Sung A. Lim

Association of IL-21 cytokine with severity of primary Sjögren syndrome dry eye.

Purpose: IL-21 plays an important role in primary Sjögren syndrome (SS) pathogenesis. The purpose of this study was to evaluate IL-21 expression in tears and the conjunctiva and to analyze the impact of IL-21 on primary SS dry eyes. Methods: Eighty subjects were enrolled in this study: 30 patients with primary SS dry eye (30 eyes); 30 patients with non-SS dry eye (30 eyes), and 20 normal controls. Tear IL-21 levels were measured by flow cytometry, and IL-21 gene expression in the conjunctiva from impression cytology was evaluated by quantitative polymerase chain reaction. Ocular Surface Disease Index, tear film breakup time, Schirmer I test, and ocular surface staining scores were obtained for all patients. Results: Primary SS dry eyes had significantly higher tear IL-21 levels than non-SS dry eyes and normal controls (P < 0.01). In addition, IL-21 gene expression in the conjunctiva was also higher in primary SS dry eyes than in non-SS dry eyes and normal controls (P < 0.01). However, there were no significant differences in IL-21 expression in tears and the conjunctiva between non-SS dry eyes and controls. The tear IL-21 level was significantly correlated with ocular surface stain scores (r = 0.54, P < 0.01) and Schirmer I test values (r = −0.23, P < 0.05) in primary SS dry eyes. Conclusions: Our findings suggest that severity of primary SS dry eye is associated with IL-21.

Serologic Markers Are Associated With Ocular Staining Score in Primary Sjogren Syndrome.

Purpose: To investigate the relationship between serologic markers and dry eye severity in subjects with primary Sjögren syndrome (SS). Methods: This study evaluated 64 patients diagnosed with primary SS according to the 2012 Sjögrens International Collaborative Clinical Alliance (SICCA) classification criteria. Serum anti-Ro/SSA, anti-La/SSB, rheumatoid factor (RF), and antinuclear antibody (ANA) levels, Ocular Surface Disease Index (OSDI), Schirmer I test values, tear film breakup time, and SICCA ocular staining score (OSS) were determined. Results: The conjunctival staining scores were 3.3 ± 1.9, 3.6 ± 2.0, 3.4 ± 1.9, and 3.5 ± 1.9 in the positive anti-Ro (≥25 EU), positive anti-La (≥25 EU), positive RF (≥20 IU/mL), and positive ANA (≥1:320) group, respectively. Subjects with positive anti-Ro, anti-La, RF, or ANA had significantly higher conjunctival staining scores compared with those with negative levels (P < 0.05). The total OSS in the positive ANA group was 5.5 ± 3.0, which was significantly higher than the total OSS (3.4 ± 2.1) in the negative ANA group (P = 0.005). Serum RF and ANA levels had strong correlations with conjunctival staining scores and the total OSS but not with corneal staining scores (r = 0.53, P < 0.001 and r = 0.382, P = 0.002). Other ocular parameters (OSDI, Schirmer I test values, and tear film breakup time) did not differ by the serologic marker level. Interestingly, the OSDI was positively correlated with the corneal staining score and total OSS (r = 0.646, P < 0.001 and r = 0.476, P < 0.001). Conclusions: Serum RF and ANA levels are associated with conjunctival staining scores and the total OSS according to the SICCA OSS in primary SS.

Efficacy and Safety of Carbomer-Based Lipid-Containing Artificial Tear Formulations in Patients With Dry Eye Syndrome.

Purpose: To evaluate the efficacy and safety profile of carbomer-based lipid-containing artificial tear formulations (CBLAT) in patients with dry eye syndrome. Methods: A multicenter parallel-group study was conducted in 412 patients with dry eye syndrome. Of these patients, 221 switched from using artificial tears to CBLAT (switching group) and 191 added CBLAT to their current treatment (add-on group). Ocular symptom scores, ocular staining grades, tear film breakup time (tBUT), Schirmer I test value, and Korean dry eye level (as defined by the Korean Corneal Disease Study Group guidelines) were evaluated at baseline and after 4 weeks of treatment. Results: After 4 weeks of treatment, ocular surface staining grade, tBUT, Schirmer I value, ocular irritation symptom scores, and the positive rate of visual symptom improved significantly in both groups. Mean reductions in ocular surface staining grades (−0.8 ± 0.9) and ocular irritation symptom scores (−0.8 ± 0.8) in the add-on group were significantly higher than those (−0.5 ± 0.8 and −0.6 ± 0.8) in the switching group (P < 0.01 and P < 0.05). The positive rate of visual symptoms (44.2%) in the add-on group was significantly higher than that (26.4%) in the switching group (P < 0.01). The decrease of Korean dry eye level was 30.1% in the switching group and 51.6% in the add-on group. More patients in the add-on group had decreased dry eye levels than those in the switching group (P < 0.0001). Conclusions: CBLAT improves ocular surface staining grades, tBUT, Schirmer I values, and ocular symptoms in patients with dry eye syndrome.

Niflumic acid reduces histamine-induced interleukin-6 and -8 expression in human conjunctival epithelial cells.

Background/Aims: Histamine remains the main mediator of allergic conjunctivitis and induces interleukin (IL)-6 and IL-8 production in human conjunctival epithelial cells (HCEC). The purpose of the present study was to determine whether histamine induced IL-6 and IL-8 expression in HCEC, and to describe the relationship between human calcium-activated chloride channel (hCLCA) 1 activity and IL-6 and IL-8 expression. Methods: HCEC were isolated from human conjunctiva and cultured at an air-liquid interface. IL-6 and IL-8 mRNA expression was examined by real-time PCR, and IL-6 and IL-8 secretion was measured by ELISA after stimulation of HCEC with histamine. Results: Histamine upregulated IL-6 and IL-8 expression and IL-6 and IL-8 secretion in a dose-dependent manner in HCEC. Niflumic acid (NFA), an hCLCA blocker, reduced histamine-induced IL-6 and IL-8 expression. Conclusion: Histamine-induced IL-6 and IL-8 production could be attenuated by NFA, an hCLCA blocker.

Comparison of Anterior Capsule Stability Following Implantation of Three Single Piece Acrylic Intraocular Lenses with Different Haptic Design

Purpose To compare the anterior capsule contraction and intraocular lens (IOL) decentration among three types of IOL to determine the influence of haptic design on anterior capsule stability. Methods One hundred fifty patients were enrolled in this prospective, randomized study and 260 eyes underwent implantation of one of the following IOLs: modified L-haptic IOL (n = 74), modified C-haptic IOL (n = 97), or a plate-haptic IOL (n = 89). The area of the anterior capsule opening, IOL decentration, and capsule overlap were measured using retroillumination photospot 1 day and 2 months after cataract surgery. Results The area of capsule opening at postoperative day 1 was significantly different between the three IOLs (p < 0.01). All IOLs showed reduction of the anterior capsule opening from 1 day to 2 months after surgery, and greater reduction was shown in the modified C-haptic IOL (p < 0.001). At postoperative month 2, IOL decentration was significantly different between the IOLs and showed a positive correlation with the mean area reduction during month 2. Conclusions The degree of anterior capsule contraction and IOL decentration in modified L-haptic IOLs were less than those in modified C-haptic IOLs and comparable to those in plate-haptic IOLs.

Clinical Features of Infectious Keratitis Caused by Propionibacterium Acnes.

Purpose: Propionibacterium acnes is a commensal bacteria whose pathogenicity in infectious keratitis is unclear. In this study, we report infectious keratitis cultured with P. acnes and evaluate its clinical characteristics. Methods: All cases of infectious keratitis submitted to the microbiology laboratory of St. Marys Hospital of Seoul between January 2013 and April 2014 were reviewed. Nonpretreated cases that were positive for P. acnes were identified, and clinical characteristics and treatment outcomes were studied. Results: Of 132 cultures submitted to the microbiology laboratory, 89 (67.4%) were positive for growth, and a total of 16 (17.9%) of the 89 cases yielded P. acnes in culture medium. Infectious keratitis that was positive for P. acnes was generally small (62.5%) with deep stromal infiltration (81.25%) and a peripheral location (56.25%). The average incubation period was 11.06±5.76 days, and the average time to reepithelialization was 23.50+13.52 days. All the cases of P. acnes evaluated in this report responded well to medical treatment. Conclusions: Infectious keratitis with P. acnes is not uncommon and can be confused with other Gram-positive cocci. Thus, P. acnes should be suspected in small-sized keratitis with an unusually long incubation period.

Contents Vol. 50, 2013

J. Alio, Alicante A.J. Augustin, Karlsruhe D. Balasubramanian, Hyderabad F. Bandello, Milano A. Bialasiewicz, Doha D. Borchman, Louisville, Ky. A. Bringmann, Leipzig T. Das, Hyderabad D. Goldblum, Basel G. Guarnaccia, Lugano K. Hegde, Baltimore, Md. J. Hua, Boston, Mass. N. Ibaraki, Shimotsuke-City T. Ishibashi, Fukuoka J. Jonas, Mannheim D. Lam, Guangzhou C. Meyer, Olten G.A. Moviglia, Buenos Aires N. Osborne, Oxford Y. Ozawa, Tokyo M. Rehak, Leipzig G. Richard, Hamburg K. Sasaki, Uchinada L. Schmetterer, Vienna J. Smith, Portland, Oreg. P. Söderberg, Uppsala J. Trevithick, London, Ont. K. Tsubota, Tokyo A. Wegener, Bonn J.O. Zárate, Buenos Aires Journal for Translational and Clinical Research