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Marcos AAA, Freitas D, Barros JDN, Fernandes AG, Lowen M, Rigueiro M, Morales MC, Belfort Neto R, Singh AD. Impression cytology of ocular surface in xeroderma pigmentosum. Arq Bras Oftalmol 2024; 87:e2023. [PMID: 38656021 DOI: 10.5935/0004-2749.2023-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/21/2023] [Indexed: 04/26/2024] Open
Abstract
PURPOSE To describe cellular alterations detected by impression cytology of the ocular surface in patients with xeroderma pigmentosum. The secondary objective was to assess the reliability of impression cytology in diagnosing ocular surface squamous neoplasia. METHODS Patients with xeroderma pigmentosum underwent a single-day complete ophthalmological examination and impression cytology for ocular surface evaluation using 13 mm diameter mixed cellulose esters membrane filters and combined staining with Periodic Acid Schiff, Hematoxylin and Eosin, and Papanicolaou stains followed by microscopic analysis. The cytological findings were correlated with the clinical diagnosis. The impression cytology findings at baseline and one-year follow-up were correlated with the clinical course (no tumor, treated tumor, residual tumor recurrent tumor, new tumor). RESULTS Of the 42 patients examined, impression cytology was performed in 62 eyes of 34 participants (65% females). The mean age of patients was 29.6 ± 17 years (range 7-62). Fifteen eyes had a clinical diagnosis of ocular surface squamous neoplasia. Impression cytology showed goblet cells (47, 75%), inflammatory cells (12, 19%), keratinization (5, 8%), and squamous metaplasia (30, 48%). Impression cytology was positive for atypical cells in 18 patients (12 with and 6 without ocular surface squamous neoplasia). The sensitivity, specificity, positive predictive value, and negative predictive value of impression cytology (at baseline) for diagnosis of ocular surface squamous neoplasia were 80%, 87%, 67%, and 93%, respectively, using clinical diagnosis of ocular surface squamous neoplasia as the reference standard. CONCLUSION Impression cytology has a moderate positive predictive value for the diagnosis of ocular surface squamous neoplasia in patients with xeroderma pigmentosum. However, the lack of detection of atypical cells on impression cytology has a high negative predictive value for ocular surface squamous neoplasia. Integration of impression cytology in the long-term management of high-risk patients, such as patients with xeroderma pigmentosum, can avoid unnecessary diagnostic biopsies.
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Affiliation(s)
- Allexya Affonso Antunes Marcos
- Department of Ophthalmology and Visual Sciences, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Pathology, Escola Paulista de Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Denise Freitas
- Department of Ophthalmology and Visual Sciences, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Jeison de Nadai Barros
- Department of Ophthalmology and Visual Sciences, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Arthur Gustavo Fernandes
- Department of Ophthalmology and Visual Sciences, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Márcia Lowen
- Department of Pathology, Escola Paulista de Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Moacyr Rigueiro
- Department of Pathology, Escola Paulista de Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Melina Correia Morales
- Department of Ophthalmology and Visual Sciences, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Rubens Belfort Neto
- Department of Ophthalmology and Visual Sciences, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Arun D Singh
- Department of Ophthalmology, Cleveland Clinic, Cleveland, US
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Marcos AAA, Freitas D, Hazarbassanov RM, Fernandes AG, Castro LP, Melo DBVD, Menck CFM, Morales MC, Gomes JÁP, Belfort Neto R, Singh AD. Evaluation of Meibomian gland dysfunction using meibography in patients with xeroderma pigmentosum. Arq Bras Oftalmol 2024; 87:e20220319. [PMID: 38451683 DOI: 10.5935/0004-2749.2022-0319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 06/14/2023] [Indexed: 03/08/2024] Open
Abstract
PURPOSE To assess Meibomian gland dysfunction using meibography in patients with xeroderma pigmentosum and correlate with ocular surface changes. METHODS This cross-sectional study evaluated patients with xeroderma pigmentosum. All patients underwent a comprehensive and standardized interview. The best-corrected visual acuity of each eye was determined. Detailed ophthalmic examination was conducted, including biomicroscopy examination of the ocular surface, Schirmer test type I, and meibography, and fundus examination was also performed when possible. Meibomian gland dysfunction was assessed by non-contact meibography using Oculus Keratograph® 5M (OCULUS Inc., Arlington, WA, USA). Saliva samples were collected using the Oragene DNA Self-collection kit (DNA Genotek Inc., Ottawa, Canada), and DNA was extracted as recommended by the manufacturer. Factors associated with abnormal meiboscores were assessed using generalized estimating equation models. RESULTS A total of 42 participants were enrolled, and 27 patients underwent meibography. The meiboscore was abnormal in the upper eyelid in 8 (29.6%) patients and in the lower eyelid in 17 (62.9%). The likelihood of having abnormal meiboscores in the lower eyelid was 16.3 times greater than that in the upper eyelid. In the final multivariate model, age (p=0.001), mutation profile (p=0.006), and presence of ocular surface malignant tumor (OSMT) (p=0.014) remained significant for abnormal meiboscores. For a 1-year increase in age, the likelihood of abnormal meiboscores increased by 12%. Eyes with OSMT were 58.8 times more likely to have abnormal meiboscores than eyes without ocular surface malignant tumor. CONCLUSION In the final model, age, xeroderma pigmentosum profile, previous cancer, and clinical alterations on the eyelid correlated with a meiboscore of ≥2. Meibomian gland dysfunction was common in patients with xeroderma pigmentosum, mainly in the lower eyelid. The severity of Meibomian gland dysfunction increases with age and is associated with severe eyelid changes.
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Affiliation(s)
- Allexya Affonso Antunes Marcos
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Academia Nacional de Medicina, Programa Jovens Lideranças Médicas, Rio de Janeiro, RJ, Brazil
| | - Denise Freitas
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Rossen Mihaylov Hazarbassanov
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Arthur Gustavo Fernandes
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Ligia Pereira Castro
- DNA Repair Laboratory, Department of Microbiology, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Danilo Batista Vieira de Melo
- DNA Repair Laboratory, Department of Microbiology, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Carlos F Martins Menck
- DNA Repair Laboratory, Department of Microbiology, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Melina Correia Morales
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - José Álvaro Pereira Gomes
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Rubens Belfort Neto
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Arun D Singh
- Department of Ophthalmology, Cleveland Clinic, Cleveland, US
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