László Marsovszky

In vivo confocal microscopic evaluation of corneal Langerhans cell density, and distribution and evaluation of dry eye in rheumatoid arthritis

Corneal Langerhans cells (LCs) offer the opportunity to gain insight into the activity of the innate immunity. We examined the density and the distribution of LCs and compared the results with dry-eye parameters in rheumatoid arthritis (RA). Fifty-two RA patients with various degrees of disease activity and 24 healthy subjects were enrolled. Peripheral and central LC number and morphology were assessed with in vivo laser confocal microscopy. In addition, ocular surface disease index (OSDI), lid parallel conjunctival folds, Schirmer test, and tear break-up time (TBUT) were evaluated. The prevalence of central and peripheral LC, and the central LC morphology values (LCM) were higher than normal in RA. Within the RA group, LC prevalence and morphology were not affected by disease activity. However, patients on anti-TNF or glucocorticosteroid (GCS) therapy exhibited normal LCM, and normal central and peripheral LC density. OSDI was higher and TBUT was lower than normal in RA. The alteration of LC in RA suggests an active inflammatory process in the cornea, which may reflect an increased activation state of the innate immune system—even in inactive stages of RA and without ocular symptoms. The results also indicate ocular effects of GCS therapy in RA.

Dry Eye and Corneal Langerhans Cells in Systemic Lupus Erythematosus

Purpose. Investigation of dry eye and corneal Langerhans cells (LCs) in systemic lupus erythematosus (SLE). Methods. Prospective consecutive case series of 27 SLE patients and 27 control subjects. Dry eye was evaluated by lid-parallel conjunctival folds (LIPCOF), Schirmer test, tear break-up time (TBUT), and ocular surface disease index (OSDI) questionnaire. In vivo investigation of corneal LCs density and morphology (LCM) was performed with confocal corneal microscopy (Heidelberg Retina Tomograph with Rostock Cornea Module). Results. Tear production and stability were pathological in SLE subjects compared to control (Schirmer: 8.45 ± 9.82 mm/5 min versus 11.67 ± 3.21 mm/5 min; TBUT: 6.86 ± 3.53 s versus 11.09 ± 3.37 s). OSDI was significantly greater in SLE patients (25.95 ± 17.92) than in controls (11.06 ± 7.18). Central LC density was greater in SLE patients (43.08 ± 48.67 cell/mm2) than in controls (20.57 ± 21.04 cell/mm2). There was no difference in the peripheral LC density (124.78 ± 165.39 versus 78.00 ± 39.51 cell/mm2). LCM was higher in SLE patients in the centre (1.43 ± 0.79) and in the periphery (2.89 ± 0.42) compared to controls (centre: 1.00 ± 0.69, periphery: 2.35 ± 0.54). Conclusions. Significant changes in dry eye parameters and marked increase of central LCs could be demonstrated in SLE patients. SLE alters not only the LC density but also the morphology, modifies corneal homeostasis, and might contribute to the development of dry eye.

Corneal Langerhans cell and dry eye examinations in ankylosing spondylitis.

APCs of the ocular surface, including corneal Langerhans cells (LCs), offer the opportunity to gain insight into the activity of innate immunity. We examined corneal LCs and dry eye parameters in ankylosing spondylitis (AS). Twenty-four AS patients with varying degrees of disease activity and 24 healthy participants were enrolled. Central and peripheral LC numbers, and Langerhans cell morphology (LCM) were assessed with in vivo laser confocal microscopy. In addition, ocular surface disease index, lid parallel conjunctival folds, tear break up time, and Schirmer test were evaluated. LC densities and central LCM were greater in AS patients than in the controls. Moreover, LCM was significantly greater in patients with higher systemic inflammation according to elevated C-reactive protein (CRP). Also, tear production was greatly suppressed in patients with more severe onset of the systemic inflammation according to the Bath Ankylosing Spondylitis Disease Activity Index and elevated CRP. Greater corneal LC density and LCM in AS may reflect an increased activation state of the innate immune system of the cornea in AS, which correlates with the systemic activity of AS even without ocular symptoms. Nonetheless, higher systemic inflammation might impair tear production, and it might partly explain the dry eye mechanism.

Amniotic Membrane and the Controlled Drug Release

In this chapter we give an overview on the factors affecting drug permeability in the normal eye, and demonstrate the effect of amniotic membrane on the ocular surface on drug release. Furthermore we focus mainly on topical ocular drug administration with regards to ocular surface and amniotic membrane. Amniotic membrane can have various effects on drug permeability and can significantly alter bioavailability of the drugs used. Beyond several biochemical, biological and biophysical benefits of amniotic membrane transplantation, amniotic membrane serves a layer with a more stable drug concentration on the ocular surface. Amniotic membrane has dual effect on drug penetration. First it acts as a barrier against drug penetration, and it has also a drug release activity.

Hornhaut Konfokal-Mikroskopie bei einer bilateralen Augenverletzung mit multiplen kornealen Fremdkörpern@@@Confocal microsopy after multiple corneal foreign body injury

SummaryBACKGROUND: To analyse the morphological alterations, epithelial, inflammatory and Langerhans cell density of cornea after longstanding bilateral multiple corneal metal foreign body (FB) injury. PATIENT AND METHODS: Clinical records of a 36 years male patient were reviewed and confocal microscopy was performed two and six years after injury. RESULTS: Corneal FBs were situated in 10–156 μm depth. The wing cells were enlarged around FBs (3564 ± 95/mm2) on visit 1, but their size decreased by visit 2 (3962 ± 71/mm2). No inflammatory cell could be detected while Langerhans cells were randomly seen around FBs (28 ± 3/mm2 on visit 1, and 38 ± 4/mm2 on visit 2 respectively). Subbasal nerves were gracile, fragmented around FBs on visit 1, and remained altered on visit 2. CONCLUSIONS: Our observation may prove that the corneal immune system can tolerate stable intracorneal metal FBs. The longstanding morphological alterations of epithelial cells and subbasal nerves mark the complex impact that such injury can cause.ZusammenfassungHINTERGRUND: Auswertung der morphologischen Unterschiede, Epithel-, Entzündungs- und Langerhanssche Zellen nach einer langjährigen bilateralen Verletzung mit multiplen Metall-Fremdkörpern. PATIENT UND METHODE: Die Augen von einem 36-jährigen männlichen Patienten wurden mit in vivo Konfokalmikroskopie 2 Jahre (Visite 1) bzw. 6 Jahre (Visite 2) nach eine bilateralen Gasofenexplosion Hornhautverletzung untersucht. ERGEBNISSE: Die Fremdkörper lagen zwischen 10–156 Mikrometer Tiefe. Die Flügelzellendichte betrug bei Visite 1 in Fremdkörpernähe (rechtes Auge (RA): 3564±95/mm2, linkes Auge (LA): 3624±73/mm2), bei Visite 2 zeigte sich aber eine Größen-Abnahme, bzw. eine Zunahme der Dichte (RA: 4121±69/mm2, LA: 3962±71/mm2). Keine Entzündungszellen waren zu erkennen, während Langerhanssche Zellen zufällig um die Fremdkörper verteilt waren (RA:26±4/mm2, LA: 30±7/mm2 bei Visite 1 und RA: 37±4/mm2, LA: 39±5/mm2 bei Visite 2). Subbasale Nerven waren in der Nähe der Fremdkörper dünn verteilt. SCHLUSSFOLGERUNG: Unsere Beobachtungen zeigen, dass das Immunsystem der Hornhaut stabile intrakorneale Fremdkörper vertragen kann. Die langdauernden, morphologischen Veränderungen der Epithelzellen und der subbasalen Nerven zeigen den komplexen Heilungsprozeß der Hornhaut nach einer solchen Verletzung.

Erratum zu: Hornhaut Konfokal-Mikroskopie bei einer bilateralen Augenverletzung mit multiplen kornealen Fremdkörpern

SummaryBACKGROUND: To analyse the morphological alterations, epithelial, infammatory and Langerhans cell density of cornea after longstanding bilateral multiple corneal metal foreign body (FB) injury. PATIENT AND METHODS: Clinical records of a 36 years male patient were reviewed and confocal microscopy was performed two and six years after injury. RESULTS: Corneal FBs were situated in 10–156 μm depth. The wing cells were enlarged around FBs (right eye (RE): 3564±95/ mm2, left eye (LE): 3624±73/mm2) on visit 1, but their size decreased by visit 2 (RE: 4121±69/mm2, LE: 3962±71/mm2). No inflammatory cell could be detected while Langerhans cells were randomly seen around FBs (RE: 26±4/mm2, LE: 30±7/ mm2 on visit 1, and RE: 37±4/mm2, LE: 39±5/mm2 on visit 2 respectively). Subbasal nerves were gracile, fragmented around FBs on visit 1, and remained altered on visit 2. CONCLUSION: Our observation may prove that the corneal immune system can tolerate stable intracorneal metal FBs. The longstanding morphological alterations of epithelial cells and subbasal nerves mark the complex impact that such injury can cause.