Association of eosinophil granule major basic protein with atopic cataract

Lens capsule pathological characteristics in cases of intraocular lens dislocation with atopic dermatitis

PURPOSE

To explore lens capsule pathological characteristics in intraocular lens (IOL) dislocation after cataract surgery in patients with atopic dermatitis (AD).

SETTING

University hospital department of ophthalmology.

DESIGN

Case series with clinicopathological correlations.

METHODS

Lens capsules and surrounding tissues excised during surgery from eyes with AD (AD group) and eyes without AD (non-AD group) with IOL dislocation were histologically evaluated. Hematoxylin and eosin staining was used to assess abnormal changes in lens epithelial cells (LECs). Masson trichrome staining distinguished the fibrous metaplasia around the lens capsule into high-density and low-density fibrosis. Capsular splitting (thinning) was identified in both stained preparations.

RESULTS

The IOL dislocation morphology in the AD group (10 eyes of 10 patients) included 7 cases of capsular bag dislocation (CBD) and 3 cases of dead bag syndrome (DBS), with an average duration to IOL dislocation of 11.5 ± 5.6 years. All patients in the non-AD group (12 eyes of 12 patients) had CBD, averaging 10.2 ± 5.7 years to dislocation. Abnormal LECs, low-density fibrosis, and capsular splitting were observed in 9 (90), 9 (90), and 6 (60) of the patients in the AD group compared with 6 (50), 3 (25), and 2 (18), respectively, in the non-AD group (total n [%]).

CONCLUSIONS

Compared with the non-AD group, the AD group exhibited higher frequencies of morphological changes in LECs, low-density fibrosis around the lens capsule, and capsular splitting characteristics of DBS. These results suggest LEC degeneration and increased lens capsule fragility occurred in patients with AD.

Lens thickness in atopic cataract: case-control study

PURPOSE

To examine whether atopic cataracts are associated with thinner lenses.

SETTING

Department of Ophthalmology, Jikei University Hospital, Tokyo, Japan.

DESIGN

Retrospective matched case-control study.

METHODS

31 eyes with atopic cataracts, 62 with nonatopic cataracts, and 31 without cataracts were analyzed. Each group was matched for age (±4 years) and sex.

RESULTS

The mean lens thickness (LT) was 3.76 ± 0.40 mm, 3.94 ± 0.49 mm, and 4.11 ± 0.40 mm in eyes with atopic cataracts, nonatopic cataracts, and normal lenses, respectively. Repeated-measures analysis of variance showed that the LT in the atopic cataract group was significantly thinner than that in the nonatopic cataract ( P = .036) and normal lens ( P < .001) groups. In multivariate logistic regression analysis, a thinner LT was negatively correlated with age (odds ratio [OR], 0.91; 95% CI, 0.86-0.96) and positively correlated with anterior subcapsular cataract (ASC) (OR, 5.61; 95% CI, 1.97-15.99). Atopy was not a significant factor. 24 (38.7%) of the 62 eyes with nonatopic cataracts and 24 (77.4%) of the 31 eyes with atopic cataracts had ASC.

CONCLUSIONS

The lenses of eyes with atopic cataracts were thinner than those of controls. Atopic cataracts frequently present with anterior subcapsular opacity, which is associated with lens thinning.

Increased risk of cataract surgery in patients with allergic disease: a population based cohort study

We investigated the association between cataract and allergic diseases, including atopic dermatitis (AD), allergic rhinitis (AR), and asthma using 2,631,015 subjects' data from the 2009 National Health Insurance Service-Health Screening Cohort in Korea. Each allergic disease was defined as three or more occasions of diagnosis within 1 year with dedicated ICD-10 codes. The primary endpoint was newly received cataract surgery during the follow-up period. In total, 447,883 subjects had at least one allergic disease. During the mean follow-up of 7.8 ± 1.7 years, newly developed cataract surgery was observed in 301,693 subjects (allergic group, n = 69,321; non-allergic group, n = 232,372). After adjusting for demographic characteristics (age, sex), systemic and ocular comorbidities, socioeconomic status, and lifestyle factors (smoking, drinking, regular exercise), the allergic group had a higher hazard ratio (HR) for cataract development compared with the non-allergic group. We further performed a subgroup analysis for patients regarding sex and age. In the subgroup analysis of subjects with AD, men aged < 50 years had a higher HR compared to women of the same age group. In conclusion, subjects with allergic diseases had a higher risk of cataract surgery than their counterparts, and the combination of AD and AR resulted in the highest risk. Particularly, the association was more evident in male than female patients with AD aged < 50 years.

Association of Pediatric Atopic Dermatitis and Cataract Development and Surgery

Importance

There is a paucity of data addressing the risk of cataract development in pediatric patients with atopic dermatitis (AD).

Objective

To investigate the association of AD with subsequent cataract development and cataract surgery in a Korean pediatric population.

Design, Setting, and Participants

This population-based retrospective longitudinal cohort study used nationally representative data from the Korean National Health Insurance Service database from 2002 to 2013. Incident AD cases, consisting of patients younger than 20 years with AD and severe AD and were matched to 4 controls each using propensity score derived from age, sex, residential area, and household income.

Main Outcomes and Measures

Incidence probabilities of cataract development and cataract surgery between the AD group and controls were compared using Kaplan-Meier methods and log-rank tests. Cox proportional hazard models were fitted for cataract and cataract surgery to determine the risk factors in the matched cohort.

Results

Of 34 375 patients with incident AD (16 159 girls [47%]; mean [SD] age, 3.47 [4.96] years), there were 3734 severe AD cases (10.9%) with 137 500 matched controls. Development of cataracts was not different between the AD and control groups, (0.216% vs 0.227%; 95% CI, -0.041% to 0.063%; P = .32) or between the severe AD cohort and their controls (0.520% vs 0.276%; 95% CI, -0.073% to 0.561%; P = .06). Cataract surgery was performed more frequently in the AD cohort than in the control group (0.075% vs 0.041%; 95% CI, 0.017%-0.050%; P = .02) and in the severe AD cohort compared with their controls (0.221% vs 0.070%; 95% CI, 0.021%-0.279%; P = .03). Severe AD was associated with both development of cataract (adjusted hazard ratio, 1.94; 95% CI, 1.06-3.58, P = .03) and requirement for cataract surgery (adjusted hazard ratio, 5.48; 95% CI, 1.90-15.79, P = .002).

Conclusions and Relevance

Absolute risk of cataract was rare, with or without AD, even after 10 years of observation. However, our results suggest that pediatric patients with AD have an increased risk for cataracts requiring surgery and that disease severity may increase the risk for cataract development and cataract surgery.

Retinal Detachment Associated With Atopic Dermatitis

Ocular manifestations related to atopic dermatitis include keratoconus, keratoconjunctivitis, cataract, and retinal detachment. The authors report three cases of retinal detachment associated with atopic dermatitis. Although the pathogenesis is poorly understood, chronic blunt trauma may play a role in the development of retinal detachment. In addition, retinal detachments associated with atopic dermatitis may have lower rates of successful retinal detachment repair. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:513-517.].

Intraocular lens implantation after atopic cataract surgery decreases incidence of postoperative retinal detachment

PURPOSE

To investigate the efficacy of intraocular lens (IOL) implantation in reducing the incidence of postoperative retinal detachment after cataract surgery in patients with atopic dermatitis.

DESIGN

Retrospective review.

PARTICIPANTS

One hundred sixty-nine eyes of 126 patients who underwent cataract surgery for atopic cataract were followed for more than 1 year. None of the eyes previously had a retinal detachment or retinal detachment surgery.

METHODS

The eyes were divided into 132 eyes of 95 patients with an IOL implantation (IOL group) and 37 eyes of 31 patients without an IOL implantation (aphakia group). The postoperative visual acuity and incidence of postoperative retinal detachment were compared between the 2 groups. The effects of the location of the causative retinal breaks, intraoperative posterior capsule rupture, and postoperative posterior capsulotomy on the incidence of retinal detachments were evaluated.

MAIN OUTCOME MEASURES

The postoperative corrected visual acuity, incidence of postoperative retinal detachment, and influence of intraoperative posterior capsule rupture on the retinal detachment.

RESULTS

The final visual acuity was better than or equal to 20/20 in 128 eyes (97.0%) of the IOL group and in 29 eyes (78.4%) of the aphakia group (P = 0.0007). Retinal detachment after an uncomplicated cataract surgery occurred in 3 eyes (2.3%) of the IOL group and in 8 eyes (25.8%) of the aphakia group (P<0.0001, Mantel-Cox). Two of 3 eyes (66.7%) in the IOL group and 1 of 8 eyes (16.7%) in the aphakia group that later developed a retinal detachment had an intraoperative posterior capsule rupture. Posterior capsulotomy by yttrium-aluminum-garnet laser did not seem to alter the incidence of postoperative retinal detachment in either the IOL (2.0%) or the aphakia group (25.0%).

CONCLUSIONS

The rate of postoperative retinal detachment in eyes with IOL and no intraoperative posterior capsule rupture seems to be low. Intraocular lens implantation with capsular bag fixation may reduce the incidence of postoperative retinal detachment triggered by lens surgery for atopic cataract.

[Ocular allergies]

Recent developments indicate that ocular allergy is more than an IgE-mediated allergic conjunctivitis. Ocular allergy is a disease affecting the entire ocular surface including conjunctiva, lids, cornea, lacrimal gland and tear film. Besides an IgE-mediated reaction, a complex chronic inflammation is involved in the pathogenesis of many ocular allergies. According to their pathogenesis and clinical picture, ocular allergies are classified into mild forms, such as seasonal and perennial allergic conjunctivitis as well as giant papillary conjunctivitis, and chronic, potentially blinding forms such as atopic keratoconjunctivitis and vernal keratoconjunctivitis. New therapeutics act on the entire inflammatory process or try to modulate the allergic reaction early and specifically. The association with non-ocular allergic symptoms requires an interdisciplinary approach.

Expression of protein gene product 9.5 in the anterior lens epithelial cells of atopic cataracts

PURPOSE

To investigate the mechanisms of atopic cataract by immunohistochemically observing protein gene product 9.5 in lens epithelial cells (LECs) of atopic cataracts.

SETTING

Departments of Ophthalmology and Anatomy, Shiga University of Medical Science, Shiga, Japan.

METHODS

Specimens of anterior capsule obtained from 6 patients with atopic cataract and 8 patients with senile cataract were stained immunohistochemically and examined by light, electron, and confocal microscopy.

RESULTS

In the LECs of the atopic cataracts, the arrangement and cell shape were varied. Immunohistochemistry for protein gene product 9.5 demonstrated selective localization, unlike with senile cataracts. This was especially prevalent in the spindle-shaped cells around the central opaque lesion. Protein gene product 9.5 positive cells overlapped with major basic protein positive cells in the atopic cataracts.

CONCLUSIONS

The results indicate that the properties of LECs of atopic cataracts are different from those of senile cataracts. Protein gene product 9.5 and major basic protein seem to be concentrated in atopic cataracts.

Chronic cicatrizing conjunctivitis

Conjunctival fibrosis may result from chronic inflammation and may lead to alterations of conjunctival architecture. This results in ocular dryness, entropion and trichiasis, and corneal complications. Causes of conjunctival cicatrization are not limited to autoimmune diseases, such as ocular cicatricial pemphigoid, a severe disease associated with poor ocular prognosis. Other well-known causes include thermal and chemical burns, postinfectious conjunctivitis, and Stevens-Johnson syndrome. Ocular rosacea and atopic keratoconjunctivitis often are underdiagnosed causes of conjunctival fibrosis. Medical history, physical exam, and laboratory tests often allow for diagnosis of the underlying disease. Medical management varies according to specific causes, and many surgical strategies are available to restore corneal transparency and normal palpebral architecture.

Cataract and retinal detachment in patients with severe atopic dermatitis who were withdrawn from the use of topical corticosteroid

Many patients with severe atopic dermatitis (AD) in Japan are afflicted with persistent erythema of the face (atopic red face) that is not only resistant to topical corticosteroid, but often becomes worse with its use. During a three-year period (1991-1993), we treated 79 inpatients with severe AD by a combination of careful daily skin care, use of emollients, and exclusion of exacerbating factors. Occular complications before and after treatment were examined in these cases. After withdrawal of topical corticosteroid, almost all of the patients showed a temporary worsening of their skin condition. Immediately thereafter, their occular symptoms did not change. Cataract was found in 20 cases (25.3%), and retinal detachment in 9 (11.4%). After 2 months, 11 cases of cataract and 5 cases of retinal detachment in the peripheral retina were observed. However, these incidences were similar to the numbers reported in Japan during conventional treatment with topical corticosteroid. The development of cataract or retinal detachment had no relationship to serum IgE levels, personal history of respiratory atopy, the duration of topical corticosteroid use on the face, or treatment with systemic corticosteroid. Our observations suggest that patients who habitually tap or rub their faces strongly tend to develop cataract or retinal detachment at a statistically significant higher frequency. Patients with AD should have ophthalmologic examinations every one to two months for at least one year after a facial oozing attack or withdrawal of corticosteroid.