Ec Campos

Performance of Tear Osmolarity Compared to Previous Diagnostic Tests for Dry Eye Diseases

Purpose: Tear osmolarity is considered a key point in dry eye disease (DED) and its measurement is the gold standard in dry eye diagnosis. Tear osmolarity was evaluated in dry eye (DE) patients vs. a control group to assess its diagnostic performance compared to clinical and laboratory tests performed in either clinical or research settings. Methods: Tear osmolarity was measured with the TearLab Osmolarity System (OcuSense) in 25 normal subjects and 105 DE patients (severity score 1–4, Dry Eye Workshop (DEWS)). The following tests were also performed: Ocular Surface Disease Index (OSDI) symptoms questionnaire, Schirmer I test, Tear Film Break Up Time (TFBUT), ferning test, lissamine green staining, tear clearance, corneal esthesiometry, and conjunctival cytology by scraping and imprint. Statistical evaluation was performed by unpaired Student’s t and Mann-Whitney tests, the Spearman’s ρ and the Pearson’s r correlation coefficients (significance p < 0.05); all variables were also analyzed for sensitivity, specificity, Receiver Operating Characteristics (ROC) curves, likelihood ratio LR+, and positive predictive value (PPV). Results: Tear osmolarity normal values were 296.5 ± 9.8 mOsm/L, increasing values were shown stepwise DE severity (mild to moderate to severe dry eye, respectively: 298.1 ± 10.6 vs. 306.7 ± 9.5 vs. 314.4 ± 10.1, p < 0.05). A progressive worsening occurred in all the parameters with DED severity increase. Tear osmolarity exhibited the larger correlation strength vs. tear clearance, TFBUT and clinical score, strength increased with DED severity, mainly to inflammatory score and corneal sensitivity. Tear osmolarity 305 mOsm/L was selected as cut-off value for dry eye, 309 mOsm/L for moderate dry eye, 318 mOsm/L for severe dry eye (Area-Under-the-Curve was 0.737, 0.759, and 0.711, respectively). Conclusions: Tear osmolarity can now be considered a test suitable to be performed in a clinical setting. It showed a good performance in dry eye diagnosis, higher than the other tests considered, mainly in severe dry eye. Tear osmolarity values should be interpreted as an indicator of DED evolutionary process to severity.

Hemifield pattern electroretinogram, frequency doubling technology and optical coherence tomography for detection of early glaucomatous optic neuropathy in ocular hypertensive patients

Purpose To assess which is the most sensitive and specific exam for detecting early glaucomatous damage in ocular hypertensive patients (OH) among hemifield test pattern electroretinogram (PERG HF), frequency doubling technology (FDT) and optical coherence tomography retinal nerve fiber layer (OCT RNFL). Methods Fifty-two OH patients (mean age of 56±9.6 yrs) with an intraocular pressure (IOP)>21mmHg and 52 healthy controls (mean age of 54.8±10.4 yrs) with IOP<21mmHg were assessed. All the patients had normal visual acuity, normal optic disc appearance and normal standard achromatic perimetric (SAP) indices. All subjects underwent OCT, FDT and PERG examination. Data were analyzed with Mann-Whitney test and Receiver Operating Characteristic (ROC) curve analysis. Results OH patients showed thinner OCT-RNFL than controls, especially in the superior and inferior quadrant (respectively, 130.16±10.02 vs 135.18±9.27μm; p<0.011 and 120.14±11.0 vs 132.68±8.03μm; p=0.001) and a significantly higher FDT pattern standard deviation (PSD) (3.46±1.48 vs 1.89±0.7dB; p=0.001). As regards PERG examination, the amplitude of the N95 wave of the lower and upper PERG HF showed significant differences (respectively, p=0.037 and p=0.023) between the two groups. ROC curve analysis revealed a sensitivity of 92% and specificity of 86% for FDT PSD (with an area under the ROC curve of 0.942), whereas by using OCT Conclusion Our study show that FDT and PERG HF are the most sensitive and specific exams for detecting early glaucomatous damages in eyes with OH and can be useful in identifying those patients who may develop glaucoma and who need hypotensive ocular medications.

Corneal biomechanics in age-related macular degeneration

Purpose To compare the corneal hysteresis (CH) and the corneal resistance was increase force (CRF) of patients with age‐related macular degeneration (ARMD) and control subjects.

Meibomian glands diagnostic expressibility: a new diagnostic medical device

Purpose To assess the expressibility of the meibomian gland we proposed a new diagnostic tool. We evaluated the use of the instrument by assessing the time of the meibomian gland expressibility and the intraocular pressure change in two groups of healthy patients.

Peripheral endothelial function in ocular hypertensive patients after palmitoylethanolamide therapy: a flow mediated dilation study

Purpose To assess peripheral vascular endothelial function and IOP in patients with ocular hypertension (OH), before and after the use of Palmitoylethanolamide per os, using non‐invasive dependent flow mediated vasodilation (FMD).

Vascular endothelial dysfunction in primary open angle glaucoma

Purpose Glaucomatous optic neuropathy (GON) is related not only to elevated intraocular pressure (IOP) but also to an insufficient ocular blood supply related to a vascular dysregulation. We evaluated peripheral vascular endothelial function in primary open-angle glaucoma (POAG) with a non-invasive endothelium flow mediated vasodilatation (FMD). Methods We studied 20 POAG patients. The diagnostic criteria for POAG was an IOP exceeded 22 mm/hg before treatment, open anterior chamber angle, cup/disc ratio >0.7 and optic nerve related visual field loss (MD>6 dB, SF>2.5 dB and CPSD>3 dB). Patients with systemic diseases such hypertension, heart failure and diabetes mellitus were excluded. All patients and 20 normal controls underwent measurement of FMD with high-resolution 2-dimensional ultrasonographic imaging of the brachial artery by a Philips ENVISOR echographic machine. To induce iperemia a sphygmomanometer cuff was inflated to 250 mm/hg for 5 minutes. The cuff then was deflated rapidly and at 60 seconds after cuff deflation 2-D images of the brachial artery were recorded for 5 seconds. A statistical analysis was made of the FMD in POAG and in normal control patients using the Student “t” test for unpaired data and the Pearson correlation test to show the correlation between the endothelial dysfunction and the visual field indexes. Results Patients affected by POAG exhibit lower values of FMD compared with healthy people In POAG patients we found an FMD 4,28%±2,49 vs. 8,66%±3,02 (p<0.001). The mean decrease (MD) visual field index was related to FMD (p<0.05). Conclusion Patients with POAG have an impaired vascular function related to a vascular endothelium dysfunction and the MD visual field is related to FMD impairment.

Choroideal neovascularisation in age related maculopathy and high myopia. A Laser Flare-Cell Meter study

Purpose We studied the subclinical ocular inflammation by laser flare-cell meter in patients with choroideal neovascularisation (CNV) in age related maculopathy (AMD) and in high myopia (HM). Methods We enrolled 22 patients (12 males and 10 females) without diabetes, systemic inflammatory disease or previous ocular surgery or laser therapy, aged between 65 and 89 years (mean 78,2±6,3) with macular CNV. Twelve of these patients have an age related maculopathy (AMD) and ten have an high myopia (HM). The myopia was mean -14,25 D. We made an indocyanine angiography and measured the extension of neovascularization with the Heidelberg Eye Explorer analysis program. The flare was measured with laser flare-cell meter (FM-500, Kowa, Tokio, Japan) in both eyes of the same patient. Subsequently we compared the flare data of AMD-patients that had an CNV with an area similar of the CNV of the HM-patients. Statistical analysis was performed considering significant a p<0.05. Results The flare in AMD and HM patients was 14,89±7,61 vs 8,00±0,86 photons/msec (p<0.013) and the CNV area was 4,03±2,236 vs 1,07±0,14 mm2 (p<0.001). We selected a sub-group of AMD-patients that had a CNV area similar to the CNV of HM-patients: 1.13±0.18 vs 1,07±0,14 mm2 (p<0.192) and the flare was 13,48±3,08 vs. 8,00±0,86 photons/msec (p<0.001). Conclusion Our results show that sub-clincal inflammation in AMD with CNV is higher than in HM with CNV. Furthermore in AMD the flare is correlated with CNV (p<0.021)but not in HM. These data could be explain with inflammatory pathogenesis of CNV in AMD. whereas in HM the CNV could be related to a spontaneous ruptures of the Bruch’s membrane.

Use of Mitomycin C in the treatment of conjunctival and corneal squamous cell carcinoma. a case report

Purpose: Corneal conjunctival squamous carcinoma is a rare form of slowly progressive carcinoma of low malignant potential. Mitomycin C (MMC) is a chemiotherapic antibiotic isolated from Streptomyces Caespitosus and medical literature reports efficacy of MMC in the treatment of squamous cell carcinoma. We present a case of conjunctival and corneal squamous cell carcinoma which was treated with both surgical excision and topical use of MMC 0.02%. Methods: A 78-year old man with a red-grey vascularized elevated epithelial lesion that started at the conjunctiva and extended past the corneoscleral limbus on to the cornea for about 1.5 mm. The patient was given surgical exeresis of the conjunctival neoformation and the histological exam highlighted a corneal conjunctival squamous cell carcinoma. after three monthes a recurrence of the neoformation was displayed and we therefore decided to start topical MMC 0.02% eye drops treatment four times daily for 7 days. Four cycles of treatment were done with a one-week interval during which only sodium hyaluronate 0.4% lubricant eye drops were administered. Results: During the period of treatment with the MMC 0.02% eye drops, the patient did not display any adverse systemic or ocular reactions. At the end of the treatment we found a complete regression of the disease. Twelve months after treatment he was without conjunctival and corneal epithelial dysplasia. Conclusions: This case highlights the efficacy of MMC 0.02% eye drops in the treatment of conjunctival and corneal squamous cell carcinoma that can avoid the topical use with sponge of MMC at higher concentration that it would present a not predictable long term effects on the conjunctival fornix and on lachrymal secretion.