A novel scraping cytology score system (SCSS) grades inflammation in dry eye patients

Longitudinal Changes of Ocular Surface Microbiome in Patients Undergoing Hemopoietic Stem Cell Transplant (HSCT)

PURPOSE

To evaluate changes in the ocular surface microbiome (OSM) between pre- and post-haemopoietic stem cell transplant (HSCT) in the same patient, and to assess the potential impact of these changes in ocular graft-versus-host disease (o)GVHD development.

METHODS

Lower fornix conjunctival swabs of 24 patients were obtained before and after HSCT and subjected to DNA extraction for amplification and sequencing of the V3-V4 regions of the bacterial 16S rRNA gene. The obtained reads were reconstructed, filtered, and clustered into zero-radius operational taxonomic units (zOTUs) at 97% identity level before taxonomic assignment, and biodiversity indexes were calculated. Transplant characteristics were recorded, and dry eye was diagnosed and staged 1-4 according to the Dry Eye WorkShop (DEWS) score.

RESULTS

No significant difference in OSM alpha diversity between pre- and post-transplant was found. A significant difference in beta diversity was observed between patients with a DEWS score of 1 versus 3 (p = 0.035). Increased corneal damage between pre- and post-HSCT was significantly associated with a decrease in alpha diversity. The changes in OSM were not associated with oGVHD, nor with any transplant parameter.

CONCLUSIONS

This preliminary study is the first study to analyse changes in the OSM before and after HSCT longitudinally. No trend in OSM biodiversity, microbial profile, or overall composition changes before and after HSCT was significant or associated with oGVHD onset. The great variability in the observed OSM profiles seems to suggest the absence of a patient-specific OSM "signature".

Comparison of five conjunctival cytology sampling methods in normal cat eyes

Background and Aim

Ophthalmological cytology is an easy, informative, rapid, and commonly-used low-cost diagnostic method, but sample collection and preparation are essential steps in obtaining qualitative material for cytological evaluation. This study aimed to evaluate cytological smear quality and animal discomfort after single or three serial conjunctival scrapings in normal cat eyes using five sampling methods.

Materials and Methods

Five cytology methods (mini brush, cotton swab, soft brush, Kimura spatula, and cytobrush) were used in 50 eyes (10 with one scraping and 10 with three consecutive scrapings for a particular method) in complete 25 clinically and ophthalmologically healthy cats of different ages, sexes, and breeds. Ocular discomfort (1 = eyes open, 2 = partially open, and 3 = eyes squinted), average cell count (ten 10× fields), cell distribution (ten 100× fields: 0 = all cells are aggregated, 1 = <25% cells are evenly distributed, 2 = 25-50% cells are evenly distributed, and 3 = >50% cells are evenly distributed) and sample quality - aggregates (two cells and more), mucus, and artifacts (1+ = fair, 2+ = moderate, and 3+ = high amount) were evaluated.

Results

The discomfort scores for the mini brush, cotton swab, soft brush, spatula, and cytobrush after a single and three scrapings were 1, 1, 1, 2, and 3, respectively. The average cell counts ± standard deviation after one and three scrapings were as follows: mini brush 11.15 ± 13.87 and 7.55 ± 12.7; cotton swab 7.17 ± 10.20 and 10.00 ± 16.44; soft brush 19.45 ± 22.22 and 8.55 ± 13.82; spatula 17.15 ± 32.94 and 13.85 ± 22.01; and cytobrush 13.35 ± 18.33 and 13.05 ± 19.29, respectively; the cell distributions were 3, 3, 3, 1, and 1 after single scraping and 3, 3, 2, 0, and 2 after three scrapings, respectively.

Conclusion

The mini brush was the optimal method since it produced less discomfort, fewer artifacts, and the highest smear quality. Spatula smears were difficult to evaluate due to material thickness. The highest mucus and aggregate amounts were found in cytobrush, cotton swab, and soft brush samples. In this study, small number of samples per each sampling method is a major limitation.

Ocular-surface temperature modification by cataract surgery

PURPOSE

To analyze ocular-surface temperature changes after microincision cataract surgery and to correlate them with surgical, clinical, and laboratory parameters.

SETTING

Ophthalmology Unit, Saint Orsola-Malpighi Hospital, Bologna, Italy.

DESIGN

Prospective case series.

METHODS

Patients affected by monolateral senile cataract were examined preoperatively and 7 days and 28 days postoperatively. Infrared thermography was used to measure the temperature soon after eye opening, the temperature after 10 seconds of sustained eye opening, and the difference between these 2 values in the central cornea, nasal limbus, and temporal limbus. The Ocular Surface Disease Index (OSDI), Schirmer test, vital staining, tear breakup time (TBUT), conjunctival scraping cytology, exudated tear-serum albumin, and laser flare-cell meter examinations were performed.

RESULTS

The study comprised 26 patients (10 men, 16 women). The temperature changed significantly after surgery. The temperature soon after eye opening showed cooling in the central cornea and nasal limbus and heating in the temporal limbus. The temperature after 10 seconds of sustained eye opening minus the temperature soon after eye opening increased in all regions. The temperature after 10 seconds of sustained eye opening minus the temperature soon after eye opening in the central cornea was inversely related to the OSDI and directly related to TBUT. The temperature soon after eye opening increased in the temporal limbus and was directly related to inflammatory indices.

CONCLUSIONS

The ocular-surface temperature changed after cataract surgery depending on the region analyzed. The cooling in the central cornea could be related to the increased tear-film instability. The heating in the temporal limbus could be related to postoperative inflammation.

FINANCIAL DISCLOSURE

None of the authors has a financial or proprietary interest in any material or method mentioned.

Predictive role of tear protein expression in the early diagnosis of Sjögren’s syndrome

Background

The contribution of tear protein expression in patients with presumed diagnosis of Sjögren syndrome is underestimated. We aimed to evaluate the role of tear proteins in the Sjögren syndrome early diagnosis.

Methods

Charts from 110 patients suspected of Sjögren syndrome were analysed and the subsequent diagnosis retrieved. Subjective symptoms (ocular surface disease index, OSDI), tear film break-up time (TFBUT), Schirmer test, Jones test, tear clearance (TC), corneal (NEI score) and conjunctival staining (van Bjerstelveldt score), esthesiometry, cytology, tear protein analysis (total protein [TP] content, lysozyme-C [LYS-C], lactoferrin [LACTO], lipocalin-1 [LIPOC-1] and albumin [ALB]) were analysed. The diagnostic performance with area under the curve (AUC) and odds ratio (OR) for each parameter were calculated.

Results

Thirty-five patients (31.8%) had been diagnosed as affected by Sjögren syndrome. Clinical tests showed lower diagnostic performance (OSDI > 44 [AUC 0.57], Schirmer ≤ 5 mm [0.59], TFBUT ≤ 3 s [0.72], TC > 1/16 [0.68], Jones ≤ 4 mm [0.68], corneal staining > 2 [0.51], conjunctival staining > 2 [0.78]) compared with tear proteins (LYS-C ≤ 1.5 mg/mL [0.79], LACTO ≤ 20% [0.94], LIPOC-1 ≤ 10% [0.89], ALB ≥ 15% [0.79]). LYS-C, LACTO, LIPOC-1 and ALB showed a significant association in predicting Sjögren syndrome vs. not-Sjögren syndrome dry eye (OR, respectively, 4.9, 5.5, 7.2, 6.7).

Conclusions

Tear proteins’ concentrations showed a significant higher accuracy compared with the traditional ocular clinical tests for reaching Sjögren syndrome’s diagnosis. In particular, LACTO and LIPOC-1 provided an excellent diagnostic performance and thus could likely be considered promising biomarkers of Sjögren syndrome.

Discomfort symptoms reduction and ocular surface parameters recovery with Artelac Rebalance treatment in mild-moderate dry eye

PURPOSE

To evaluate Artelac Rebalance® eyedrops' efficacy in symptoms reduction, ocular surface parameters recovery, and tolerability in the treatment of mild to moderate dry eye.

METHODS

Fifteen patients were enrolled. Inclusion criteria were Ocular Surface Disease Index (OSDI) score >16, tear film break-up time (TFBUT) <10 seconds, Schirmer test I >10 mm/5 min, and mild ocular surface damage (Oxford grading) ≤3. Artelac Rebalance® eyedrops were administered 3 times daily for 2 months. Patients were evaluated at enrollment, after 2 days of washout (baseline), and after 1 and 2 months of treatment. Parameters for ocular discomfort (OSDI score), tear film quality (Schirmer test I, TFBUT, tear osmolarity), ocular surface damage (fluorescein staining, conjunctival imprint cytology), and inflammation (scraping cytology and exuded serum albumin) were measured. Tolerability and satisfaction were assessed by validated questionnaires.

RESULTS

At endpoint versus baseline, all variables showed a statistically significant improvement (paired Student t test, p<0.01 for all parameters) as follows: OSDI score (21.9 ± 10.6 vs 35.8 ± 12.2), TFBUT (6.5 ± 1.1 s vs 5.2 ± 2.3 s), Oxford grading of corneal and conjunctival damage (0.56 ± 0.50 vs 1.16 ± 0.37), tear osmolarity (294.6 ± 2.1 mOsm/L vs 303.1 ± 4.6 mOsm/L), conjunctival goblet cell density/mm2 (140.8 ± 43.3 cells/mm2 vs 115.1 ± 15.8 cells/mm2), scraping cytology score (2.9 ± 1.0 vs 4.2 ± 1.3), and percentage of serum albumin in tears (9.2% ± 4.8% vs 24.1% ± 10.8%). Tolerability and satisfaction were scored high, with no adverse events reported.

CONCLUSIONS

Application of Artelac Rebalance® eyedrops for 2 months in mild to moderate dry eye resulted in a reduction of ocular inflammation parameters, ocular surface damage, and subjective discomfort symptoms, with a parallel improvement in tear film quality (measured by TFBUT and osmolarity).

Dry eye disease: an immune-mediated ocular surface disorder

Dry eye disease is a multifactorial disorder of the tears and ocular surface characterized by symptoms of dryness and irritation. Although the pathogenesis of dry eye disease is not fully understood, it is recognized that inflammation has a prominent role in the development and propagation of this debilitating condition. Factors that adversely affect tear film stability and osmolarity can induce ocular surface damage and initiate an inflammatory cascade that generates innate and adaptive immune responses. These immunoinflammatory responses lead to further ocular surface damage and the development of a self-perpetuating inflammatory cycle. Herein, we review the fundamental links between inflammation and dry eye disease and discuss the clinical implications of inflammation in disease management.

The economic burden of dry eye disease in the United States: a decision tree analysis

PURPOSE

The aim of this study was to estimate both the direct and indirect annual cost of managing dry eye disease (DED) in the United States from a societal and a payer's perspective.

METHODS

A decision analytic model was developed to estimate the annual cost for managing a cohort of patients with dry eye with differing severity of symptoms and treatment. The direct costs included ocular lubricants, cyclosporine, punctal plugs, physician visits, and nutritional supplements. The indirect costs were measured as the productivity loss because of absenteeism and presenteeism. The model was populated with data that were obtained from surveys that were completed by dry eye sufferers who were recruited from online databases. Sensitivity analyses were employed to evaluate the impact of changes in parameters on the estimation of costs. All costs were converted to 2008 US dollars.

RESULTS

Survey data were collected from 2171 respondents with DED. Our analysis indicated that the average annual cost of managing a patient with dry eye at $783 (variation, $757-$809) from the payers' perspective. When adjusted to the prevalence of DED nationwide, the overall burden of DED for the US healthcare system would be $3.84 billion. From a societal perspective, the average cost of managing DED was estimated to be $11,302 per patient and $55.4 billion to the US society overall.

CONCLUSIONS

DED poses a substantial economic burden on the payer and on the society. These findings may provide valuable information for health plans or employers regarding budget estimation.