Nabeel Shalabi

Dry eye symptoms align more closely to non-ocular conditions than to tear film parameters

Objective To evaluate the relationship between dry eye symptoms, non-ocular conditions and tear film parameters. Methods Design: Cross-sectional study. Participants/setting: The study population consisted of patients who were seen in the Miami Veterans Affairs eye clinic. Patients filled out standardised questionnaires assessing dry eye symptoms (dry eye questionnaire 5 (DEQ5) and ocular surface disease index (OSDI)), non-ocular pain, depression and post-traumatic stress disorder (PTSD), and also underwent measurement of tear film parameters. Main outcome measures: Correlations between dry eye symptoms and non-ocular conditions as compared with tear film parameters. Results 136 patients with a mean age of 65 (SD 11) years participated in the study. All correlations between the dry eye questionnaire scores (DEQ5 and OSDI) and (A) self-reported non-ocular pain measures (numerical rating scale and pain history), (B) depression and (C) PTSD were significant and moderate in strength (Pearsons coefficient 0.24 to 0.60, p<0.01 for all). All correlations between the dry eye questionnaires and tear film measures were weak (Pearsons coefficient −0.10 to 0.18) and most were not significant. Multivariable linear regression analyses revealed that PTSD and non-ocular pain more closely associated with dry eye symptoms than did tear film parameters. Specifically, non-ocular pain and PTSD accounted for approximately 36% of the variability in DEQ5 scores (R=0.60) and approximately 40% of variability in OSDI scores (R=0.64). Of note, none of the tear parameters remained significantly associated with dry eye symptoms in either model. Conclusions Dry eye symptoms more closely align to non-ocular pain, depression and PTSD than to tear film parameters.

Sub-basal Corneal Nerve Plexus Analysis Using a New Software Technology

Purpose: To study sub-basal corneal nerve plexus (SCNP) parameters by in vivo corneal confocal microscopy using a new software technology and examine the effect of demographics and diabetes mellitus (DM) on corneal nerves morphology. Methods: A Confoscan 4 (Nidek Technologies) was used in this cross-sectional study to image the SCNP in 84 right eyes at the Miami Veterans Affairs eye clinic. Images were analyzed using a new semiautomated nerve analysis software program (The Corneal Nerve Analysis tool) which evaluated 9 parameters including nerve fibers length (NFL) and nerve fibers length density (NFLD). The main outcome measure was the examination of SCNP morphology by demographics, comorbidities, and HbA1c level. Results: Interoperator and intraoperator reproducibility were good for the 9 parameters studied (Intraclass Correlations [ICCs] 0.73–0.97). Image variability between two images within the same scan was good for all parameters (ICC 0.66–0.80). Older individuals had lower SCNP parameters with NFL and NFLD negatively correlating with age (r=−0.471, and −0.461, respectively, P<0.01 for all). Patients with diabetes had lower mean NFLD 10987.6 &mgr;m/mm2 (±3,284.6) and NFL 1,289.5 &mgr;m/frame (±387.2) compared with patients without diabetes (mean NFLD 15077.1 &mgr;m/mm2 [±4,261.3] and NFL 1750.0 &mgr;m/frame [±540.7]) (P<0.05 for all). HbA1c levels in patients with diabetes were inversely correlated with NFL and NFLD (r= −0.568, and −0.569, respectively, P<0.05 for all). Conclusions: The Corneal Nerve Analysis tool is a reproducible diagnostic software technique for the analysis of the SCNP with confocal microscopy. Older age, DM, and higher level of HbA1c were associated with a significant reduction in SCNP parameters.

Atypical Fibroxanthoma of the Conjunctiva in Xeroderma Pigmentosum.

Background: Atypical fibroxanthoma (AFX) is a pleomorphic tumor that most commonly presents in the elderly and arises on sun-exposed skin. Methods: We report a case of a 24-year-old white male with xeroderma pigmentosum (XP), who developed an AFX of the conjunctiva, and review the literature. Results: The patient presented with a rapidly growing conjunctival mass which was surgically excised and found to be AFX. The patient has done well with no recurrence. A review of the literature was performed, and we found that only one other case has been published so far. Conclusion: Patients with XP may present with unusual tumors, including nonepithelial soft-tissue tumors. AFX is a rapidly growing tumor which may rarely present on the ocular surface.

Superficial epithelial keratectomy, cautery, and amniotic membrane transplant for the treatment of painful bullous keratopathy in eyes with poor visual potential.

Purpose: The aim of this study was to report a new technique for the treatment of painful bullous keratopathy in eyes with poor visual potential. Methods: Review of technique and outcomes of treated patients. Results: The surgical technique involved superficial epithelial keratectomy, corneal cautery, amniotic membrane transplantation, and temporary bandage contact lens placement. Four patients were treated with this technique. All had significant pain due to bullous keratopathy before the surgery. After a mean follow-up of 16 months (1–42), 3 patients reported complete resolution of pain, and an examination disclosed a smoother corneal surface without bullae. One patient had recurrent pain after the removal of his bandage contact lens 1 month after the surgery. Separation of the amniotic membrane from the underlying cornea was noted. The patient underwent incision of the amniotic membrane with drainage of the fluid and is currently stable. Conclusions: Superficial epithelial keratectomy, cautery, and amniotic membrane transplantation can be used to treat painful bullous keratopathy in a minimally invasive fashion with improved cosmetic results.

Intracorneal and Intraocular Invasion of Ocular Surface Squamous Neoplasia after Intraocular Surgery: Report of Two Cases and Review of the Literature

Purpose: The aim of this paper was to describe 2 cases of ocular surface squamous neoplasia (OSSN) of the conjunctiva with intracorneal and intraocular extension following intraocular surgery. Methods: We conducted a clinical pathological retrospective case series. Results: Case 1 underwent cataract surgery in the setting of an unnoticed adjacent OSSN. An excisional biopsy with cryotherapy and intraoperative mitomycin C was subsequently performed, confirming OSSN. The patient had two recurrences treated topically with resolution. While the conjunctiva remained clear, a corneal haze emanating from the cataract incision site was noted. Penetrating keratoplasty (PK) for this haze revealed midstromal infiltrative carcinoma. Case 2 had a history of herpes simplex keratitis that ultimately required corneal grafts. Fifteen years later, he developed an OSSN treated with excisional biopsy and had clear margins. Eight months later, he presented with a recurrence of his OSSN and was treated briefly with topical interferon for 4 weeks; however, he developed an infectious keratitis with a corneal perforation requiring another PK. Four months after PK, low-grade inflammation was noted. Cytology of the anterior chamber aspirate revealed neoplastic squamous cells. Another PK was then performed. Pathology confirmed extensive intraocular neoplasia. Limited exenteration was performed. Conclusion: Patients with a history of OSSN may be at increased risk of neoplastic intraocular extension following intraocular surgery.