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Surface Disease (surface + disease)

Distribution by Scientific Domains

Medical Sciences	100%

Kinds of Surface Disease

ocular surface disease

Selected Abstracts

3445: Evaluation, diagnosis and grading of severity of MGD

ACTA OPHTHALMOLOGICA, Issue 2010
AJ BRON
Purpose To evaluate current diagnostic tests and make future recommendations. Methods An evidence-based review of procedures. Results MGD is a common symptomatic disorder leading to associated ocular surface disease including evaporative dry eye. A two stage diagnostic approach is recommended including an assessment of meibomian function based on lid morphology, gland mass, expressibility, lipid layer appearance and tear evaporation. A diagnosis of dry eye is based on measures of tear production and clearance, tear osmolarity, tear film stability and the presence of ocular surface changes revealed by tissue staining and inflammatory biomarkers. Quantification of MGD depends on grading meibum quality and expressibility. Newer, quantitative methods will make grading more accurate in the future and include quantitative meibomian expression, non-invasive meibography, confocal microscopy, video-interferometry and the use of inflammatory biomarkers. Meibomian gland dropout can be to monitor and stratify MGD in clinical trials. Conclusion A provisional severity rating of MGD and MGD-related disease has been proposed as a guide to the selection of treatment and the monitoring of disease progression. [source]

4232: OOKP protocol update

ACTA OPHTHALMOLOGICA, Issue 2010
FC LAM
Purpose The OOKP remains the procedure of choice for restoring sight in patients with corneal blindness caused by end-stage ocular surface disease not amenable to cadaveric keratoplasty. Falcinelli's modifications of Strampelli's technique of OOKP surgery remains the gold standard for its excellent visual and keratoprosthesis-retention results. To maintain good outcomes, aid research and to maintain standards, it is important that benchmarks are maintained in patient selection and preoperative assessment, surgical technique and post-operative care. We therefore present, for discussion, the updated protocol that is currently used in the British National OOKP Referral Centre at the Sussex Eye Hospital, Brighton. Methods Members of the OOKP Study Group met in Rome, Italy in 2001 and Vienna, Austria in 2002 to produce and up-to-date standard and protocol. Since then, we have continued to update our protocol on the basis of our own outcomes and findings. We present our updated protocol for discussion and for use in other OOKP centres. Results Our updated protocol includes a discussion on the indications and contraindications for surgery, criteria for patient selection, surgical technique, routine postoperative care, and the recognition and management of postoperative complications. Conclusion 5 years have passed since the standards for modified OOKP surgery were published. This paper highlights changes to this standard resulting from our practice in our national OOKP centre. [source]

4233: Outcomes of the Boston Keratoprosthesis Type II

ACTA OPHTHALMOLOGICA, Issue 2010
J CHODOSH
Purpose To report the long term outcomes of Boston keratoprosthesis type II implantation in the management of severe ocular surface disease and corneal blindness. Methods A retrospective review of medical records of patients after Boston keratoprosthesis type II implantation at the Massachusetts Eye and Ear Infirmary from January, 1, 2000 through December 31, 2009. Main outcome measures included visual acuity, device retention, and postoperative complications. Results A total of 29 eyes of 26 patients received a Boston keratoprosthesis type II during the study period. Operated patients had corneal blindness due to mucous membrane pemphigoid (51.7%), Stevens Johnson syndrome/toxic epidermal necrolysis (41.4%), or other ocular surface disease (6.9%). Visual acuity after surgery improved to at least 20/200 in 23 eyes (79.3%), and to 20/30 or better in 10 eyes (34.5%). In patients with at least 1 year of follow-up (n=21), visual acuity of 20/200 or better was maintained in 14 eyes (66.7%). Of these 14 eyes, 6 eyes (42.9%) retained visual acuity of 20/200 or better for more than 5 years. Overall, visual acuity of 20/200 or better was maintained for at least 5 years in 6 of 23 eyes (26.0%). Eyes that failed to improve to 20/200 or lost vision during follow-up were found to have end stage glaucoma, previous retinal detachment, or age related macular degeneration. Of the total of 29 eyes, 17 devices (58.6%) were retained without extrusion or replacement during a total follow-up time of 107.9 person-years. Conclusion The Boston keratoprosthesis type II is a viable option for corneal blindness from severe autoimmune ocular surface diseases. Complications require prompt recognition and management to promote retention of the device and preservation of vision. [source]

3222: New developments in dry eye treatment

ACTA OPHTHALMOLOGICA, Issue 2010
JM BENITEZ-DEL-CASTILLO
Purpose This study summarizes the management and therapeutic options for treating dry eye disease. Goals of this review is to identify appropriate therapeutic methods for the management of dry eye disease and recommend a sequence or strategy for their application, based on evidence-based review of the literature. Methods To achieve this a comprehensive review of clinical textbooks and scientific literature was performed and the quality of published evidence graded according to an agreed standard, using objective criteria for clinical and basic research studies. Results There have been tremendous advances in the treatment of dry eye and ocular surface disease in the last decades related to the increase in knowledge regarding the pathophysiology of dry eye. This has led to a paradigm shift in dry eye management from simply lubricating and hydrating the ocular surface with arti,cial tears to strategies that stimulate natural production of tear constituents, maintain ocular surface epithelial barrier function, and inhibit the in,ammatory factors that adversely impact the ability of ocular surface and glandular epithelia to produce tears. Conclusion The authors will present current and future treatment options for dry eye disease. [source]

3223: Dry eye syndrome and omega-3 fatty acids

ACTA OPHTHALMOLOGICA, Issue 2010
T KAERCHER
Purpose Dry eye disease is characterized by an inflammatory component of the ocular surface. Pathways to modulate inflammation include corticoids and cyclosporine. Omega-3 fatty acids like eicosapentaenoic acid and docosahexaenoic acid represent an alternate pharmacologic way to influence the inflammatory cascade. Methods Clinical studies. Results An epidemiologic study in 32.470 healthy women showed that those with a higher intake of omega-3 fatty acids had a 68% decreased prevalence of dry eye syndrome. Hyposecretory dry eye was tested after intake of omega-3 fatty acids for 45 days. Symptoms, signs and inflammatory markers like HLA-DR improved. Hyperevaporative dry eye improved after a long-term supplementation with omega-3 fatty acids with respect to symptoms, break-up time and meibom score. Patients with refractive surgery (PRK) improved after omega-3 fatty acids intake; this was derived from the OSDI-score, Schirmer I test and tear clearance. In 102 contact-lens wearers the symptoms and signs of dry eye improved after 12 weeks therapy with omega-3 fatty acids. Conclusion Nutricionals with omega-3 fatty acids show evidence-based effects on the inflammatory component of ocular surface disease and tear film disorder. Their beneficial effect was tested for hypovolemic and hyperevaporative dry eye. Patients after refractive surgery and contact lens wearers improved after supplementation, too. In contrast to the available anti-inflammatory therapy the supplementation is apt for a long-term application. [source]

2434: Alterations of the lid wiper zone in ocular surface disease

ACTA OPHTHALMOLOGICA, Issue 2010
J NEPP
Purpose The marginal part of the tarsal conjunctiva forms a lid wiper structure that wipes the ocular surface and distributes the tear film during the blink. It was attempted to investigate whether this region of the upper and lower lid shows specific changes in several kinds of ocular surface diseases. Methods 44 eyes of patients from the outdoor department of the university eye clinic Vienna were observed by slit lamp investigation of the ocular surface, vital staining with fluorescein and lissamin green. It was focused on evaluation of the tarsal conjunctiva including the lid margin and the wiper. Vessel dilatation, teleangiectatic changes and vital staining were each designed in three stages. The patients suffered from inflammation or affections of the lid, the conjunctiva and the cornea including chemical burns, graft versus host disease and injuries Results Compared to normal eyes dilatation of vessels and staining was observed more in patents with inflammations but although in serious affections like chemical burn or injuries. Even in corneal affections changes of vessels were observed. Conclusion Changes of the wiper can be observed in several diseases of the ocular surface and may be a sign of strain in this region. [source]

An epidemiologic analysis of staphylococcus aureus-associated keratitis in Boston

ACTA OPHTHALMOLOGICA, Issue 2009
I BEHLAU
Purpose S. aureus is a normal commensal of the human skin and nasopharynx. It is therefore of interest to determine whether S. aureus keratitis is caused by a subset of these organisms. In this study, the phenotypic and genotypic characteristics of S.aureus keratitis isolates were analyzed. Methods All S. aureus clinical isolates were prospectively collected over a 24 month period at the MEEI (2006-2008). The diagnosis of clinical keratitis and associated risk factors was by medical record review. Keratitis-associated S. aureus strains were assessed for: 1) antibiotic susceptibility, 2) biofilm robustness by gentian violet staining using an in vitro microtiter plate assay, and 3) genetic lineage by multi-locus sequence typing (MLST). Results 26 cases of keratitis were identified from the 600 S. aureus clinical isolates. Risk factors associated with S.aureus keratitis included trauma, prior surgery, soft contact lens wear, and the presence of a foreign body. Ocular surface disease does not appear to be an independent risk factor. All 26 isolates were tetracycline- and trimethoprim-sulfamethoxazole- sensitive. All the MRSA strains were found to be ciprofloxacin-resistant (10/26). Nearly one-half of all the S.aureus keratitis-associated isolates were caused by a single clone, ST5. Both methicillin sensitive and resistant S. aureus strains were represented within ST5. Conclusion These results suggest that there may be specific S.aureus lineages which possess phenotypic and genotypic characteristics that enable S. aureus to more effectively cause sight-threatening keratitis. Future work will examine their virulence traits and a comparison to commensal S.aureus strains. [source]

Zonal differentiation of the epithelium including the lid wiper at the human lid margin

ACTA OPHTHALMOLOGICA, Issue 2008
E KNOP
Purpose The lid margin represent the "other end" of the tear film and appear critically important for ocular surface integrity, in addition to the glandular structures that produce the tears. It guarantees the thin expansion of the tear film with every blink and prevents the leakage of tears over the lid border. However, the differentiation of the lid margin zones is insufficiently known as yet. Methods The upper and lower lid margin in human whole-mount specimens from ten body donors was investigated in serial section histology and compared to the image by in-vivo confocal microscopy in four eyes with a Heidelberg retina tomograph and Rostock cornea module (RLSM). Results At the inner lid border, following the keratinised epidermis of the free lid margin, a narrow zone (100-150µm) of para-keratinised squamous epithelium represented the muco-cutaneous junction (MCJ) corresponding to the line of Marx. This was followed by a much broader zone of epithelial thickening (50-100µm) that formed a kind of cushion, reclined sharply at the inner lid border and represented the so called lid wiper which extended for about 1mm and finally transformed into the epithelium of the sub-tarsal fold. MCJ and lid wiper extended all along the lid margin from nasal to temporal in upper and lower lid. Details of the epithelial structure as well as the underlying dermal papillae in these zones were also detectable by RLSM. Conclusion Due to its location and structure, the lid wiper appears as the structure that actually spreads the tear film and is distinct from the MCJ/line of Marx. Better knowledge of the lid margin structure and its different zones appears important for the understanding of ocular surface disease, in particular the dry eye disease. [source]

Alterations of the ocular surface epithelial mucins 1, 2, 4 and the tear functions in patients with atopic keratoconjunctivitis

CLINICAL & EXPERIMENTAL ALLERGY, Issue 12 2006
M. Dogru
Summary Background An increased understanding of the ocular surface alterations at the cellular level in the conjunctiva and the cornea, may help explain the pathogenesis and the subsequent clinical appearance of atopic ocular allergies, which may be potentially blinding. Purpose To investigate MUC 1, 2 and 4 alterations, tear function and the ocular surface disorder in patients with atopic keratoconjunctivitis. Methods Twenty-eight eyes of 14 atopic keratoconjunctivitis patients as well as 22 eyes of 11 age-and sex-matched normal subjects were studied. The subjects underwent corneal sensitivity measurements, Schirmer's test, tear film break-up time (BUT), fluorescein and Rose Bengal staining of the ocular surface, conjunctival impression cytology and brush cytology. Impression cytology samples underwent periodic acid-Schiff and immunohistochemical staining with MUC 1, 2 and 4 antibodies. Brush cytology specimens underwent evaluation for inflammatory cell numbers and quantitative real-time-PCR for MUC 1, 2 and 4 mRNA expression. Patient eyes with fluorescein and Rose Bengal scores greater than four points were regarded to have significant epithelial disease in this study. Results The mean corneal sensitivity and BUT values were significantly lower in atopic patients with significant epithelial disease, compared with patients with insignificant epithelial disease and controls (P<0.01). Brush cytology specimens from patients with significant epithelial disease revealed significantly higher numbers of inflammatory cells (P<0.01). Specimens from patient eyes showed positive staining for MUC 1, 2 and 4. MUC 1, 2 and 4 mRNA expressions were significantly higher in eyes with significant epithelial disease compared with eyes with insignificant epithelial disease and eyes of control subjects. Conclusion Ocular surface inflammation, decline in corneal sensitivity, tear film instability, changes in conjunctival epithelial MUC 1, 2 and 4 mRNA expressions were thought to be important in the pathogenesis of atopic ocular surface disease. [source]

Low molecular weight analysis of tears using matrix assisted laser desorption ionization-time of flight mass spectrometry

CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 3 2000
Irene Mulvenna BSc
ABSTRACT Many low molecular weight substances in human tears, including protein and lipid species, have yet to be characterized. Some of these uncharacterized substances may well be important in the pathogenesis of ocular surface disease or in ocular discomfort. The aim of this study was to build a biochemical profile of low molecular weight species in tears, and to determine its repeatability. A total of 80 tear samples were collected from 11 subjects. Tear samples were dialysed to remove salts, added to a matrix of ,-cyano-4- hydroxycinnamic acid, and analysed using matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry. Species were separated based on their mass to charge ratio (m : z). The repeatability of the appearance of the different species was analysed using logistic regression and diurnal and day-to-day repeatability were ascertained. Peptides were identified in the range of 848,3897 Da. Of these, 39 peptides were found to be present in more than 10 / 80 samples. There was no diurnal variation in the peptides. All species were found to occur repeatably, with the exception of peptide 1653 Da. This study has demonstrated that the majority of low molecular weight species in tears are repeatably present and do not exhibit diurnal variation. Further study aims to characterize these species and to identify changes in tear profiles between subject groups. [source]

4233: Outcomes of the Boston Keratoprosthesis Type II

2434: Alterations of the lid wiper zone in ocular surface disease

In vivo confocal microscopic evaluation of inflammatory changes in the ocular surface

ACTA OPHTHALMOLOGICA, Issue 2009
A LABBE
Purpose The ocular surface constitutes a complex physiopathological and anatomical entity assuring the barrier between the outside world and the fragile ocular structures. Ophthalmic instruments such as the slit lamp, which magnifies approximately 40 times, cannot provide details of the corneal structures at the cellular level. Methods In vivo confocal microscopy using the HRT Rostock Cornea module® (HRT / RCM) provides better resolution and therefore outlines distinctively in vivo inflammatory changes occurring in the ocular surface. Results In vivo confocal microscopy is capable of providing corneal, conjunctival and limbal cellular details in different ocular surface diseases such as dry eye, infectious keratitis, toxic keratitis, corneal intraepithelial neoplasia or vernal keratoconjunctivitis. Conclusion In correlation with ex vivo impression cytology analysis, in vivo confocal microscopy constitutes an interesting aid in the diagnosis and management of complex ocular surface conditions. [source]

How do we get started with offering MOOKP clinical service?

ACTA OPHTHALMOLOGICA, Issue 2009
M FUKUDA
Modified osteo-odonto keratoprosthesis (MOOKP) is complicated two step surgery. Firstly, we must understand why it is effective for visual recovery of end-stage ocular surface diseases like Stevens- Johnson syndrome. MOOKP have a lot of advantages compared to other K-pros, for example the using auto tissue of canine tooth root and buccal mucous membrane, the tight adhesions between optical cylinder and canine tooth root, the adhesion between MOOKP lamina and sclera or cornea, the strong ocular surface by auto buccal mucous membrane, no inflammation on the back of optical cylinder and so on. However, the precise surgical techniques and proper instructions are necessary to succeed the very first case in newly set surgical center. In Japan, we successfully set up the MOOKP center and did perform 4 cases of MOOKP since 2003. We share our experience about it and point out our modification adjustable for Japanese patients. [source]