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Görlitz M, Justen L, Rochette PJ, Buonanno M, Welch D, Kleiman NJ, Eadie E, Kaidzu S, Bradshaw WJ, Javorsky E, Cridland N, Galor A, Guttmann M, Meinke MC, Schleusener J, Jensen P, Söderberg P, Yamano N, Nishigori C, O'Mahoney P, Manstein D, Croft R, Cole C, de Gruijl FR, Forbes PD, Trokel S, Marshall J, Brenner DJ, Sliney D, Esvelt K. Assessing the safety of new germicidal far-UVC technologies. Photochem Photobiol 2024; 100:501-520. [PMID: 37929787 DOI: 10.1111/php.13866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023]
Abstract
The COVID-19 pandemic underscored the crucial importance of enhanced indoor air quality control measures to mitigate the spread of respiratory pathogens. Far-UVC is a type of germicidal ultraviolet technology, with wavelengths between 200 and 235 nm, that has emerged as a highly promising approach for indoor air disinfection. Due to its enhanced safety compared to conventional 254 nm upper-room germicidal systems, far-UVC allows for whole-room direct exposure of occupied spaces, potentially offering greater efficacy, since the total room air is constantly treated. While current evidence supports using far-UVC systems within existing guidelines, understanding the upper safety limit is critical to maximizing its effectiveness, particularly for the acute phase of a pandemic or epidemic when greater protection may be needed. This review article summarizes the substantial present knowledge on far-UVC safety regarding skin and eye exposure and highlights research priorities to discern the maximum exposure levels that avoid adverse effects. We advocate for comprehensive safety studies that explore potential mechanisms of harm, generate action spectra for crucial biological effects and conduct high-dose, long-term exposure trials. Such rigorous scientific investigation will be key to determining safe and effective levels for far-UVC deployment in indoor environments, contributing significantly to future pandemic preparedness and response.
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Affiliation(s)
- Maximilian Görlitz
- Massachusetts Institute of Technology, Media Lab, Cambridge, Massachusetts, USA
- SecureBio, Inc., Cambridge, Massachusetts, USA
| | - Lennart Justen
- Massachusetts Institute of Technology, Media Lab, Cambridge, Massachusetts, USA
- SecureBio, Inc., Cambridge, Massachusetts, USA
| | - Patrick J Rochette
- Centre de recherche du CHU de Québec-Université Laval, Axe Médecine Régénératrice Quebec, Quebec City, Quebec, Canada
| | - Manuela Buonanno
- Center for Radiological Research, Columbia University Medical Center, New York City, New York, USA
| | - David Welch
- Center for Radiological Research, Columbia University Medical Center, New York City, New York, USA
| | - Norman J Kleiman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Ewan Eadie
- Photobiology Unit, Ninewells Hospital, Dundee, UK
| | - Sachiko Kaidzu
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan
| | - William J Bradshaw
- Massachusetts Institute of Technology, Media Lab, Cambridge, Massachusetts, USA
- SecureBio, Inc., Cambridge, Massachusetts, USA
| | - Emilia Javorsky
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, Massachusetts, USA
- Future of Life Institute, Cambridge, Massachusetts, USA
| | - Nigel Cridland
- Radiation, Chemicals and Environment Directorate, UK Health Security Agency, Didcot, UK
| | - Anat Galor
- Miami Veterans Affairs Medical Center, University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, USA
| | | | - Martina C Meinke
- Department of Dermatology, Venerology and Allergology, Center of Experimental and Applied Cutaneous Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Schleusener
- Department of Dermatology, Venerology and Allergology, Center of Experimental and Applied Cutaneous Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Paul Jensen
- Final Approach Inc., Port Orange, Florida, USA
| | - Per Söderberg
- Ophthalmology, Department of Surgical Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Nozomi Yamano
- Division of Dermatology, Department of Internal Related, Kobe University, Kobe, Japan
| | - Chikako Nishigori
- Division of Dermatology, Department of Internal Related, Kobe University, Kobe, Japan
- Japanese Red Cross Hyogo Blood Center, Kobe, Japan
| | - Paul O'Mahoney
- Optical Radiation Effects, UK Health Security Agency, Chilton, UK
| | - Dieter Manstein
- Department of Dermatology, Cutaneous Biology Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rodney Croft
- International Commission on Non-Ionizing Radiation Protection (ICNIRP), Chair, Wollongong, New South Wales, Australia
- University of Wollongong, Wollongong, New South Wales, Australia
| | - Curtis Cole
- Sun & Skin Consulting LLC, New Holland, Pennsylvania, USA
| | - Frank R de Gruijl
- Department of Dermatology, Universiteit Leiden, Leiden, South Holland, The Netherlands
| | | | - Stephen Trokel
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - John Marshall
- Institute of Ophthalmology, University College London, London, UK
| | - David J Brenner
- Center for Radiological Research, Columbia University Medical Center, New York City, New York, USA
| | - David Sliney
- IES Photobiology Committee, Chair, Fallston, Maryland, USA
- Consulting Medical Physicist, Fallston, Maryland, USA
| | - Kevin Esvelt
- Massachusetts Institute of Technology, Media Lab, Cambridge, Massachusetts, USA
- SecureBio, Inc., Cambridge, Massachusetts, USA
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Lee BWH, Ip MH, Tat L, Chen H, Coroneo MT. Modified Limbal-Conjunctival Autograft Surgical Technique: Long-Term Results of Recurrence and Complications. Cornea 2023; 42:1320-1326. [PMID: 37433157 DOI: 10.1097/ico.0000000000003337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/22/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE The aim of this study was to report the recurrence and complication rates of a modified limbal-conjunctival autograft surgical technique for pterygium excision. METHODS This was a retrospective, single-surgeon, single-operating environment, consecutive case series of 176 eyes in 163 patients with a biopsy-proven diagnosis of pterygium. All patients underwent excision using a 23-gauge needle to "behead" the pterygium head, followed by a limbal-conjunctival autograft including ∼50% of the palisades of Vogt. Outcomes measured included recurrence, defined as any conjunctival fibrovascular growth, and complication rates. Correlations between preoperative patient characteristics, pterygium morphology, and intraoperative factors (width of corneal extension, conjunctival defect, and graft) with postoperative recurrence were examined using logistic regression models. RESULTS The median age was 59.5 years and 122 eyes (69.3%) had primary pterygium (type I: 17%, II: 37.5%, and III: 45.5%). Kaplan-Meier analysis demonstrated the median pterygium-free follow-up period to be 723 days (range 46-7230 days). Recurrence was observed in 3 eyes of 2 patients (1.7%). No postoperative graft-related complications were observed. Postoperative symptomatology was transient. Age demonstrated a negative correlation with recurrence (odds ratio 0.888, 95% CI, 0.789-0.998, P = 0.046). However, no other correlations with preoperative or intraoperative factors, including whether pterygium was primary or recurrent, were identified (all P > 0.05). CONCLUSIONS This modified limbal-conjunctival autograft technique represents an effective alternative that offers a very low recurrence rate and avoids extensive dissection or antimetabolites, with minimal complications and transient postoperative symptomatology, over a long-term follow-up period. This technique is relatively simple and successful for both primary and recurrent pterygia. Future comparative studies with other surgical techniques may determine which are superior.
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Affiliation(s)
- Brendon W H Lee
- Department of Ophthalmology, Prince of Wales Hospital, Randwick, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Kensington, Sydney, New South Wales, Australia; and
- Ophthalmic Surgeons, Randwick, Sydney, New South Wales, Australia
| | - Matthew H Ip
- Department of Ophthalmology, Prince of Wales Hospital, Randwick, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Kensington, Sydney, New South Wales, Australia; and
- Ophthalmic Surgeons, Randwick, Sydney, New South Wales, Australia
| | - Lien Tat
- Ophthalmic Surgeons, Randwick, Sydney, New South Wales, Australia
| | - Helen Chen
- Ophthalmic Surgeons, Randwick, Sydney, New South Wales, Australia
| | - Minas T Coroneo
- Department of Ophthalmology, Prince of Wales Hospital, Randwick, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Kensington, Sydney, New South Wales, Australia; and
- Ophthalmic Surgeons, Randwick, Sydney, New South Wales, Australia
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Rajasingam P, Shaw A, Davis B, Alonso-Caneiro D, Hamwood J, Collins M. The association between conjunctival and scleral thickness and ocular surface ultraviolet autofluorescence. Sci Rep 2023; 13:7931. [PMID: 37193731 DOI: 10.1038/s41598-023-35062-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/11/2023] [Indexed: 05/18/2023] Open
Abstract
Ultraviolet autofluorescence (UVAF) imaging is used to visualise ocular surface changes due to sunlight exposure and so is considered to be a biomarker for UV damage. The conjunctival and scleral thicknesses of participants with and without ocular surface UVAF were measured to examine the UVAF associated tissue thicknesses. The presence of UVAF on the ocular surface was associated with significant differences in tissue thickness including thinner conjunctival epitheliums and thicker scleras but predominantly thickening of the conjunctival stroma. Participants were also classified into four groups according to the presence and absence of UVAF on both the temporal and nasal conjunctivas. It was noted that for those that had only nasal UVAF, the temporal conjunctival stroma was significantly thicker even without the presence of UVAF. Some participants with temporal UVAF had signs of pinguecula observed with slit lamp examination and some had OCT SLO enface imaging darkening. These findings highlight the potential of techniques other than slit lamp examination, including tissue thickness measurement and UVAF photography, in the detection of early UV-related changes to the ocular surface.
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Affiliation(s)
- Pryntha Rajasingam
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
| | - Alyra Shaw
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia.
| | - Brett Davis
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
| | - David Alonso-Caneiro
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
| | - Jared Hamwood
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
| | - Michael Collins
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
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Yoon CH, Seol BR, Choi HJ. Effect of pterygium on corneal astigmatism, irregularity and higher-order aberrations: a comparative study with normal fellow eyes. Sci Rep 2023; 13:7328. [PMID: 37147412 PMCID: PMC10163024 DOI: 10.1038/s41598-023-34466-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/30/2023] [Indexed: 05/07/2023] Open
Abstract
Pterygium is an abnormal growth of fibrous conjunctival tissue that invades the cornea, resulting in corneal distortion, astigmatism, and increased higher-order aberrations (HOAs). However, few studies have compared eyes with pterygium to normal fellow eyes when interpreting HOAs and there is no study that revealed the effect of the thickness or grading of the pterygium on the change of HOAs. Therefore, we evaluated the effects of nasal pterygium by comparing the normal fellow eye of 59 patients. The pterygium significantly increased with-the-rule corneal astigmatism and corneal irregularity. Trefoils, horizontal coma, and quatrefoils were significantly induced by the pterygium. The grading of the pterygium was not correlated with its characteristics except for the thickness. In multiple linear regression analysis, pterygium-induced corneal astigmatic/irregularity values and horizontal trefoil/quatrefoil were associated with the area of the pterygium. The length of the pterygium was an independent inducer of oblique trefoil/quatrefoil, while horizontal coma was independently associated with both its length and width. The thickness was not correlated with any optical parameters. Together, the results demonstrate that nasal pterygium significantly induces corneal astigmatism, irregularity and some HOAs. These pterygium-associated changes in optical parameters could be predicted by the length, width and area of the pterygium.
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Affiliation(s)
- Chang Ho Yoon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
| | - Bo Ram Seol
- Department of Ophthalmology, VHS (Veterans Health Service) Medical Center, Seoul, South Korea
| | - Hyuk Jin Choi
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea.
- Department of Ophthalmology, Seoul National University Hospital Healthcare System Gangnam Center, 39th Fl., Gangnam Finance Center, 152 Teheran-ro, Gangnam-gu, Seoul, 06236, South Korea.
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He MX, Zhang JF, Yang L, Qin B, Gu HW, Tang QY, Guan HJ, Shi HH. Doxycycline Suppresses Vasculogenic Mimicry in Human Pterygium Fibroblasts. Curr Eye Res 2022; 47:1381-1388. [PMID: 35923150 DOI: 10.1080/02713683.2022.2108455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To explore the effect of doxycycline on vasculogenic mimicry (VM) formation and the potential mechanism in human pterygium fibroblasts in order to find novel targets for pterygium therapy. METHODS First, we demonstrate the existence of VM in 73 pterygium specimens by CD31 and periodic acid Schiff (PAS) dual staining. Then we used cell counting kit-8, clone formation assay and flow cytometry to prove the inhibitory effect of doxycycline on cell proliferation and apoptosis. The VM formation was evaluated through wound healing assay, cell transwell assay and three-dimensional cell culture combined with PAS staining. Finally, we used Western blot to testify the correlation of the VM and the factors in protein level preliminarily. RESULTS Our results showed that VM existed in human pterygium specimens exactly. Otherwise, in human pterygium fibroblasts, doxycycline induced a dose-dependent inhibitory effect on cell proliferation and apoptosis induction. Besides, doxycycline significantly suppressed vasculogenic mimicry tube formation, cell migration and invasion. Furthermore, doxycycline impaired the expression of MMP-9, MMP-2 and VEGF which may related to pterygium VM formation. CONCLUSIONS Doxycycline decelerated pterygium progression might be through inhibiting VM formation according to the downregulation of MMP-9, MMP-2 and VEGF, which may provide the basis of further studies involving doxycycline for pterygium treatment.
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Affiliation(s)
- Meng-Xuan He
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, China
| | - Jun-Fang Zhang
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, China
| | - Ling Yang
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, China
| | - Bai Qin
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, China
| | - Hong-Wei Gu
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, China
| | - Qiu-Yang Tang
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, China
| | - Huai-Jin Guan
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, China
| | - Hai-Hong Shi
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, China
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Bunod R, Tahiri Joutei Hassani R, Robin M, Liang H, Rabut G, Baudouin C, Labbé A. Evaluation of pterygium severity with en face anterior segment optical coherence tomography and correlations with in vivo confocal microscopy. J Fr Ophtalmol 2021; 44:1362-1369. [PMID: 34384622 DOI: 10.1016/j.jfo.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe en face anterior segment optical coherence tomography (EF-OCT) characteristics of pterygia and their correlation with in vivo confocal microscopy (IVCM). PATIENTS AND METHODS In this observational case series, we prospectively included 21 eyes of 17 subjects with pterygium. All subjects underwent detailed ophthalmic examination, anterior segment photography, an ocular surface disease index (OSDI) questionnaire, IVCM, and EF-OCT. Eyes were divided into two groups according to pterygium severity (Modified Pterygium Classification System) and OSDI score. EF-OCT images for both groups were analyzed for surface area of Fuchs Patches (FP). The IVCM activity score was based on the number of inflammatory cells, blood vessels, activated keratocytes and the appearance of the cornea/pterygium at the head of the pterygium. The correlations between EF-OCT and IVCM images were then analyzed and compared in both groups. RESULTS EF-OCT permits clear visualization and evaluation of FPs and the border between the pterygium and the adjacent cornea. The severe pterygium group was characterized by irregular borders and larger FPs (0.13±0.06 mm2 versus 0.06±0.02 mm2 respectively) (P=0.003). The mean IVCM activity score was 2.36±0.81 in the severe pterygium group and 1.2±0.42 in the mild pterygium group (P=0.0013). There was a positive correlation between FP surface area and IVCM activity score. A larger FP surface area was associated with a higher activity score on IVCM. CONCLUSION EF-OCT allows good evaluation of pterygium extension, borders and FP surface area. EF-OCT analysis of pterygium could represent a simple, non-invasive and reproducible method to evaluate pterygium severity and activity.
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Affiliation(s)
- R Bunod
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France.
| | | | - M Robin
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France
| | - H Liang
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France; Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17, rue Moreau, 75012 Paris, France
| | - G Rabut
- CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France
| | - C Baudouin
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France; Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17, rue Moreau, 75012 Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, University of Versailles Saint-Quentin-en-Yvelines, AP-HP, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - A Labbé
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France; Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17, rue Moreau, 75012 Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, University of Versailles Saint-Quentin-en-Yvelines, AP-HP, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
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Damage of the ocular surface from indoor suntanning-Insights from in vivo confocal microscopy. Cont Lens Anterior Eye 2021; 44:101438. [PMID: 33840575 DOI: 10.1016/j.clae.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 03/12/2021] [Accepted: 03/22/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the ocular surface at the microstructural level of adults who habitually undertake indoor-suntanning utilising in vivo confocal microscopy. METHODS Participants were prospectively recruited and enrolled into either а study group (n = 75) with a history UV indoor tanning, or a control group (n = 75) with no prior history of artificial tanning. The study group participated in voluntary tanning sessions performed with standard equipment and maintained their usual routine for eye protection. Slit lamp biomicroscopy and in vivo confocal microscopy were performed at baseline before undertaking a series of suntanning sessions (10 sessions of 10 min duration over a 15 day period), within three days after the last session, and four weeks after the last session. Control group participants were examined at baseline and 8 weeks later and did not participate in tanning sessions. RESULTS All participants were female with a mean age of 25 ± 4 years and 24 ± 4 years in the study and control groups, respectively. No clinically significant changes were observed in either group over time using slit lamp biomicroscopy (all p ≥ 0.05), however, statistically significant differences were observed between the study and the control group for all corneal layers imaged using confocal microscopy (all p ≤ 0.03). Characteristic cystic conjunctival lesions with dark centres and bright borders were observed in 95% of the study group before and in 100% after the suntanning sessions. CONCLUSION Indoor suntanning resulted in statistically significant microstructural changes in the cornea and the bulbar conjunctiva that are undetectable with slit lamp biomicroscopy.
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Pterygium Pathology: A Prospective Case-Control Study on Tear Film Cytokine Levels. Mediators Inflamm 2019; 2019:9416262. [PMID: 31780873 PMCID: PMC6875004 DOI: 10.1155/2019/9416262] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/05/2019] [Indexed: 12/31/2022] Open
Abstract
Pterygium is a common eye disease, linked to an increased exposure to UV radiation and dry environments. The associated pathology culminates in visual impairment and, in some rare cases, blindness. However, there remains a lot of uncertainty concerning the pathogenesis of this fibrovascular lesion. As the composition of the tear film provides a reflection into the pathological changes at the ocular surface, tear analysis represents an ideal approach to gain insight in the progression of disease following pterygiectomy. This study enrolled 19 patients and age/gender-matched healthy controls. Tear film levels of interleukin- (IL-) 6, IL-8, and vascular endothelial growth factor (VEGF) were investigated over time, and preoperative concentrations were linked to corneal neovascularization and pterygium size. Diminished tear film levels were found in unilateral patients who show no clinical signs of pterygium recurrence over a period of one year. Hence, our results highlight the potential of using the course of IL-6, IL-8, and VEGF levels in tears as biomarkers for recovery. In addition, when focusing on the affected eyes (i.e., primary and recurrent pterygium), we detected fold changes in preoperative cytokine concentrations to correspond with disease severity. As our proposed biomarkers did not reveal a linear relationship with corneal neovascularization nor the invasive behaviour of pterygium, no exact role in the pterygium pathology could be established. Hence, our data point to these factors being contributors rather than decisive players in the pathological processes.
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Clinical Aspects of Pterygium in the Presence of Cataract. CURRENT HEALTH SCIENCES JOURNAL 2019; 45:263-271. [PMID: 32042453 PMCID: PMC6993772 DOI: 10.12865/chsj.45.03.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/17/2019] [Indexed: 11/18/2022]
Abstract
Two of the most common UV-induced eye affections are pterygium and cataract. They are both defined as progressive diseases that impair patients’ vision and share some common elements in their evolution process. The purpose of this study was to determine whether the presence of cataract influences the clinical signs and symptoms of patients with pterygium. Therefore, we have analyzed 84 patients with pterygium, among which 23 also presented cataract, as an overall study lot, as well as divided by age decades. We have determined that almost all patients with both pterygium and cataract declared extensive UV exposure in antecedents and have also reported a blurred vision. We found no correlation between the presence of cataract and the size of pterygium lesions, or symptoms like foreign body sensation, tearing or symblepharon.
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Miyashita H, Hatsusaka N, Shibuya E, Mita N, Yamazaki M, Shibata T, Ishida H, Ukai Y, Kubo E, Sasaki H. Association between ultraviolet radiation exposure dose and cataract in Han people living in China and Taiwan: A cross-sectional study. PLoS One 2019; 14:e0215338. [PMID: 31022200 PMCID: PMC6483175 DOI: 10.1371/journal.pone.0215338] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/29/2019] [Indexed: 12/01/2022] Open
Abstract
Purpose We investigated associations between ocular ultraviolet (UV) radiation exposure dose and cataract opacities among Han people living in China and Taiwan, to assess the effects of UV exposure intensity. Methods This cross-sectional study included Han people aged ≥40 years (1,801 individuals, 450 in Sanya, 636 in Taiyuan, and 715 in Taichung) as subjects who completed a questionnaire including items about diabetes, smoking, steroid use, work history, and time spent outdoors, and underwent an ophthalmic examination. Right eye axial length was measured using A-mode ultrasonography or IOLMaster. Slit-lamp imaging under maximum mydriasis was used to classify cataracts into three major types [cortical (COR), nuclear (NUC), and posterior subcapsular cataracts (PSC)] and two subtypes [retrodots (RD) and waterclefts (WC)] by one ophthalmologist. COR was divided into opacity presence (CEN+) or absence (CEN-) in the central 3-mm diameter area of the pupil. COR was also subdivided into three groups according to opacity shape: axle-shaped opacity concomitant with WC, wedge-shaped opacity around the pupil to the eye center, and ring-shaped opacity in the lens equator along the pupillary margin. The cumulative ocular UV exposure (COUV) was calculated. A logistic regression analysis was used for multivariate analysis. Results Cataract odds ratios in high COUV eyes were 5.35 for NUC, 1.87 for PSC, and 1.35 for RD. In eyes with WC, risk of COR ring-shaped opacity significantly increased but that of wedge-shaped opacity (CEN+) significantly decreased. In eyes without WC, risk of COR axle-shaped opacity (CEN–) and ring-shaped opacity significantly increased but that of wedge-shaped opacity (CEN+) significantly decreased. Conclusions Increased COUV level among Han people may be a risk factor for the development of nuclear cataracts, PSC, retrodots and ring-shaped cortical cataract. Risk of ocular UV exposure for cortical cataract may differ by opacity shape.
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Affiliation(s)
- Hisanori Miyashita
- Department of Ophthalmology, Kanazawa Medical University, Uchinada, Japan
| | - Natsuko Hatsusaka
- Department of Ophthalmology, Kanazawa Medical University, Uchinada, Japan
| | - Eri Shibuya
- Department of Ophthalmology, Kanazawa Medical University, Uchinada, Japan
| | - Norihiro Mita
- Department of Ophthalmology, Kanazawa Medical University, Uchinada, Japan
| | - Mai Yamazaki
- Department of Ophthalmology, Kanazawa Medical University, Uchinada, Japan
| | - Teppei Shibata
- Department of Ophthalmology, Kanazawa Medical University, Uchinada, Japan
| | - Hidetoshi Ishida
- Department of Ophthalmology, Kanazawa Medical University, Uchinada, Japan
| | - Yuki Ukai
- Department of Ophthalmology, Kanazawa Medical University, Uchinada, Japan
| | - Eri Kubo
- Department of Ophthalmology, Kanazawa Medical University, Uchinada, Japan
| | - Hiroshi Sasaki
- Department of Ophthalmology, Kanazawa Medical University, Uchinada, Japan
- * E-mail:
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Grupcheva CN, Grupchev DI, Radeva MN, Hristova EG. UV damage of the anterior ocular surface - microstructural evidence by in vivo confocal microscopy. Cont Lens Anterior Eye 2018; 41:482-488. [PMID: 30458934 DOI: 10.1016/j.clae.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 06/10/2018] [Accepted: 06/24/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate and describe the microstructural changes at the ocular surface in response to habitual ocular sun exposure, correlate them with the UV protection habits and follow their dynamics using in vivo confocal microscopy(ICM). METHODS For a period of minimum 4 months 200 subjects (400 eyes), aged 28 ± 7.3 years, were recruited with the agreement that they will spend their summer exclusively in the region of the Black Sea coast at 43 °N latitude and will be examined before and after the summer. All subjects filled in a questionnaire about habitual UV protection and were examined clinically and by ICM. RESULTS Questionnaire results demonstrated that 83.5% (167 participants) of the subjects considered the sun dangerous for their eyes, but 78% (156 subjects) believed that there is danger exclusively during the summer period. Although no clinical changes were detected, microstructural analysis of the cornea demonstrated statistically significant (p = 0.021) decrease of the basal epithelial density - from 6167 ± 151 cells/mm2 before to 5829 ± 168 cells/mm2 after the summer period. Microstructural assessment of the conjunctiva demonstrated characteristic cystic lesions with dark centres and bright borders encountered in only 25 eyes(6%) before, and affecting 118 eyes(29.5%) after the summer. The total area of the cysts after the summer increased fivefold. Spearman analysis proved negative correlation between sun protection habits and number of cysts. CONCLUSION Summer sun exposure for one season leads to clinically undetectable, microstructural changes affecting the cornea, bulbar and palpebral conjunctiva with transient, but possibly cumulative nature.
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Affiliation(s)
- Christina N Grupcheva
- Department of Ophthalmology and Visual Science, Medical University, 55 Marin Drinov Str., Varna, 9002, Bulgaria.
| | - Dimitar I Grupchev
- Department of Ophthalmology and Visual Science, Medical University, 55 Marin Drinov Str., Varna, 9002, Bulgaria.
| | - Mladena N Radeva
- Department of Ophthalmology and Visual Science, Medical University, 55 Marin Drinov Str., Varna, 9002, Bulgaria.
| | - Elitsa G Hristova
- Department of Ophthalmology and Visual Science, Medical University, 55 Marin Drinov Str., Varna, 9002, Bulgaria.
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The Role of Limbal Epithelial Stem Cells in Regulating Corneal (Lymph)angiogenic Privilege and the Micromilieu of the Limbal Niche following UV Exposure. Stem Cells Int 2018; 2018:8620172. [PMID: 29853920 PMCID: PMC5964490 DOI: 10.1155/2018/8620172] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 04/18/2018] [Indexed: 12/02/2022] Open
Abstract
The cornea is a clear structure, void of blood, and lymphatic vessels, functioning as our window to the world. Limbal epithelial stem cells, occupying the area between avascular cornea and vascularized conjunctiva, have been implicated in tissue border maintenance, preventing conjunctivalisation and propagation of blood and lymphatic vessels into the cornea. Defects in limbal epithelial stem cells are linked to corneal neovascularisation, including lymphangiogenesis, chronic inflammation, conjunctivalisation, epithelial abnormalities including the presence of goblet cells, breaks in Bowman's membrane, persistent epithelial defects and ulceration, ocular surface squamous neoplasia, lipid keratopathy, pain, discomfort, and compromised vision. It has been postulated that pterygium is an example of focal limbal deficiency. Previous reports showing changes occurring in limbal epithelium during pterygium pathogenesis suggest that there is a link to stem cell damage. In this light, pterygium can serve as a model disease of UV-induced stem cell damage also characterised by corneal blood and lymphangiogenesis. This review focuses on the role of corneal and limbal epithelial cells and the stem cell niche in maintaining corneal avascularity and corneal immune privilege and how this may be deregulated following UV exposure. We present an overview of the PUBMED literature in the field as well as recent work from our laboratories.
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Coroneo MT. Paradigm shifts, peregrinations and pixies in ophthalmology. Clin Exp Ophthalmol 2017; 46:280-297. [PMID: 28715851 DOI: 10.1111/ceo.13023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/28/2017] [Accepted: 07/05/2017] [Indexed: 12/21/2022]
Abstract
Human ingenuity is challenged by defending vision, our highest bandwidth sense. Special challenges are presented by the replacement or repair of highly specialized but scarce tissue within the constraints of transparency, tissue shape and alignment, tissue borders and pressure maintenance. Many, mostly destructive, surgical procedures were developed prior to an understanding of underlying pathophysiology. For a number of conditions, both reconstructive and destructive procedures co-exist, yet there are few guidelines as to the better approach. Because the consequences of these procedures may take many years to surface (consistent with a stem cell role in long-term tissue maintenance), guidance may be provided by the elucidation of underlying principles from these approaches. Illustrative examples from clinical, basic research and biotechnology, particularly relating to pterygium, ocular surface squamous neoplasia, dry-eye syndrome, corneal rehabilitation and replacement, cataract surgery, strabismus surgery and bionic eye research, are described. An unexpected consequence of bionic device development has been an appreciation of the sophistication of tissues being replaced, given the limitations of available biomaterials. Examples of how this has provided insights into ocular disease will be illustrated. Stem cell and biomaterial technologies are starting to impact at a time when cost-effectiveness is under scrutiny. Both efficacy and cost will need to be considered as these interventions are introduced. It appears that the paradigm shift rate is accelerating and there is evidence of this in ophthalmology. Lessons learned from the areas of destructive versus reconstructive surgery and the limitations of development of bionic replacements will be used to illustrate how new procedures and technologies can be developed.
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Affiliation(s)
- Minas T Coroneo
- Department of Ophthalmology, University of New South Wales at Prince of Wales Hospital, Sydney, Australia.,Ophthalmic Surgeons, Sydney, Australia.,East Sydney Private Hospital, Sydney, Australia.,Look for Life Foundation, Sydney, Australia
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Abstract
PURPOSE Intralesional single low-dose vascular endothelial growth factor antagonists have traditionally failed in causing regression of pterygia. The current pilot study investigates the role of high-dose repeated intralesional ziv-aflibercept in causing regression of inflamed or recurring pterygia. METHODS This prospective study from January 2015 to April 2017 consisted of using high dose of ziv-aflibercept between 0.1 mL (2.5 mg) and 0.3 mL (7.5 mg), depending on the pterygium size and the degree of inflammation. The injection was deep after tunneling the 30-gauge needle away from the injection site to avoid reflux. Reinjection was done at the first sign of recurrence of inflammation. The main outcome measure was regression of pterygial vessels by central retraction as documented by slit-lamp photography and anterior optical coherence tomography. RESULTS Four subjects, one with bilateral pterygia, were treated. Regression of new vessels and retraction of the leading edge of pterygial vessels occurred in all treated eyes (5 eyes) with dramatic visual gain in 1 eye from counting fingers to 6/9 (20/30). Numbers of injections were 9 (1 eye; 18 mo), 3 (2 eyes; 12 and 18 mo), and 1 (2 eyes; 2.5 and 7 mo). CONCLUSIONS Frequent high-dose intralesional ziv-aflibercept can lead to regression and/or retraction of inflamed pterygia in this pilot study. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov, NCT02486484.
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