Qihua Le

Impact of Dry Eye Syndrome on Vision-Related Quality of Life in a Non-Clinic-Based General Population

BackgroundDry eye syndrome (DES) is a common ocular disorder occurring in general population. The purpose of this study is to evaluate the impact of DES on vision-related quality of life (QoL) in a non-clinic-based general population.MethodsThis population-based cross-sectional study enrolled subjects older than 40 years, who took part in an epidemiological study on dry eye in Sanle Community, Shanghai. Apart from the collection of sociodemographics, dry eye symptoms, and other clinical data, a Chinese version of the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) was administered to all subjects. Comparisons of the NEI VFQ-25 subscale item scores and composite score were made among subgroups divided according to the presence of dry eye symptoms or signs. Multivariate regression analysis was performed to investigate the relationship between the clinical variables and the VFQ-25 composite score.ResultsA total of 229 participants were enrolled in the study, with an average age of (60.7 ±10.1) years old. Majority of these participants were female (59.8 %, 137/229). The total DES symptom scores (TDSS) in subjects either with definite DES or only with dry eye symptoms were significantly higher (F = 60.331, P < 0.001). The values of tear break-up time (TBUT) and Schirmer test were significantly lower in participants with DES and those with dry eye signs only (F = 55.158 and 40.778, P < 0.001). The composite score of the NEI VFQ-25 was significantly lower in subjects with DES (F = 4.901, P = 0.003). Moreover, the subscale scores of ocular pain and mental health were significantly lower in those with either DES or dry eye symptoms only (F = 10.962 and 7.362 respectively, both P < 0.001). The multiple regression analysis showed that the TDSS had a significant negative correlation with the VFQ-25 composite score as well as with the subscale score for ocular pain and mental health, even after the adjustment of all other factors (all P < 0.01).ConclusionsThe symptoms of dry eye are associated with an adverse impact on vision-related QoL in non-clinic-based general population, which is mainly represented as more ocular pain and discomfort, and impaired mental health as well. Apart from clinical examination, it is also important to refer to subjective symptoms and QoL scores when assessing the severity of DES.

An in vivo confocal microscopy and impression cytology analysis of goblet cells in patients with chemical burns.

PURPOSE To evaluate goblet cell density (GCD) on conjunctiva and cornea in patients with ocular chemical burns by in vivo laser scanning confocal microscopy (LSCM) and impression cytology (IC) and to explore the correlation between two methods. METHODS Fifty-four patients (58 eyes) with chemical burn were enrolled in the study. LSCM was applied to identify the goblet cells on conjunctiva and cornea under in vivo conditions, and GCD was analyzed with the customized software. Impression cytology was then performed, and the biopsy specimens were stained to visualize goblet cells in vitro and to measure the density. Statistical software was used to analyze the correlation between GCD taken by two methods. RESULTS Conjunctival goblet cells could be discriminated in 55 eyes and 57 eyes by in vivo LSCM and IC. They could be identified on the cornea in nine eyes and eight eyes by two methods. The positive rate of two methods had no significant difference. GCDs on conjunctiva measured by in vivo LSCM and IC were 136 +/- 79 cells/mm(2) and 121 +/- 66 cells/mm(2). Median GCDs on cornea detected by two methods were 30 cells/mm(2) and 23 cells/mm(2), respectively. A significant positive correlation was found between the GCDs on conjunctiva measured by these two methods as well as the GCDs on cornea. CONCLUSIONS GCD decreased in patients with chemical burns. A positive correlation was found between GCD measured by in vivo LSCM and IC after chemical burns. In vivo LSCM was a promising device to study goblet cells in vivo under pathologic conditions.

In vivo confocal microscopy of conjunctival goblet cells in patients with Sjögren's syndrome dry eye

Background To study the morphology and the density of conjunctival goblet cells (GC) in patients with Sjögrens syndrome dry eye with in vivo laser scanning confocal microscopy (LSCM), and to explore its correlation with the GC density detected by impression cytology. Methods A total of 43 Sjögrens syndrome dry eye patients were recruited. All were required to fill in the Ocular Surface Disease Index Questionnaires. The tear break-up time was measured, followed by corneal fluorescein staining examination and Schirmer I test. The images of conjunctiva were taken by the Heidelberg retina tomography (HRT-II)/Rostock cornea module. Finally, the specimens for impression cytology were obtained. SPSS V.13.0 software was used to analyse the data. Results Tear film function test showed that all patients had moderate to severe dry eye. The GC in LSCM images was characterised as a large hyper-reflective oval-shape cell with relatively homogeneous brightness. Though GC density assessed by LSCM (332±137) cells/mm2 was higher than that measured by impression cytology (200±141) cells/mm2, they showed a significant positive correlation, ρ=0.908 (p<0.05). Conclusion Conjunctival GC could be easily discriminated under the LSCM. LSCM may be a valuable tool in monitoring the progress and the follow-up of patients with Sjögrens syndrome dry eye.

Comparison of Anterior Segment Parameters Between the Acute Primary Angle Closure Eye and the Fellow Eye

PURPOSE To investigate features of the anterior segment (AS) of the affected eye compared to the fellow eye within the same patient in acute primary angle closure (APAC). METHODS Thirty-six patients with unilateral APAC were imaged with AS optical coherence tomography (OCT) before medical or laser treatment for the acute attack. Anterior chamber depth (ACD), iris curvature (IC), iris thickness at 750 μm from the scleral spur (IT750), lens vault (LV), anterior chamber area (ACA), and iris area were estimated by using ImageJ software (version 1.46). Conditional logistic regression analysis was performed to find the associated factors with the prediction of APAC. RESULTS When compared to fellow eyes, affected eyes showed significantly shallower ACD (1.90 ± 0.24 and 1.55 ± 0.30 mm, respectively; P < 0.001), smaller ACA (12.96 ± 2.38 and 10.41 ± 2.34 mm(2), respectively; P < 0.001), and greater LV (1.06 ± 0.31 and 1.26 ± 0.36 mm, respectively; P = 0.017). Less IC (odds ratio [OR]*100: 0.935 [95% confidence interval: 0.894, 0.979], P = 0.004) and IT750 (OR*100: 0.904 [0.8294, 0.987], P = 0.024), greater central corneal thickness (OR*100: 2.100 [1.245, 3.542], P = 0.005), greater LV (OR: 66.7 [2.529, 1761.3], P = 0.012), less ACA (OR: 0.386 [0.193, 0.774], P = 0.007), and less ACD (OR*100: 0.912 [0.855, 0.972], P = 0.005) were significantly associated with prediction of APAC. CONCLUSIONS Greater LV was the most prominent feature of affected eyes compared to fellow eyes in APAC patients when assessed by AS OCT. This may play a role in the development of acute attack in primary angle closure.

Comparison on the vision-related quality of life between outpatients and general population with dry eye syndrome

Purpose:  To compare the impact of dry eye syndrome (DES) on vision‐related quality of life (VR‐QoL) between outpatients and general populations.

In vivo laser scanning confocal microscopy of vernal keratoconjunctivitis

Background:  To demonstrate the morphological characteristics of vernal keratoconjunctivitis (VKC) by using in vivo laser scanning confocal microscope (LSCM).

T-style keratoprosthesis based on surface-modified poly (2-hydroxyethyl methacrylate) hydrogel for cornea repairs

Corneal disease is a common cause of blindness, and keratoplasty is considered as an effective treatment method. However, there is a severe shortage of donor corneas worldwide. This paper presents a novel T-style design of a keratoprosthesis and its preparation methods, in which a mechanically and structurally effective artificial cornea is made based on a poly(2-hydroxyethyl methacrylate) hydrogel. The porous skirt was modified with hyaluronic acid and cationized gelatin, and the bottom of the optical column was coated with poly(ethylene glycol). The physical properties of the T-style Kpro were analyzed using ultraviolet and visible spectrophotometry and electron scanning microscopy. The surface chemical properties were characterized using Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy. The surface modification in the spongy skirt promoted cell adhesion and produced a firm bond between the corneal tissue and the implant device, while the surface modification in the optic column resisted cell adhesion and prevented retroprosthetic membrane formation. Through improved surgical techniques, the novel T-style keratoprosthesis provides enough mechanical stability to facilitate long-term biointegration with the host environment. In vivo implantation experiments showed that the T-style keratoprosthesis is a promising cornea alternative for patients with severe limbal stem cell deficiency and corneal opacity.

Effect of rapamycin and interleukin-2 on regulatory CD4+CD25+Foxp3+ T cells in mice after allogenic corneal transplantation.

BACKGROUND We explored the effect of rapamycin (RAPA) and interleukin (IL)-2 on regulatory CD4(+)CD25(+)Foxp3(+) T cells (Treg) in recipient mice after allogenic corneal transplantation and analyzed its correlation with graft outcome. METHODS Allogenic corneal transplantation was performed using C57/BL6 mice as donors and Balb/c mice as recipients. RAPA, IL-2, and RAPA + IL-2 (mixed group) were administered to recipient mice, with three dosages for each therapeutic protocol. The graft status was assessed twice per week. The percentage of CD4(+)CD25(+)Foxp3(+) Treg in the peripheral blood, spleen, and draining lymph nodes was analyzed. The expression of Foxp3 mRNA in grafts was tested, and the concentration of IL-10 and transforming growth factor (TGF)-β1 in serum and aqueous humor was measured. RESULTS The lowest scores of graft neovascularization and opacity were mainly found in mixed groups. The percentage of CD4(+)CD25(+)Foxp3(+) Tregs in blood was increased significantly in mice treated with either high-dose RAPA or high-dose IL-2, and a synergistic effect was found in mixed high-dose group. So were the Tregs in either spleen or draining lymph nodes. However, such effects were weakened with decreased dosage. Foxp3 gene expression in grafts was elevated significantly in the recipients treated with median dosage of RAPA, IL-2, and mixed agents. The concentration of IL-10 in serum and aqueous humor was increased significantly in mice with mixed- high-dose treatment. Mixed treatments also enhanced TGF-β1 level in serum and aqueous humor, except those receiving low dosage. CONCLUSION In vivo administration of RAPA prohibited graft rejection after allogenic penetrating keratoplasty through expansion of CD4(+)CD25(+)Foxp3(+) Tregs. Simultaneous treatment of IL-2 enabled further elevation of Tregs. However, the synergistic effect was dosage-dependent, being the most potent at high dosage. The protocol may be beneficial to induce transplantation tolerance.

In vivo confocal microscopy of meibomian glands and palpebral conjunctiva in vernal keratoconjunctivitis

Purpose: To investigate the correlations between conjunctival inflammatory status and meibomian gland (MG) morphology in vernal keratoconjunctivitis (VKC) patients by using in vivo confocal microscopy (CM). Materials and Methods: Nineteen VKC patients (7 limbal, 7 tarsal, and 5 mixed forms) and 16 normal volunteers (controls) were enrolled. All subjects underwent CM scanning to obtain the images of upper palpebral conjunctiva and MGs. Inflammatory cell (IC) density in palpebral conjunctival epithelial and stromal layers, Langerhans cell (LC) density at lid margins and the stroma adjacent to the MG, and MG acinar unit density (MGAUD) were recorded. The longest and shortest diameters of MG acinar were measured. The Kruskal-Wallis test was used to compare the parameter differences whereas the Spearmans rank correlation analysis was applied to determine their correlations. Results: Among all groups, no significant statistical differences were found in epithelial and stromal IC densities, mean values of MG acinar unit densities, or longest and shortest diameters. Both LC parameters in the tarsal-mixed groups were significantly higher than those in the limbal and control groups. All LC densities of VKC patients showed a positive correlation with MGAUD and shortest diameter. Conclusions: In VKC patients, the conjunctival inflammatory status could be associated with the MG status. In vivo CM is a noninvasive, efficient tool in the assessment of MG status and ocular surface.

Impact of Conjunctivochalasis on Visual Quality of Life: A Community Population Survey

Conjunctivochalasis (Cch) is a very common ocular disorder, which can cause an unstable tear film and ocular discomfort. The study of vision-related quality of life (VR-QoL) in a community population with Cch can provide a better understanding of the impact of Cch on common people than objective clinical examinations alone. This cross-sectional comparative study enrolled 360 participants ≥40 years old living in Sanle Community, Shanghai. In the study, 198 subjects were diagnosed with Cch and 86 with dry eye syndrome (DES) without Cch. The remaining 76 subjects were normal controls. Socio-demographical data were collected, and Cch and related ocular symptoms and signs were evaluated. In addition, all participants were required to complete the Chinese version of the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) and Ocular Surface Disease Index Questionnaire (OSDI). Main outcome measures include the comparison on the OSDI score and VFQ-25 score among the subgroups, and the correlation of these scores with the socio-demographical and clinical data. The results revealed that subjects with Cch had significantly decreased tear film stability even compared with those with DES (P = 0.001). The participants with either Cch or DES reported significantly higher OSDI scores and lower VFQ-25 composite scores than the normal controls (P<0.001 and 0.007 respectively). Further comparisons among the subgroups of Cch revealed that the following factors were associated with higher OSDI scores and lower VFQ-25 composite scores: nasal-side Cch, chalasis folds higher than tear meniscus height, punctal occlusion, or increased extent of chalasis on digital pressure. In conclusion, Cch was associated with an adverse impact on VR-QoL in a community population, and the impairment in VR-QoL had a significant correlation with disease severity and tear film abnormalities.