R. Caramazza

Eye discomfort and air pollution.

Discomfort eye syndrome (DES) comprises a series of ‘minor’ subjective symptoms in patients where no relevant clinical signs are observed suggesting ocular disease. Our study includes 100 DES patients, excluding video terminal users, selected from the First Aid Service of our Department over two peak periods in both winter and summer time. The Schirmer test I, ferning test, breakup time and conjunctival cytology (scraping and imprint) were performed and data were related to sex, age and air pollution indexes, recorded in the patients’ living zones. Our results demonstrate that: (i) the ocular surface cytology and the analysis of tear film changes provide significant information in those patients where no other clinical signs are evident; (ii) DES symptoms are more frequent in women than in men (ratio about 2:1), both with ages over 51 years; (iii) DES is significantly associated with ocular surface inflammation, as detected by cytological methods, and (iv) ocular surface subclinical inflammation and ocular dryness are related to high concentrations of atmospheric polluters, in both sexes.

In vitro adhesion of Staphylococcus epidermidis on heparin-surface-modified intraocular lenses

Abstract This quantitative study assessed the in vitro adhesion of Staphylococcus epidermidis on two types of intraocular lenses: conventional poly(methyl methacrylate) (PMMA) and heparin‐surface‐modified PMMA. Level adhesion was measured by microbiological turbidimetry. We also measured modifications in the bacterium’s structural fatty acids after adhesion using gas chromatography.

Adhesion mechanisms of human lens epithelial cells on 4 intraocular lens materials

PURPOSE To evaluate lens epithelial cell (LEC) adhesion on different intraocular lens (IOL) materials with particular attention to the distribution of proteins located in the focal contacts. SETTING Center of Biotechnological and Clinical Research in Ophthalmology, University of Bologna, Italy. METHODS The IOL materials tested were poly(methyl methacrylate) (PMMA), heparin-surface-modified PMMA (HSM PMMA), polyHEMA, and silicone. Primary cultures of human LECs were established from human anterior capsules obtained during cataract surgery. The mean number of cells attached per square millimeter was calculated for each material after 24 and 72 hours. Transmission electron microscopy and immunocytochemical analysis were performed to detect the proteins actin, vinculin, and talin. RESULTS Mean adhesiveness of human LECs increased over time with PMMA and decreased with the other materials. At 72 hours, mean LECs ranged from 54.8 cells/mm2 +/- 12.8 (SD) on PMMA to 2.1 +/- 0.7 cells/mm2 on silicone. The means for HSM PMMA and polyHEMA fell in between. The cytoskeletal proteins were arranged to produce focal contacts in only the LECs cultured on PMMA. The LECs cultured on polyHEMA, HSM PMMA, and silicone attached but failed to develop focal contacts or stress fibers. CONCLUSION This study confirms the multifactorial pathogenesis of posterior capsule opacification and suggests its incidence will be reduced by improving surgical techniques and using IOL surfaces that discourage cell adhesion.

Inhibition of bacterial adherence to a high-water-content polymer by a water-soluble, nonsteroidal, anti-inflammatory drug

Deposition and aggregation of lachrymal proteins on the contact lens surface can promote bacterial adherence. Lysozyme is the major tear protein and is also mainly responsible for the formation of protein deposits on contact lenses. Nonsteroidal anti-inflammatory drugs (NSAID) prevent protein aggregation. The effect of a water-soluble NSAID drug on bacterial adherence to high-water-content/ionic disposable contact lenses was examined in a radiolabeling study. Dose-related inhibition of adherence of Staphylococcus aureus, S. epidermidis, and Pseudomonas aeruginosa on both pretreated lenses and after adding the drug to the medium was investigated. When the drug was added to the media, maximal inhibition of S. aureus adherence was observed in trypticase soy broth (59-98% at the lower and higher drug concentrations, respectively); inhibition progressively decreased in calf aqueous humor (48-75%), lysozyme (34-63%), and saline (12-20%) solutions. Inhibition of adherence varied with the three bacterial species; it was maximal with S. aureus, intermediate with S. epidermidis, and minimal with P. aeruginosa. When lenses were pretreated with the drug, consistent, and even higher, inhibitory effects were observed. The results suggest that water-soluble NSAIDs could be used in preventive treatments for conjunctivae and corneal infections in contact lens wearers, and may provide a clue as to which compounds might inhibit protein interaction and bacterial adhesion.

The Biocompatibility of Silicone, Fluorosilicone and Perfluorocarbon Liquids as Vitreous Tamponades

Purpose: To investigate the interactions occurring at the interface between some currently used vitreous tamponading substances and the ocular tissues, in an early follow-up after surgery. Methods: Adult albino rabbit eyes underwent vitrectomy and were injected intravitreally with silicone oils at 1,000 or 3,000 cSt, fluorosilicone oil and perfluorodecalin. Different morphological techniques (light microscopy, scanning and electron microscopy, immunohistochemistry) were applied. Results: All the tested materials, although non-toxic, penetrate the ocular tissues also at the anterior segment level, and in the long-term follow-up this can yield functional impairment. No massive inflammation has been detected in the zones in contact with the materials, but immunoglobulins and complement fractions are anyway present in the stroma of various tissues and around the droplets of emulsified materials, suggesting a local immune reaction. Conclusions: Data from this study confirmed that a permanent vitreous substitute, showing a perfect biocompatibility, still does not exist. The indication to remove the tamponading substance within 2 months after the surgery emerges from this investigation, confirming previous studies. Despite some negative features, silicone oil still appears the most biocompatible material for vitreous replacement.

Prostaglandin analogs and blood-aqueous barrier integrity: a flare cell meter study.

Purpose: To study, with an objective method, inflammation of the anterior segment of the glaucomatous eye after treatment with latanoprost, travoprost and bimatoprost. Materials and Methods: Sixty patients with chronic open-angle glaucoma aged between 38 and 76 years (mean 64.0 ± 12.2) were randomly assigned to latanoprost 0.005, travoprost 0.004 and bimatoprost 0.03%. The study period lasted 6 months. Intraocular pressure (IOP) was measured every 2 weeks. We studied the intraocular inflammation before and after 3 and 6 months of therapy with an instrument composed of a He-Ne laser beam system, a photomultiplier mounted on a slitlamp microscope and a computer. This flare meter allows objective determination of the flare and the number of cells in the aqueous of the anterior chamber. Results: At the baseline, IOP was 26.4 ± 3.6 mm Hg. After 3 months of treatment, mean IOP in the latanoprost group was 17.9 ± 0.3 mm Hg (p < 0.001) with a mean cellularity of 12.638 ± 3.284 photons/ms (p < 0.001). The travoprost group had an IOP of 17.2 ± 0.3 mm Hg (p < 0.001) with a cellularity of 9.719 ± 1.927 photons/ms (0.001). Finally, IOP in the bimatoprost group was 17.6 ± 0.5 mm Hg (p < 0.001) with a cellularity of 6.138 ± 1.475 photons/ms (p < 0.032). After 6 months of treatment, IOP in the latanoprost group was 18.1 ± 0.3 (p < 0.001), in the travoprost group 17.3 ± 0.3 (p < 0.001) and in the bimatoprost group 17.7 ± 0.5 mm Hg (p < 0.001), whereas cellularity was 11.838 ± 3.218 (p < 0.001), 8.950 ± 3.692 (p < 0.001) and 7.617 ± 2.603 photons/ms (p < 0.001), respectively. After 3 months, the travoprost (p < 0.013) and the bimatoprost groups (p < 0.001) had less flare compared with the latanoprost group and this remained so even at 6 months. When we compared the travoprost group with the bimatoprost group, we found significantly less flare at 3 months in the bimatoprost group (p < 0.001) but not at 6 months (p < 0.246). Conclusions: The flare meter analysis shows that the eyes treated with bimatoprost and travoprost have a less significantly broken blood-aqueous barrier and their anterior chamber is also significantly less inflamed.

Dryness Symptoms, Diagnostic Protocol and Therapeutic Management: A Report on 1,200 Patients

Purpose: To report the diagnostic and therapeutic data obtained from 1,200 patients suffering from dry eye symptoms not due to Sjögren’s syndrome or other auto-immune diseases. Methods: Schirmer test I, ferning test, breakup time, vital dye staining, brush and imprint cytology were performed; data were grouped into diagnostic profiles, and the therapy was prescribed according to these. Results: Eight diagnostic profiles were identified. Dry eye was diagnosed in 57.1% of patients; the remaining 42.9% were found to suffer from eye discomfort or conjunctivitis of different aetiologies. Conclusions: Subjective symptoms of dryness can hide diseases other than dry eye; combined clinical and laboratory tests are requested to make a diagnosis. Our experience indicates that a therapy prescribed on the basis of diagnostic profiles provides relief in 79.1% of cases.

Colour Doppler Analysis of the Choroidal Circulation in Chronic Open-Angle Glaucoma

PURPOSE To assess any alteration of the blood flow in the ophthalmic artery, in the posterior ciliary arteries and in the choroid of the glaucomatous eye. METHODS We studied 15 patients, 11 males and 4 females (mean age 62.4 years), with chronic open-angle glaucoma in good tonometric control by medical therapy. All patients underwent colour Doppler examination of the ophthalmic artery, posterior ciliary artery and choroid. The data for peak systolic velocity (Pv) and resistance index (RI) were compared with those of healthy control subjects. RESULTS The Pv in the ophthalmic artery of glaucomatous patients was 32.961 +/- 3.045 cm/s (p < 0.033) and RI 0.789 +/- 0.018 (p < 0.001). The Pv of posterior ciliary arteries was 8.720 +/- 1.645 cm/s (p < 0.001) and RI 0.722 +/- 0.024 (p < 0.005). In the choroid the Pv was 10.637 +/- 1.401 cm/s (p < 0.001) and RI 0.643 +/- 0.051 (p < 0.022). CONCLUSIONS Our data indicate that in a chronic open-angle glaucoma there is an alteration in the eye blood flow especially in the posterior ciliary arteries and the choroid.

Detection of mucus glycoconjugates in human conjunctiva by using the lectin‐colloidal gold technique in TEM

Abstract The mucus glycoconjugates produced by conjunctival goblet cells in dry‐eye patients were studied by a specific cytochemical reaction in Transmission Electron Microscopy (TEM). Four lectins, proteins of vegetal origin which specifically bind glycosidic residues, (WGA, PNA, SBA and ConA) were used conjugated with colloidal gold as ultrastructural marker. We performed a quantitative analysis by counting the colloidal gold particles present on mucus granules. The results were compared with normal conditions. We found a decrease in sialic acid, N‐acetyl‐glucosamine, N‐acetyl‐galactosamine and galactose‐N‐acetyl‐galacto‐samine and an increase in mannose. The different content of glycoconjugates in goblet cells may reflect in the change of physical and functional properties of mucus. We think these data may be useful in the search for a therapeutic mucomimetic drug.

Detection of mucus glycoconjugates in human conjunctiva by using the lectin-colloidal gold technique in TEM. II. A quantitative study in dry-eye patients.

Abstract We applied a specific cytochemical reaction to characterize the glycoconjugates produced by goblet and non‐goblet epithelial cells of normal human conjunctiva. For this purpose we utilized the lectins, proteins of vegetal origin, which are extremely sensitive in binding glycosidic residues. In particular, we used WGA, PNA, SBA and ConA conjugated with colfoidal gold as ultrastructural marker for Transmission Electron Microscopy. This technique allowed us also to perform a quantitative analysis, by counting colloidal gold particles present on mucus granules. In this way we analyzed the content both of goblet and non‐goblet epithelial cells. In the former, WGA, PNA, SBA and ConA receptors, here reported in decreasing density, were present. In the latter WGA was always positive, SBA and PNA sometimes were negative, ConA was always negative. We speculate the different contribution to mucus production by these two sources may be important in evaluating tear film stability alterations occurring in those diseases in which non‐goblet epithelial cell vesicles increase.