Anna M. Roszkowska

Corneal endothelium evaluation in type I and type II diabetes mellitus.

Background: The purpose of this study is to evaluate the corneal endothelium in type I and type II diabetic patients. Methods: Seventy-five diabetics divided into type I and type II groups and 62 healthy volunteers took part in the study. The mean endothelial cell density and morphology, and the central corneal thickness were evaluated and statistical analysis was done. Results: All evaluated parameters were found to be significantly different in both diabetic groups with reduction of the mean cell density of 5% in type II and of 11% in type I diabetes with respect to the normal age-matched control group. Important alterations of endothelial morphology were observed. The central corneal pachymetry was significantly higher in diabetics, with p < 0.01 in the type I group and p < 0.05 in the type II group. Conclusion: It is concluded that corneal endothelium in diabetices should still be considered as a tissue under continuous metabolic stress with consequent high vulnerability, especially in case of any external insult such as a surgical procedure.

Age-related modifications of corneal sensitivity.

Purpose: To evaluate central and peripheral corneal sensitivity (CS) in relation to age. Methods: Five hundred eyes of 320 healthy subjects (185 males and 135 females) were examined. The age of participants ranged from 20 to 90 years. All subjects were divided into 3 groups according to age. CS was assessed with the Cochet-Bonnet esthesiometer in the central cornea and in 8 peripheral points. The averages were used as the values of central and peripheral CS. Results: In the young population, CS was equal in both examined zones (p > 0.05); although, with respect to the periphery after the fifth decade, it was significantly higher in the centre (p < 0.05). Both central and peripheral sensitivity decreased with age (p < 0.05), and such variations are represented by parabolic curves. No differences were observed between males and females. Conclusions: The age-related decrement of CS involves at first the corneal periphery and successively spreads toward the central zone. Topographical distribution and age-related modifications should be considered in clinical investigations of CS, especially in patients who underwent any corneal surgical procedure.

Matrix Metalloproteinase 9 and Transglutaminase 2 Expression at the Ocular Surface in Patients with Different Forms of Dry Eye Disease

OBJECTIVE To evaluate the expression of matrix metalloproteinase 9 (MMP9) and transglutaminase 2 (TG2) in different forms of dry eye. DESIGN Case control study. PARTICIPANTS Seventy-five female subjects divided into 3 groups: group 1, 15 healthy controls; group 2, 30 subjects with Sjögren syndrome (SS); and group 3, 30 subjects with Meibomian gland dysfunction (MGD). METHODS A clinical assessment was carried out and impression cytologic specimens were processed for immunoperoxidase staining for MMP9 and TG2 and real-time polymerase chain reaction analyses were carried out for MMP9, TG2, interleukin-6, interferon-γ, B-cell lymphoma 2, and caspase 3. To study MMP9 and TG2 expression after anti-inflammatory treatment, patients were divided into 2 subgroups, one treated with saline and the other treated with saline plus topical corticosteroid eye drops (0.5% loteprednol etabonate) 4 times daily for 15 days. For statistical analysis, Student t test, Mann-Whitney U test, and Spearmans correlation coefficient were used as appropriate. MAIN OUTCOME MEASURES Conjunctival expression of MMP9 and TG2. RESULTS MMP9 and TG2 expression were higher in both patient groups than in controls (P < 0.0001). Group 2 patients showed higher expression than group 3 (P < 0.0001). The Spearmans correlation coefficient showed in group 2 a positive correlation between MMP9 and TG2 expression (ρ = 0.437; P = 0.01), but no correlation in group 3 (ρ = 0.143; P = 0.45). Corticosteroid treatment significantly reduced MMP9 and TG2 expression in both groups, ameliorating symptoms and signs. A much higher percentage reduction was observed in SS. CONCLUSIONS The pathogenic mechanisms of the 2 forms of dry eye give an account for the different MMP9 and TG2 expressions in the 2 groups of patients. The higher expression in SS is determined by the direct autoimmune insult to the ocular surface epithelia, whereas in MGD patients, with an epithelial damage due to an unbalanced tear secretion, the molecules expression is significantly lower, although higher than in controls. The corticosteroid treatment induced a reduction of both molecules, although higher in SS than in MGD, because of its direct inhibitory effect on inflammation.

Age-related modifications of the corneal endothelium in adults.

Purpose: To obtain the topographical distribution of the corneal endothelial cell density, in different age ranges. Methods: Three hundred eyes of 204 healthy subjects (110 males (M) and 94 females (F)) aged from 20 to 83 years were evaluated. Participants were divided into three groups according to age. First group (120 eyes) comprised patients aged from 20 to 44 years (mean 32.27 ± 7.5), the second group (110 eyes) comprised patients aged from 45 to 70 years (mean 54.13 ± 7.1) and the third group (70 eyes), comprised participants older than 70 years (mean 79.28 ± 5.9). Specular microscopy was performed in the central zone and in four peripheral points. Results: Central and peripheral cell densities decrease with age (p < 0.05). In young adults the endothelial cell density did not show any significant variation in the central area with respect to the periphery (p > 0.05). In older adults the difference between central and peripheral endothelial cell densities showed the significance level of p=0.05. Conclusions: Topographical distribution of the corneal endotheliul cell density is maintained lifelong. Age-related changes involve both center and periphery. The higher peripheral decrement observed in the ancient subjects could be considered as a major finding and in elderly a topographical disparity might occur.

Safety and efficacy of 0.1% clobetasone butyrate eyedrops in the treatment of dry eye in Sjögren syndrome

Purpose To study the effects of a low administration rate and low concentration (0.1%) of clobetasone butyrate eyedrops in patients with Sjögren syndrome (SS). Methods This prospective, double-masked, randomized, placebo-controlled study included 40 subjects divided into 2 treatment groups: group 1 (2% polyvinylpyrrolidone eyedrops and placebo) and group 2 (2% polyvinylpyrrolidone and 0.1% clobetasone butyrate, 1 drop BID). The treatment lasted for 30 days, with visits at enrollment, baseline, day 15, day 30, and after 15 days of treatment discontinuation. At each visit, symptoms questionnaire, tear film break-up time, corneal fluorescein stain, lissamine green stain, conjunctival impression cytology for human leukocyte antigen–DR (HLA-DR) expression, intraocular pressure (IOP) measurement, and fundus examination were performed. Results No changes in IOP or fundus examination were observed in either group at each time point. Group 1 patients showed at day 30 a statistically significant amelioration of symptoms and reduction of HLA-DR expression. No changes in other parameters were detected. Group 2 patients showed at day 15 a statistically significant improvement of corneal and conjunctival stain versus baseline values and group 1 at the same time; after 30 days the symptoms score was statistically significantly better than baseline values and group 1 at the same time. The HLA-DR expression and the epithelial cells area were statistically significantly reduced versus baseline and group 1 at the same time. Conclusions Anti-inflammatory therapy is critical for the treatment of SS dry eye. Clobetasone butyrate, at low dosage, proved to be safe and effective in treating this condition.

The eye in cystic fibrosis.

Purpose To investigate modifications of ocular surface and lens transparency in patients with cystic fibrosis in relation to the stage of digestive insufficiency. Methods Forty consecutive patients with cystic fibrosis and 24 age- and sex-matched healthy volunteers were examined. The tear tests (Schirmers basic test, tear film break-up time) and conjunctival exfoliative cytology (CC) were used to study the ocular surface. The lens transparency was measured with the Opacity Lens Meter 701 (OLM 701, Interzeag AG, Switzerland). Digestive insufficiency was evaluated by the steatocrit method. Results Significant changes in conjunctival cytology and lens opacity, and abnormal tear tests were detected in CF patients; the alterations were more pronunced in patients with severe digestive insufficiency. Conclusions Cystic fibrosis patients present ocular surface abnormalities and lens transparency modifications and their severity is related to the digestive insufficiency. Simple, rapid and non-invasive tear tests and cytological procedures might be used as additional tests for assessing the severity of cystic fibrosis.

Effect of basic fibroblast growth factor on corneal epithelial healing after photorefractive keratectomy.

PURPOSE To evaluate the effect of basic fibroblast growth factor (bFGF) eye drops on corneal epithelial healing after photorefractive keratectomy (PRK). METHODS One hundred patients treated with PRK for myopia were enrolled in this prospective, randomized study. Fifty patients were treated postoperatively with standard topical therapy and bFGF eye drops and 50 patients, used as controls, received standard postoperative therapy plus placebo (saline drops). Postoperatively, patients were examined daily until the epithelium healed. The velocity of resurfacing was recorded. Corneal clarity, visual acuity, and refraction were evaluated during the 3-month postoperative period. RESULTS Complete epithelial healing was observed starting at postoperative day 3 in 46% of eyes in the bFGF group and 14% of eyes in the control group. At day 4, 98% and 72% of eyes in the bFGF and control groups, respectively, had healed. Five days after PRK, 100% of eyes treated with bFGF and 92% of control eyes achieved complete epithelial healing. In the control group, 98% of eyes healed at day 6 and all eyes completed healing at day 7. The difference in healing time was statistically significant (P<.001). No statistically significant differences were noted for haze prevalence, uncorrected distance visual acuity, and spherical equivalent refraction after treatment between groups (P>.05). No side or toxic effects were reported during the study. CONCLUSIONS Basic fibroblast growth factor accelerates epithelial healing after PRK and could be used as additional treatment in circumstances of delayed healing.

Morphologic and Confocal Investigation on Salzmann Nodular Degeneration of the Cornea

PURPOSE To investigate the ultrastructure of advanced Salzmann nodular degeneration (SND) and to correlate it to confocal in vivo findings. METHODS The corneal degenerative nodules from four patients with SND were examined with confocal microscopy and then removed and processed for light microscopy (LM) and transmission electron microscopy (TEM). RESULTS The confocal examination revealed elongated basal epithelial cells and activated keratocytes in the anterior stroma near the nodules. Occasional subbasal nerves and tortuous stromal nerve bundles were observed. With LM and TEM, five zones were described: one internodular and four pertaining the nodule, each characterized by peculiar aspects of the epithelium and stroma. As also confirmed by the morphometry, in the zones corresponding to the nodules, the epithelium was lower and with fewer cell layers than the peripheral zones. Over the nodules, the basement membrane was discontinuous or absent and the Bowmans layer, when present, had a granular-filamentous appearance. The nodular stroma was formed by many activated keratocytes and irregular lamellae. Subbasal nerves were always isolated and had degenerative changes in the center of the nodule. CONCLUSIONS This work illustrates the confocal microscopic findings associated with LM and TEM observations in patients with advanced SND. Our data revealed milder changes of the epithelium together with more pronounced changes of the basement membrane and Bowmans layer, which are aspects of increased keratocyte activity and an altered nerve pattern. All of these structures seem to contribute to the characteristic corneal disorganization of SND.

Effects of amino acids enriched tears substitutes on the cornea of patients with dysfunctional tear syndrome.

Purpose:  To evaluate the effect of aminoacid enriched artificial tears on the ocular surface of patients with dysfunctional tear syndrome (DTS).

Experimental and clinical investigation of efficiency and ablation profiles of new solid-state deep-ultraviolet laser for vision correction

Purpose: To investigate the efficiency and ablation profiles of a newly developed, all‐solid‐state laser platform. Setting: Experimental investigations performed at Katana Technologies GmbH, Kleinmachnow, Germany, and clinical study, at the Ophthalmology Clinic, University of Messina, Messina, Italy. Methods: Experimental studies were performed on poly(methyl methacrylate) (PMMA) and in porcine eyes using an all‐solid‐state, Q‐switched, frequency‐shifted laser (LaserSoft, Katana Technologies GmbH) with a Gaussian spot with a diameter of 0.2 mm in the target plane, a peak fluence of 350 mJ/cm2, and a repetition rate of 1 kHz. The ablation profiles were determined using a profile meter (MicroProf, Fries Research and Technology GmbH), corneal topography was analyzed with a TMS 2N (Tomey Inc.), and corneal thickness was measured with an ultrasound pachymeter (DGH Technology). In the clinical study, 9 human eyes were treated with photorefractive keratectomy. The mean outcome measures were uncorrected visual acuity (UCVA), best spectacle‐corrected visual acuity (BSCVA), corneal topography, and corneal transparency. The follow‐up was 1 month for all eyes and 3 months for 4 eyes. Safety, efficacy, and predictability were evaluated. Results: Smooth profiles were found in the PMMA and the porcine eyes. The topographic maps showed central steepening after the hyperopic ablation and slight central flattening of the surface after the myopic treatment. No eye lost lines of BSCVA; the UCVA improved in all eyes. All eyes were within ±1.00 diopter (D) of emmetropia, and 89% were within ±0.50 D. Conclusion: The efficacy of the ablation was good, with the profile meter results confirmed by the topographic measurements.