central retina in the high myopia individuals may conduce to severe visual impairment.

[The role of chemokines in ocular diseases. Part I. Structure and role of chemokines in chosen diseases]

The chemokines are a large family of chemotactic cytokines produced by leucocytes, fibroblasts, keratynocytes and the others tissue cells. Chemokines stimulate and regulate leucocytes migration in inflammations. All the described human chemokines transmit intracellular signals by binding and activating specific G protein-coupled receptors on the cell surfaces of their target cells. Chemokines are involved in variety of inflammatory and autoimmune diseases.

[Retrospective evaluation of ocular axial length after unilateral cataract surgery with intraocular lens implantation in children and adolescents]

PURPOSE

To evaluate the postoperative ocular axial length in children, who had unilateral cataract extraction with intraocular lens implantation.

MATERIAL AND METHODS

In this retrospective study we studied 20 children (12 boys and 8 girls) in age from 7 to 20 years (mean 14 +/- 3.65 years), who had undergone surgery for unilateral cataract: 8 children had congenital cataract; 7 patients had traumatic cataract; in 5 cases there were secondary cataract: 3 children had cataract after uveitis, in 1 child cataract was due to steroid therapy because of nephrotic syndrome and 1 patient had neurodermatic cataract. In 16 cases PMMA lens was used, heparinized lens was implanted in 3 eyes and acrylic lens in 1 eye. The power of implants was from + 19 D to +24 D (mean 20.98 +/- 1.6 D). All measurements of axial length were obtained using ultrasound A scan. Examination was done from 14 months to 7.5 years after surgery (mean 3.5 +/- 1.55 years). The axial length in the operated eyes was compared with axial length of the fellow nonoperated eyes.

RESULTS

Mean axial length in operated eyes was 22.58 +/- 1.56 mm. Mean axial length in fellow eyes was 22.96 +/- 1.42 mm. There were no significant differences between operated and nonoperated eyes (p>0.05).

CONCLUSIONS

Cataract extraction with intraocular lens implantation does not influence rate of axial growth in children and adolescents.

[The evaluation of chosen cytokines in induction of ocular changes in Sjögren's syndrome of dry eye]

PURPOSE

To evaluate the role of pro-inflammatory cytokines interleukin-8 (IL-8) and interferon-gamma (IFN-gamma) in pathogenesis of Sjogren's syndrome of dry eye (SS--dry eye), and in induction of ocular changes in this disease.

MATERIAL AND METHODS

Tear samples were collected from 25 patients with Sjogren's syndrome of dry eye and 33 healthy volunteers. Cytokine levels were determined by ELISA. Ophthalmic examinations, including tests for dry eye, were used to study the ocular surface. The levels of these cytokines in tears and dry eye findings were compared.

RESULTS

The tears level of IL-8 and IFN-gamma in SS--dry eye patients were significantly higher than those in controls. We found positive correlation between the tears levels of pro-inflammatory cytokines and dry eye findings (subjective and objective assessments and diagnostic tests).

CONCLUSIONS

The elevated level of pro-inflammatory cytokines in tears fluid of patients with Sjogren's syndrome of dry eye may be important factor in the pathogenesis of this disease. Significant correlation between tears level of cytokines and dry eye findings suggest, that these cytokines induce inflammatory changes of ocular surface in Sjogren's syndrome of dry eye.

Flow cytometric analysis of HLA-DR antigen in conjunctival epithelial cells of patients with cystic fibrosis

PURPOSE

Cystic fibrosis (CF) is an autosomal-recessive genetic disorder. The disease affects all secretory epithelia including the eye and belongs to the group of ocular surface epithelial diseases, termed keratoconjunctivitis sicca that develop in dry eye. In the pathogenesis of dry eye, inflammation plays a crucial role. The aim of this study was to investigate the expression of HLA-DR on conjunctival epithelial cells from patients with CF.

MATERIALS AND METHODS

Twenty-five patients with CF and 25 normal subjects underwent ocular examination. Tear film break-up time (TBUT), Schirmer test, lissamine green staining, and conjunctival impression cytology were carried out. Cells were processed for flow cytometry, by using monoclonal antibodies to HLA-DR.

RESULTS

The Schirmer test and TBUT scores were significantly lower in CF patients compared with controls. A significant increase of HLA-DR expression on epithelial cells was found in patients with CF compared with normal eyes. The Schirmer and TBUT test were positively correlated with HLA-DR expression for the percentage of cells.

CONCLUSION

These results suggest that conjunctival epithelial cells play an important proinflammatory role in ocular changes in CF patients. Our findings confirm the presence of an inflammatory background and the immune nature of this disease. HLA-DR measurement might be a useful method for monitoring of inflammatory processes in the conjunctiva and could be helpful in the use of anti-inflammatory drugs in the treatment of ocular findings in CF patients.

Pattern visual evoked potentials in the early diagnosis of optic neuropathy in the course of Graves' ophthalmopathy

THE AIM OF THE STUDY

To investigate by means of pattern visual evoked potentials (PVEPs) early neuropathic changes in Graves' ophthalmopathy (GO) patients without any clinical symptoms of optic neuropathy in order to evaluate the prevalence of subclinical optic neuropathy in GO patients and to elucidate whether there is a relationship between PVEP (P100 and N75 latency), intraocular pressure (IOP) and exophthalmometry.

MATERIAL AND METHODS

Two groups of patients were examined: 15 patients with GO without clinical signs of dysthyroid optic neuropathy (DON) and 12 healthy controls. The correlations between the N75 and P100 latencies, IOP and Hertel exophthalmometry were investigated.

RESULTS

The mean PVEP N75 and P100 latencies were significantly delayed in the GO uncomplicated with DON in comparison with controls (LP100- 106.2 +/- 4.4 ms vs. 102.4 +/- 2.7 ms, p < 0.01 and LN75- 79.0 +/- 3.7 ms vs. 73.9 +/- 2.8 ms, p < 0.001). In GO patients we documented a positive correlation between the LN75 latency and exophthalmometric readings (R = 0.51; p < 0.01). The value of LP100 and LN75 was above the normal limit in 5/30 eyes (17%) and in 3/30 eyes (10%) respectively.

CONCLUSIONS

The assessment of PVEPs (especially the P100 latency) in GO patients without clinical signs of DON is a useful tool for the early diagnosis of optic nerve involvement.

[Impression cytology in patients with dry eye syndrome and various rheumatic diseases]

PURPOSE

The aim of this study was to evaluate the cytological changes of bulbar conjunctiva in patients with various rheumatic diseases and dry eye syndrome.

MATERIAL AND METHODS

60 patients with rheumatoid arthritis (RA), systemic scleroderma (SScl), primary Sjbgren syndrome (pSS), systemic lupus erythematosus (SLE) and dry eye syndrome were studied. The ocular examination consisted of Schirmer I, break- up time of tear film (BUT), fluorescein and lissamine green staining and impression cytology of bulbar conjunctiva.

RESULTS AND CONCLUSIONS

The morphological alternations of bulbar conjunctiva seen in impression cytology specimens correlated with clinical signs of dry eye syndrome.