Evaluation of Ocular Surface Epithelial and Stromal Thicknesses in Psoriasis Using Anterior Segment Optical Coherence Tomography

Purpose: To evaluate the epithelial and stromal thicknesses of conjunctiva and cornea in psoriatic patients with anterior segment optical coherence tomography (AS-OCT),Methods: In this cross-sectional study, 61 patients with psoriasis and 42 age-matched, healthy individuals were enrolled. The epithelial and stromal thicknesses of both inferotemporal bulbar conjunctiva and central cornea were measured using AS-OCT. Results: Both the Tear break-up time and Schirmer-1 test values were significantly lower in the psoriasis group compared with the controls (p<0.05). The epithelial thickness of conjunctiva and cornea did not differ between psoriasis and control groups. (p>0.05) The central corneal stroma was significantly thicker in the psoriasis group (p=0.04). PASI was positively correlated with the thickness of central cornea stroma (r=0.442, p=0.006) in the nail psoriasis group. Conclusions: Psoriasis is not associated with altered epithelial thicknesses of the cornea and conjunctiva. It is accompanied by the stromal thickening of the cornea without conjunctival stromal involvement.

Pseudopterygium in a Rabbit - Treatment with Tracolinus

Background: Pseudopterygium, also known as aberrant conjunctival growth, is poorly described in the literature, although it is known that this abnormality is uncommon and affects dwarf rabbits and their crossbreeds. The etiology of this disease is unknown, but there are hypotheses that the conjunctival growth cause may have its origins in immunological factors, inflammation, traumatic conditions, or cartilage dysplasias. Thus, this study reports the treatment efficacy applied in a rabbit, through the continuous use of tracolimus eye drops, after surgical procedure of conjunctival fold resection, as a way of controlling the pseudopterygium in rabbits.Case: This case report discusses the positive results from the surgical and therapeutic conduct of a clinical case attended by the Ophthalmology and Microsurgical Veterinary Service at the Hospital Veterinário Universitário (HVU) of the UFSM. The patient was a male rabbit, sterilized cunicle, approximately 2-year-old, crossed with a dwarf rabbit. The owner's main complaint was the change in the aspect of the left eye, with progressive worsening in the previous four weeks. In the ophthalmological examination, the animal did not present impaired vision or discomfort, however, a vascularized pink membrane was noted, which consisted of a fold of the bulbar conjunctiva, that grew centripetally and covered 90% of the cornea in 360 degrees. The diagnosis was confirmed through visual inspection and the patient's history. The eye alteration had a characteristic aspect, described as proliferation of the bulbar conjunctiva over the cornea, in a centripetal manner and without signs of inflammation. In addition, other ophthalmological alterations were ruled out during the patient's physical and specific examination. The patient was referred for anesthetic evaluation and, in addition, pre-surgical blood tests were performed, which were normal, according to the expected ranges for the species. Subsequently, the animal was submitted to surgical treatment, which consisted of dividing the exuberant conjunctiva, followed by three radial incisions in equal portions. Next, the conjunctival fold was completely incised to the edge of the limbus, without the need of sutures. Anterior lamellar keratectomy was performed on the portion where the membrane was attached to the cornea. For home care, tobramycin-based eye drops (QID, for 7 days) and 0.02% aqueous tacrolimus eye drops (BID - continuous use) were prescribed. The animal was reevaluated 7, 14, 30, 60, 120 and 180 days after surgical correction, and no recurrence of pseudopterygium was observed during the follow-up period. The prognosis of patients with pseudopterygium is reserved, as it is known that the disease may recur after surgical treatment. Therefore, the continuous use of the chosen immunomodulating eye drops was recommended as well as periodic follow-up of the patient.Discussion: In the current study, it was not possible to increase knowledge regarding about the pseudopterygium etiology. Although the condition is not serious, it can cause partial impairment of vision and chronic discomfort. However, the vision field described in the rabbit in this current case remained unchanged, in accordance with other cases described in the literature. Furthermore, no signs of patient discomfort were detected. Some surgical techniques described in the literature for correction of pseudopterygium, shows membrane’s growth recurrence. The use of immunomodulatory drugs is suggested for relapses controlling. In this study, the tracolimus eye drops efficacy was tested, and presented good results in the patient's evaluations for a long period after surgery. The use of immunomodulators is an option for adjuvant topical treatment for controlling pseudopterygium growth, which, associated with corrective surgical treatment, has shown positive results.Keywords: conjunctiva, aberrant, immunomodulator, treatment, bunny.Título: Pseudopterígio em coelho - tratamento com tracolimusDescritores: conjuntiva, aberrante, imunomodulador, tratamento, coelho.

The Role of the Stromal Extracellular Matrix in the Development of Pterygium Pathology: An Update

Pterygium is a benign fibrovascular lesion of the bulbar conjunctiva with frequent involvement of the corneal limbus. Its pathogenesis has been mainly attributed to sun exposure to ultraviolet-B radiation. Obtained evidence has shown that it is a complex and multifactorial process which involves multiple mechanisms such as oxidative stress, dysregulation of cell cycle checkpoints, induction of inflammatory mediators and growth factors, angiogenic stimulation, extracellular matrix (ECM) disorders, and, most likely, viruses and hereditary changes. In this review, we aim to collect all authors’ experiences and our own, with respect to the study of fibroelastic ECM of pterygium. Collagen and elastin are intrinsic indicators of physiological and pathological states. Here, we focus on an in-depth analysis of collagen (types I and III), as well as the main constituents of elastic fibers (tropoelastin (TE), fibrillins (FBNs), and fibulins (FBLNs)) and the enzymes (lysyl oxidases (LOXs)) that carry out their assembly or crosslinking. All the studies established that changes in the fibroelastic ECM occur in pterygium, based on the following facts: An increase in the synthesis and deposition of an immature form of collagen type III, which showed the process of tissue remodeling. An increase in protein levels in most of the constituents necessary for the development of elastic fibers, except FBLN4, whose biological roles are critical in the binding of the enzyme LOX, as well as FBN1 for the development of stable elastin. There was gene overexpression of TE, FBN1, FBLN5, and LOXL1, while the expression of LOX and FBLN2 and -4 remained stable. In conclusion, collagen and elastin, as well as several constituents involved in elastic fiber assembly are overexpressed in human pterygium, thus, supporting the hypothesis that there is dysregulation in the synthesis and crosslinking of the fibroelastic component, constituting an important pathogenetic mechanism for the development of the disease.

Occhio… alla chemosi congiuntivale

A 4-year-old boy presented with a sudden swelling in his right eye associated with itch, unilateral tearing and presence of jelly-like oedema in the bulbar conjunctiva. The diagnosis was conjunctival chemosis. Conjunctival chemosis is the oedematous imbibition of the tissues underlying the bulbar conjunctiva that determines the jelly-like swelling from the eyeball. It is an unspecific sign of eye inflammation that in most cases is ascribable to allergic diathesis or viral or bacterial infections. The diagnosis is clinic and therapy should be targeted to the treatment of its trigger.

Hemodynamics and functional state of the contralateral kidney in the early postoperative period after surgical treatment of kidney cancer

AIM:To study the hemodynamics and functional state of the renal tissue of the contralateral kidney in the early postoperative period after surgical treatment of kidney cancer. MATERIALS AND METHODS:The prospective study included 58 patients with renal cell carcinoma, 36 (62.1%) of whom underwent radical nephrectomy, and 22 (37.9%) underwent partial nephrectomy. Tumor sizes ranged from 1.0 to 12.0 cm. All patients before surgery and in the early postoperative period underwent ultrasound examination of the structure and size of the kidneys, Doppler ultrasonography of the renal vessels, biomicroscopy of the bulbar conjunctiva, measured peripheral blood pressure, determined the glomerular filtration rate (GFR) and performed a coagulogram. The control group included 16 healthy adults. RESULTS:In 83.3% of patients after radical nephrectomy and in 13.6% of patients after partial nephrectomy a tendency towards an increase in blood pressure compared with the initial values was noted by the 2-4th day after the operation. By the 5th day after surgery, the volume of the only kidney remaining after radical nephrectomy increased by an average of 4% (from 126.1 1.4 to 131.2 2.1 cm3,p 0.05), while after partial nephrectomy has not changed reliably. After surgery, a decrease in GFR was detected in 34 (58.6%;p 0.05) patients, including after radical nephrectomy (n= 28) up to 73.4 8.2 ml / min / 1.73 m2, after partial nephrectomy (n= 6) up to 98.2 3.4 ml / min / 1.73 m2. Doppler ultrasonography of the vessels of a single kidney in patients after radical nephrectomy showed a moderate increase in linear blood flow, an increase in the resistance index in the main trunk of the renal artery, and a decrease in the pulsation index in the segmental and arc arteries. In patients after partial nephrectomy in the contralateral kidney these changes were not observed. When performing biomicroscopy of the bulbar conjunctiva in 83.3% of patients after radical nephrectomy and in 13.6% of patients after partial nephrectomy, changes in the microvasculature were revealed: narrowing of arterioles, expansion of venules, slowing of venular and capillary blood flow. Before the operation and in the early postoperative period, the content of fibrinogen and soluble fibrin-monomer complex in the blood of patients with renal cell carcinoma was significantly higher than in the control group. CONCLUSIONS:In patients with renal cell carcinoma, changes in the contralateral kidney in the early postoperative period after radical nephrectomy are significantly more pronounced than after partial nephrectomy, and are accompanied by changes in systemic and local hemodynamics and kidney function. The results of the study confirm the feasibility of performing organ-preserving surgeries in patients with renal cell carcinoma.

Should we care about the ocular surface in the anophthalmic patient?

Purpose: To assess clinical and biomolecular changes of the conjunctival epithelium in anophthalmic patients wearing an ocular prosthesis. Methods: Thirty-five unilateral anophthalmic patients were enrolled. Patients with blepharitis, lid abnormalities, and topical/systemic medication affecting the ocular surface were excluded. Symptom Assessment in Dry Eye (SANDE) questionnaire and tear function test (Schirmer Test Type I) were recorded. Conjunctival inflammation and meibomian gland dysfunction (MGD) were graded in the anophthalmic side and fellow eye. Impression cytology sampling of the upper, lower tarsal, and posterior/bulbar conjunctiva from the anophthalmic socket were collected and compared to healthy controls. Results: Patients had significantly higher SANDE ( p < 0.001), Schirmer I test ( p = 0.004), conjunctival inflammation ( p < 0.001), and MGD scores ( p < 0.001) on the anophthalmic side compared to the fellow eye. Mucin 5AC, inflammatory markers (MMP-9, ICAM-1) expression ( p < 0.001), and response to oxidative stress (NRF2-KEAP1 signaling pathway) ( p < 0.05) were significantly upregulated in the posterior conjunctival surface in the anophthalmic socket. Conclusions: Anophthalmic patients complained of more pronounced dry eye symptoms and presented more significant signs of inflammation and MGD on the anophthalmic side. The bulbar conjunctiva, behind the prosthesis, showed more significant hyperexpression of mucins, markers of inflammation, and increased response to oxidative stress compared to the tarsal conjunctiva. Patients wearing ocular prosthesis had signs of inflammation resembling dry eye disease.

Symptomatic Metabolic Treatment of Ophthalmopathies in Patients with COVID-19-Associated Pneumonia

Background. The causative agent of the coronavirus infection – SARS-CoV-2 – remains active and causes new cases despite the measures taken around the world. In order to timely detect ophthalmopathies in patients with dyslipidemia who have gone through COVID-19-associated pneumonia, prospective observation during the period of convalescence is advisable, justified and relevant. The assessment of the microcirculation of the bulbar conjunctiva is simple, non-invasive, safe, and allows assessing changes in the entire microcirculatory system of the body. Purpose. To study the features of the somatic status, hemodynamics of the bulbar conjunctiva in patients with dyslipidemia who have gone through COVID[1]19-associated pneumonia, depending on gender, homocysteine and cystatin C indicators during symptomatic therapy. Methods. 55 patients (110 eyes) with a documented diagnosis of COVID-19-associated pneumonia with an increased level of homocysteine and cystatin C were prospectively examined 3 months after discharge from the hospital. After consulting with therapist, cardiologist and functional diagnostics doctor, patients were divided into two groups according to gender. Results. In both groups, the dependence of the severity of lung damage on age was noted: Spearman’s correlation coefficient (r) amounted to r = 0.4; p = 0.017 and r = 0.5; p = 0.045, respectively. A direct correlation on the stage of AH was noted in patients of Group 1 (r = 0.4; p = 0.016), however, in patients of Group 2, this dependence was not found to be significant (r = 0.2; p = 0.367). There were no statistically significant changes in lipid profile in patients of both groups. The severity of endotheliosis during the period of convalescence in the study groups was confirmed by the average values of homocysteine and cystatin C compared to the reference values (1.4/1.6 and 1.62/1.67 times higher, respectively). A month of symptomatic metabolic treatment (Rosuvastatin, 1 mg of folic acid three times a day, 1 pill of Combilipen once a day, 1 drop of Chiloparin[1]Komod solution in both eyes 3 times a day) has shown its effectiveness in the course of changes in bulbar conjunctival microcirculation and disturbed total tear secretion in patients of both groups. Conclusion. In patients who went through COVID-19-associated pneumonia, markers of endotheliosis (homocysteine and cystatin C) remain during the period of convalescence, which indicates the severity of endotheliosis and the need for symptomatic metabolic treatment.

Conjunctival biomicroscopy in the diagnosis of microcirculatory disorders in systemic sclerosis: A new look at the “old” method

Microcirculatory (MC) disorders in systemic sclerosis (SS) are an important part of pathogenesis, morphogenesis, determine the clinical picture of the disease, the severity of the patient’s condition and prognosis. The authors draw attention to a direct method for studying microcirculatory disorders – conjunctival biomicroscopy (CBM). The use of improved equipment for conducting CBM and the survey algorithm allows at the present stage to improve the quality of the data obtained, to simplify and standardize the CBM procedure, to record and analyze new MC predictors.The study of the correlations between MC changes identified in CBM in patients with SS, with the data of the clinical picture, will make it possible to determine a limited set of the most significant MC parameters, simplify the analysis of primary CBM data and take a fresh look at the CBM method, rethinking its diagnostic capabilities SS, which determined the aim of this study.Materials and methods. In 48 patients suffering from SS (mean age 51±1.7 years), MC was studied by the direct method – conjunctival biomicroscopy. Quantitative parameters of MC are compared with the clinical manifestations of SS by the methods of linear Pearson correlation and Spearman non-linear correlation. The critical value of the level of statistical significance in testing null hypotheses was taken to be 0.05.Results. The main clinical manifestations of SS: the duration of the disease (months), skin count (points), the activity of the disease (points), the duration of skin syndrome (months) and the duration of vascular syndrome (months) showed statistically significant linear and non-linear correlation with seven MC parameters: the value of the arteriolo- to-venule ratio (AVR), five parameters characterizing the density of capillaries on the bulbar conjunctiva and the average diameter of capillaries.Conclusion. A limited set of the most informative MC signs in the form of AVR and the number of capillaries in various areas of the temporal section of the bulbar conjunctiva greatly simplify the interpretation of CBM data and allow a new look at the diagnostic capabilities of the “old” method in SS. A promising direction, in our opinion, is the further study of the indicated MC parameters and the identification of possible correlations with the data of laboratory, instrumental methods of research and assessment of the dynamics of the indicated MC parameters in case of SS.