Samir Al-Mansouri

Immunopathogenesis of conjunctival remodelling in vernal keratoconjunctivitis

PurposeTo study the processes involved in mediating conjunctival remodelling in vernal keratoconjunctivitis (VKC) by investigating the expression of integrin receptors, epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), transforming growth factor-β(TGF-β), basic fibroblast growth factor (bFGF), platelet-derived growth factor (PDGF), and Ki67 antigen, which is a marker for cell proliferation.MethodsConjunctival biopsy specimens from 16 patients with active VKC and nine control subjects were studied by immunohistochemical techniques using monoclonal and polyclonal antibodies directed against the integrin α3 and α6 subunits, EGFR, VEGF, TGF-β, bFGF, PDGF, and Ki67 antigen. The phenotype of inflammatory cells expressing growth factors was examined by double immunohistochemistry.ResultsIn the normal conjunctiva, very weak immunoreactivity was observed for EGFR and VEGF in epithelial cells, and for α3 and α6 integrin subunits on basal epithelial cells, and on vascular endothelial cells in the upper substantia propria. There was no immunoreactivity for the other antibodies. In VKC specimens, strong staining for α3 and α6 integrin subunits was observed on the membranes of basal and suprabasal epithelial cells, and all vascular endothelial cells. Immunoreactivity for Ki67 antigen was observed in the nuclei of the basal and suprabasal epithelial cells. Strong immunoreactivity was observed for EGFR in the deeper layers of the epithelium, and for VEGF in all epithelial cells. Inflammatory cells expressing EGFR, VEGF, TGF-β, bFGF, and PDGF were noted in 8, 9, 11, 10, and 10 specimens, respectively. The majority of inflammatory cells expressing growth factors were eosinophils (45±4%) and monocytes/macrophages (35±4%).ConclusionsChronic conjunctival inflammation in VKC is associated with increased staining of α3, and α6 integrin subunits, EGFR, VEGF, TGF-β, bFGF, and PDGF that might mediate conjunctival remodelling.

Heparin surface-modified intraocular lenses in patients with inactive uveitis or diabetes.

OBJECTIVE This study aimed to determine whether heparin surface-modified (HSM) intraocular lenses (IOLs) with a hydrophilic surface would reduce cell adherence and other postoperative changes compared with the conventional polymethylmethacrylate (PMMA) IOLs in patients with either diabetes mellitus or inactive uveitis. DESIGN The study design was a randomized, double-masked, clinical trial. PARTICIPANTS Twenty-five patients with bilateral cataracts, 14 with inactive anterior uveitis and 11 with diabetes, with an age range of 11 to 81 years (mean, 52.8 years) participated. INTERVENTION Bilateral cataract extraction with posterior chamber IOL implantation was measured, each patient receiving an HSM lens in one eye and a PMMA lens in the other. Pharmacia one-piece HSM and PMMA IOLs were used. Postoperative ocular changes were evaluated at regular intervals for 24 months in patients with inactive uveitis and for 6 months in patients with diabetes. Patients and physicians alike were unaware of which eye contained which lens until postoperative results were compiled. Records were kept by a study coordinator. MAIN OUTCOME MEASURES Comparisons of posterior synechiae, IOL cellular deposits, and posterior capsular fibrosis between PMMA and HSM IOLs were measured. RESULTS Using the chi-square test, no statistically significant difference was found between the HSM and PMMA IOLs in the number of cellular deposits found on the anterior IOL surface, the number of adhesions between the iris and IOL, or the incidence of capsular opacification. CONCLUSION The HSM and PMMA IOLs showed similar postoperative results in patients with inactive uveitis or diabetes mellitus.

Lubrithal® (Leo viscous eye gel), precorneal residence time in normal and dry eyes

In an open, right/left controlled study we compared the effects of topical carbomer gel Lubrithal® (Leo viscous eye gel) and polyvinyl alcohol (Liquifilm®, Allergan) in 20 patients with dry eyes and in 20 healthy subjects. The average precorneal residence time of carbomer gel in patients and healthy subjects was 92.8 min (± 35.7) and 36.5 min (± 14.2), respectively, while it was 40.8 min (± 19.4) and 19.5 min (± 8.3) in the polyvinyl alcohol group. The tear break up time was 10 min after instillation significantly longer with the carbomer gel: 23.0 seconds (± 5.5) in dry eye patients and 26.2 seconds (± 4.4) in healthy subjects compared to polyvinyl alcohol: 10.4 seconds (± 3.4) in dry eye patients and 16.5 seconds (± 7.1) in healthy subjects (p < 0.001). Seventy-five per cent of the dry eye patients preferred Lubrithal®.

Efficacy of punctal occlusion in management of dry eyes after laser in situ keratomileusis for myopia.

Abstract Purpose: To evaluate the effect of punctal plug use in preventing dry eye after laser in situ keratomileusis (LASIK). Materials and Methods: A randomized clinical trial at a tertiary eye care center, Riyadh, Saudi Arabia. Participants underwent LASIK for myopia in both eyes and a lower punctal occlusion in one eye only while the other eye served as control. Both eyes received the same postoperative medications except for lubricant duration (subject eye: four times per day for one week; control eye: four times per day for 6 months). Participants were evaluated at 1 week, 2, and 6 months after surgery for signs and symptoms of dry eye. The main outcome measures were visual acuity; ocular surface parameters; and Ocular Surface Disease Index questionnaire. Results: Seventy-eight eyes of 39 patients were included in this study. The Ocular Surface Disease Index scores of eyes with punctal plugs were better at all follow-up visits, and the differences between both eyes were statistically significant (1 week, p < 0.0001; 2 months, p < 0.0001; 6 months, p = 0.008). At the final follow-up visit, the percentage of normal eyes was higher in eyes with punctal plugs for all ocular surface parameters (Schirmer 1 test, 94.9%; tear breakup time, 77.8%; punctate epithelial keratitis score, 71.8%) compared to eyes without occlusion (Schirmer 1 test, 92.3%; tear breakup time, 58.3%; punctate epithelial keratitis score, 53.8%); however, such differences were not statistically significant. Conclusion: Punctal plug insertion after LASIK surgeries may minimize the need for frequent lubricant application and hence improve patient satisfaction.

Glaucoma After Open-globe Injury at a Tertiary Care University Hospital: Cumulative Causes and Management.

Purpose:To investigate causes and treatment modalities of traumatic glaucoma after open-globe injury (OGI). Materials and Methods:The medical records of all patients with postrepair follow-up of OGI at a tertiary care university hospital from January 1996 to December 2010 were reviewed. These patients had persistent elevated intraocular pressure (IOP) of >21 mm Hg at 2 consecutive visits, with or without optic disc damages. Results:Over the 14-year study period, 41 eyes of 41 patients with repaired OGI that developed glaucoma were identified. In the early stage (within 1 mo), high IOP levels occurred owing to the presence of unremoved lens particles in 11 patients (26.8%), inflammation in 6 patients (14.6%), and hyphema in 3 patients (7.3%). In the intermediate stage (2 to 6 mo), the IOP increased owing to the presence of synechial angle closure in 9 patients (21.9%) and ghost cells in 3 patients (7.3%). In the late stage (>6 mo), the IOP rose owing to the presence of unremoved lens particles in 2 patients (4.8%), angle recession in 4 patients (9.7%), and synechial angle closure in 3 patients (7.3%). Surgical interventions included trabeculectomy in 9 eyes (22%), lens aspiration in 9 eyes (22%), cyclophotocoagulation (CPC) in 5 eyes (12.2%), anterior chamber washout in 3 eyes (7.3%), and tube surgery in 2 eyes (4.9%). Conclusions:Traumatic glaucoma is not uncommon long-term complication after OGI. It is important to inspect the association between the initial cause and achieving a successful treatment. Surgical intervention may be crucial in the majority of cases.

Traumatic Transection of the Optic Nerve and Evulsion of the Eye Globe: Case Report and Review of Literature

Purpose: To report a case of traumatic transection of the optic nerve (ON) and evulsion of the eye globe in an adult farm worker caused by cow horn and review of literature. Methods: A 50-year-old male farm worker was attacked by an unprovoked cow. In addition to the subdural hematoma, the cow horn transected the ON and evulsed the patients left eye resulting in total loss of vision. Results: Patient required evacuation of subdural hematoma and the left eye globe was severed from the remaining attached lateral rectus muscle. Conclusion: Unprovoked severe ocular injuries caused by cow horn are rare. To the best of our knowledge, cow horn caused traumatic transaction of the ON and evulsion of the eye globe has never been reported in ophthalmic literature.