Short-Term Efficacy and Safety of Phacoemulsification Associated With iStent Inject W in Patients With Controlled Open Angle Glaucoma

PRCIS

The iStent inject W implanted during phacoemulsification effectively reduces IOP.

PURPOSE

The purpose of this study was to evaluate the efficacy and safety of iStent inject W combined with phacoemulsification in patients with controlled open angle glaucoma undergoing cataract surgery.

PATIENTS AND METHODS

We conducted a retrospective, bicentric study of patients with controlled chronic open angle glaucoma who underwent phacoemulsification combined with the injection of 2 iStent inject Ws. Patient characteristics, including intraocular pressure (IOP) and the number of glaucoma medications, were evaluated preoperatively and 1 week, 1 month, and 6 months postoperatively. The primary end point was IOP reduction, and the secondary end point was the reduction in the number of glaucoma medications.

RESULTS

In this study, 85 eyes were included. The majority of patients had primary open angle glaucoma (85% of eyes). Preoperative mean IOP was 16.1±2.0 mm Hg with a mean of 2.3±0.5 glaucoma medications. At 1 week postoperatively, the mean IOP was 16.7±3.1 mm Hg with a mean of 2.0±0.7 hypotensive medications. At 1 and 6 months, the mean IOP was 14.2±2.1 and 13.0±1.5 mm Hg, with a mean of 2.0±0.6 and 1.8±0.5 glaucoma medications, respectively. The percentage IOP reduction at 1 and 6 months was 11.6% ( P =0.001) and 19.3% ( P <0.0001), respectively. Regarding glaucoma medications, at 1 and 6 months, the reduction in the number of medications was 12.9% ( P =0.025) and 22.4% ( P =0.003), respectively. The most frequent significant postoperative adverse events were corneal edema in 7%, IOP spikes in 6%, and hyphema in 6% of eyes, which resolved spontaneously.

CONCLUSIONS

The iStent inject W implanted during phacoemulsification effectively reduces IOP and the number of glaucoma medications needed at 6 months of follow-up, with a favorable safety profile in patients with controlled open angle glaucoma.

Severe macular complications in glaucoma: high-resolution multimodal imaging characteristics and review of the literature

PURPOSE

To describe imaging characteristics of severe macular complications occurring in glaucoma and discuss available treatments.

METHODS

Retrospective case series of glaucomatous patients with macular retinoschisis (MR) and/or serous retinal detachment (SRD). Patients underwent a complete ophthalmological examination and multimodal imaging including retinography, SD-OCT, fluorescein and indocyanine green angiography (FA & ICGA) and adaptive optics (AO).

RESULTS

Ten eyes (8 patients) were included. Initial BCVA was 1.04 ± 1.12 logMAR and IOP was 24.0 ± 9.3mmHg. All eyes presented with MR while SRD was present in 5 eyes (5 patients), with a central macular thickness of 573 ± 152 μm. FA and ICGA allowed to exclude leakage in all cases. A focal lamina cribrosa defect (LCD) was found in four eyes (4 patients) using OCT, with AO providing en-face visualization of the defect in one eye. Outer retinal hole was present in 3 eyes (3 patients). No visual improvement or resolution of the macular retinoschisis was observed in eyes with medical or surgical IOP control (N = 9). Vitrectomy with internal membrane limiting peeling and gas tamponade was performed in one eye with good visual results.

CONCLUSIONS

Multimodal high-resolution imaging is essential to diagnose severe macular complications associated with advanced glaucoma.

Safety and efficacy of iStent Inject trabecular micro-bypass stents in combination with phacoemulsification for chronic open angle glaucoma associated with cataract

BACKGROUND

The goal of this study was to assess the efficacy and safety of phacoemulsification combined with iStent Inject® implantation for the treatment of chronic open-angle glaucoma controlled on topical anti-glaucoma medications and associated with cataract.

METHODS

This study was a retrospective analysis of patients who underwent phacoemulsification and implantation of an iStent Inject® for chronic open-angle glaucoma associated with cataract. For all patients, pre- and postoperative characteristics, including number of glaucoma medications and intraocular pressure (IOP), were compared using Paired-sample t-tests and Wilcoxon signed-rank tests, respectively. Postoperative visits were scheduled at 7 days and 1, 3, 6, and 12 months after surgery.

RESULTS

Forty-nine eyes of 39 patients were included in the study. Mean preoperative IOP at baseline was 16.3±4.3mmHg (range, 10-29mmHg) with a mean of 2.2±1.0mmHg antiglaucoma medications. At 1 month, the mean IOP reduction was 16% (P<0.05) along with an 18.7% reduction in the mean number of medications. At 6 months, the mean IOP was 12.8±2.6, with a mean of 1.1±0.9 antiglaucoma medications. The mean IOP reduction at 6 months was 22% (P<0.05) along with a 49% reduction in the mean number of medications. At 12 months, the mean IOP was 13.8±2.5 with a mean of 1.1±1.2 medications. The mean IOP reduction at 12 months was 15% (P<0.05) along with a 47% reduction in the mean number of medications. No severe device-related side effects were observed.

CONCLUSIONS

iStent Inject® implantation combined with phacoemulsification resulted in effective IOP reduction and medication burden in patients with mild to advanced chronic open-angle glaucoma and preoperative IOP well controlled with topical hypotensive medications.

Safety and Efficacy of the Preserflo® Microshunt in Refractory Glaucoma: A One-Year Study

Purpose: To evaluate the safety and efficacy of Preserflo^® microshunt implantation in eyes with refractory glaucoma. Methods: In this retrospective study, a cohort of patients who underwent Preserflo^® microshunt implantation between April 2019 and August 2020 for refractory glaucoma were evaluated. At the time of surgery, all eyes had uncontrolled intraocular pressure (IOP) despite maximally tolerated medical therapy and at least one previous failed glaucoma filtering surgery. The primary outcome was a complete success, defined as postoperative IOP ≤ 21 mm Hg with an IOP reduction ≥ 20% and no repeat filtering surgery. The secondary outcome was qualified success, defined as a complete success with the use of antiglaucoma medications. The rates of needling, bleb repair, and postoperative complications were also recorded. Results: Forty-seven eyes with a mean preoperative IOP of 30.1 ± 7.1 mm Hg and a mean of 3.4 ± 1 glaucoma medications were included. The mean number of previous surgeries prior to microshunt implantation was 2.3 ± 1.3. After 1 year, the mean IOP was significantly reduced to 18.8 ± 4.6 mm Hg, with the mean number of medications significantly reduced to 1.4 ± 1.2. Complete success was achieved in 35% of eyes, and a qualified success in 60% of eyes. A decrease in IOP of at least 30% was found in 55% of eyes. Needling or bleb repair was performed in 49% of eyes. Complications were minimal and transient, except for one eye which presented with tube extrusion, and another eye with a transected tube. A repeat glaucoma surgery had to be performed in 17% of eyes. Conclusions: The Preserflo^® Microshunt provided moderate success but a significant reduction in IOP, with a good safety profile after one year of follow-up in eyes at high risk for failure of filtering surgery.

[Artificial intelligence and glaucoma: A literature review]

In recent years, research in artificial intelligence (AI) has experienced an unprecedented surge in the field of ophthalmology, in particular glaucoma. The diagnosis and follow-up of glaucoma is complex and relies on a body of clinical evidence and ancillary tests. This large amount of information from structural and functional testing of the optic nerve and macula makes glaucoma a particularly appropriate field for the application of AI. In this paper, we will review work using AI in the field of glaucoma, whether for screening, diagnosis or detection of progression. Many AI strategies have shown promising results for glaucoma detection using fundus photography, optical coherence tomography, or automated perimetry. The combination of these imaging modalities increases the performance of AI algorithms, with results comparable to those of humans. We will discuss potential applications as well as obstacles and limitations to the deployment and validation of such models. While there is no doubt that AI has the potential to revolutionize glaucoma management and screening, research in the coming years will need to address unavoidable questions regarding the clinical significance of such results and the explicability of the predictions.

Glare and Mobility Performance in Glaucoma: A Pilot Study

PRCIS

Glare disability affects patients with moderate and severe glaucoma. Under glare conditions, mobility performances of glaucoma patients are reduced.

PURPOSE

The aim of this study was to evaluate glare disability and its impact on mobility and orientation in glaucoma patients.

METHODS

Twenty-two glaucoma patients and 12 age-matched control subjects were included. All patients underwent a clinical evaluation of visual function and halo size measurements to determine glare disability with a glare score (GS) of the best eye and worse eye. Mobility was evaluated by 4 mobility courses on an artificial street (StreetLab) under photopic conditions (P) and mesopic conditions with an additional light source in front of the patient to mimic dazzling conditions (M+G). Mobility time, mobility incidents, trajectory segmentation, distance traveled, preferred walking speed on trial (WS) and percentage of preferred walking speed (PPWS) were recorded, and the Nasa task load index (Nasa-TLX) was evaluated.

RESULTS

GS of the worse eye and GS of the best eye were significantly higher in glaucoma patients than in the control group (P=0.001 and 0.003). It was significantly different between moderate glaucoma patients and controls (P=0.001 and 0.010, respectively) and between severe glaucoma patients and controls (P=0.049 and 0.016). In locomotion tasks, comparing performance under M+G and P conditions, mobility performance was significantly different concerning mobility time (P=0.010), distance traveled (P=0.008), WS (P=0.007), PPWS (P=0.006), and Nasa-TLX (P=0.017) in the glaucoma group. Under M+G lighting conditions, mobility performance for glaucoma patients was significantly worse than controls with regard to WS (P=0.038), PPWS (P=0.0498), mobility time (P=0.046), and Nasa-TLX (P=0.006).

CONCLUSION

Glare disability was observed in patients with moderate and severe glaucoma and had an impact on their mobility performance.

Cataract and glaucoma combined surgery: XEN® gel stent versus nonpenetrating deep sclerectomy, a pilot study

Background

To compare the efficacy of phacoemulsification (PKE) combined with nonpenetrating deep sclerectomy (NPDS) with mitomycin C (MMC) versus XEN® gel stent with MMC.

Methods

In this nonrandomized, retrospective, comparative, single-center pilot study, 105 consecutive eyes of 75 patients with uncontrolled primary open-angle glaucoma (POAG) and cataract who underwent PKE combined with either XEN implantation (n = 47) or NPDS (n = 58) between May 2013 and November 2018 were included. The primary outcome was complete success at 9 months, which was defined as intraocular pressure (IOP) ≤18, 15 or 12 mmHg without treatment; qualified success was IOP ≤18, 15 or 12 mmHg with antiglaucoma medications. Secondary outcome measures included the number of antiglaucoma medications, visual acuity (VA), and postoperative adverse events.

Results

Using the 18 mmHg threshold, complete or qualified success was achieved in 69.6 and 89.1% in the PKE + XEN group, and 63.8 and 89.7% in the PKE + NPDS group (p = .54 and p = .93), respectively, at 9 months. The mean IOP decreased from 20.8 ± 6.8 mmHg to 16.2 ± 2.8 mmHg in the PKE + XEN group (p < .001, 18.9% mean drop), and from 21.5 ± 8.9 mmHg to 14.9 ± 3.9 mmHg in the PKE + NPDS group (p < .001, 25.6% mean drop). Best-corrected VA significantly improved (p < .001) in both groups. The mean number of antiglaucoma medications was significantly reduced from 2.66 ± 1.1 to 0.49 ± 1.0 in the PKE + XEN group (p < .001) and from 2.93 ± 0.9 to 0.69 ± 1.2 in the PKE + NPDS group (p < .001).

Conclusions

The XEN stent combined with PKE seemed to be as effective and safe as PKE + NPDS at 9 months in this pilot study.

Clinical Features and Diagnosis of Anterior Segment Inflammation Related to Cytomegalovirus in Immunocompetent African, Asian, and Caucasian Patients

Objective: To report the clinical features and treatment outcomes in immunocompetent patients with anterior segment inflammation (ASI) related to human cytomegalovirus (HCMV) depending on their ethnic origin.Material and Methods: Multicenter retrospective study of 38 patients with at least one test, either HCMV-positive PCR or GWc.Results: Features of Posner-Schlossman syndrome were observed in 50% of the eyes, Fuchs heterochromic iridocyclitis in 13% of the eyes, chronic nonspecific anterior uveitis in 21% of the eyes, and corneal endotheliitis in 18% of the eyes. PCR and GWc were positive for HCMV in 50% and 96.2% of the eyes, respectively. Glaucoma was diagnosed in 50% of eyes. Treatment was oral valganciclovir in about half of the patients. Other treatments were intravenous ganciclovir and/or ganciclovir topical ointment and/or intravitreal ganciclovir.Conclusions: No obvious association of specific clinical features with individual ethnicity could be identified. We found a high rate of glaucoma in all ethnic groups. There was a delay in diagnosis and specific treatment of HCMV in most patients.

Optical Coherence Tomography Angiography Evaluation of Conjunctival Vessels During Filtering Surgery

Purpose

To evaluate the changes in conjunctival vascularization with optical coherence tomography angiography (OCT-A) before and after filtering surgery and to correlate these results with filtering surgery success.

Methods

We evaluated 20 blebs of 20 patients after a first-time trabeculectomy. Conjunctival vascularization was quantified using ImageJ software. Eyes were classified into two groups according to the preoperative conjunctival vessel density: hypovascularized conjunctiva (HypoV; 10 eyes) and hypervascularized conjunctiva (HyperV; 10 eyes). The density of intraepithelial microcysts (0 to 3) was also analyzed.

Results

There were significantly more needling procedures in the HyperV group, with 70% of the eyes undergoing needling during follow-up compared to 20% in the HypoV group (P = 0.012). In the HyperV group, 50% of the eyes required IOP-lowering eyedrops after surgery, compared to 10% in the HypoV group (P = 0.029). HypoV showed significantly more intraepithelial microcysts than did HyperV at 1 week (1.1 vs. 0.4, P = 0.0215), 1 month (2.2 vs. 0.4, P = 0.0003), and 6 months postoperatively (2.0 vs. 0.7, P = 0.0068). A statistically significant correlation was found between preoperative conjunctival vascular density and mean IOP at 1 week (r = 0.483, P = 0.038), 1 month (r = 0.714, P = 0.001), and 6 months postoperatively (r = 0.471, P = 0.043). There was no statistically significant correlation between the preoperative conjunctival vascularization density and the eyedrop-year rate (r = 0.036, P = 0.8704) or the preservative-year rate (r = 0.1444, P = 0.5107).

Conclusions

Poor conjunctival vascularization was associated with lower IOP and a higher number of intraepithelial microcysts evaluated with OCT-A. OCT-A provides a simple, noninvasive, and reproducible method to analyze and quantify bleb vessels before and after filtering surgery.

Translational Relevance

Several studies have demonstrated that highly vascularized blebs might be associated with a higher risk of failure. OCT-A may provide a dye-free, noncontact method for monitoring conjunctival vascularization after filtering surgery.

Changes in choroidal thickness and optic nerve head morphology after filtering surgery: nonpenetrating deep sclerectomy versus trabeculectomy

Background

The purpose of this study was to evaluate the changes in choroidal thickness and lamina cribrosa position after nonpenetrating deep sclerectomy (NPDS) and trabeculectomy.

Methods

Twenty-three eyes with glaucoma that required filtering surgery were included (12 NDPS and 11 trabeculectomies) in this prospective observational study. OCT-enhanced depth imaging (OCT-EDI) was used to measure choroidal thickness, prelaminar tissue thickness and lamina cribrosa position before and 7 days and 1 month after surgery. All results are shown as median (interquartile range values).

Results

Intraocular pressure (IOP) was significantly lower 1 week after surgery than at baseline (7 (6/10) mmHg vs. 21 (18/26) mmHg; p < 0.001) with a mean 64% decrease. IOP remained significantly lower at 1 month with a 55% mean decrease as compared to baseline (10 (8/12) mmHg; p < 0.001). One week after surgery, the subfoveolar choroidal thickness (SFCT) significantly increased (372 (306/523) μm vs. 317 (227/413) μm; p = 0.04) and the prelaminar tissue (PLT) was significantly thicker (269 (162/360) μm vs. 138 (87/268) μm; p = 0.02) as compared to preoperative measurements. These changes were not statistically significant at one month. There were no differences concerning these parameters between the NPDS and trabeculectomy groups. During the first week, the SFCT increase was correlated with IOP reduction (r = − 0.41; p = 0.04).

Conclusions

OCT-EDI allowed the visualization of structural changes at the level of the optic nerve and choroidal vascularization during acute IOP changes. No difference was observed between NPDS and trabeculectomy concerning these structural modifications.

En-face optical coherence tomography as a novel tool for exploring the ocular surface: a pilot comparative study to conventional B-scans and in vivo confocal microscopy

PURPOSE

To explore the potential of spectral-domain optical coherence tomography (SD-OCT) using the en-face technology for the imaging of ocular surface diseases and to correlate the findings with in vivo confocal microscopy (IVCM) images.

PATIENTS AND METHODS

113 eyes of 75 subjects with various ocular surface diseases were investigated with the RTVue(®) anterior-segment en face OCT. En face OCT images were compared to B-scan OCT and IVCM images.

RESULTS

Patients with corneal dystrophies, corneal deposits, keratitis, pterygium, conjunctivochalasis, or ocular surface squamous neoplasia and patients who underwent lamellar corneal surgeries were included. En-face OCT images showed ocular surface tissue changes that were not discernible using conventional B-scan OCT. Nevertheless, there was a good correlation with IVCM analysis. Compared with IVCM, the major advantages of en-face OCT included easy operation and rapid image acquisition, with minimal operator experience required. In addition, the non-contact method avoided patient discomfort and external pressure on the globe, which was especially useful in patients with corneal dystrophies, ulcers, or corneal abscesses. Although the resolution of en-face OCT was lower than that of IVCM, it allowed useful overall visualization of corneal lesions due to the larger areas analyzed.

CONCLUSION

En-face SD-OCT is a novel, valuable tool to assess a wide variety of ocular surface diseases. It can provide additional information and new insight into different ocular surface conditions with no corneal contact.

The relationship between subbasal nerve morphology and corneal sensation in ocular surface disease

PURPOSE

The purpose of this study was to evaluate the relationship between the in vivo confocal microscopic (IVCM) morphology of subbasal corneal nerves and corneal sensitivity in patients with ocular surface disease.

METHODS

Ten healthy volunteers (control group), 12 patients with dry eye (dry-eye group), and 14 patients treated with IOP-lowering topical medications (glaucoma group) were included. Central corneal sensation was measured using the contact Cochet-Bonnet esthesiometer. IVCM of the cornea was performed and the following subbasal corneal nerves parameters were analyzed: density, number, width, number of beadings, number of branching, tortuosity, and reflectivity. One eye of each subject was included in the study.

RESULTS

Corneal sensitivity was significantly decreased in dry-eye and glaucoma patients compared with controls. The density and number of subbasal corneal nerves were also significantly decreased in dry eye and glaucoma patients compared with controls. There was no difference in terms of subbasal nerve width, number of beadings, tortuosity, reflectivity, and number of branching between the dry-eye, the glaucoma, and the control groups. In all subjects, corneal sensitivity correlated positively with the density and number of subbasal nerves; however, in the dry-eye group, corneal sensitivity correlated with the density and the number of nerves, whereas in the glaucoma group, corneal sensitivity correlated only with the tortuosity of subbasal nerves.

CONCLUSIONS

The relationship between corneal sensation and subbasal nerve morphology, as evaluated with IVCM, depends on the pathophysiological mechanism of ocular surface disease.

In vitro interactions between peripheral blood lymphocytes and the Wong-Kilbourne derivative of Chang conjunctival cells

PURPOSE

To investigate the interactions between conjunctival cells and peripheral blood lymphocytes (PBLs) in vitro and to analyze the role of benzalkonium chloride (BAC)-induced apoptosis in this model.

METHODS

Wong-Kilbourne derivative (WKD) cells were cocultured in cell-contact cultures or on cell inserts for 1 to 7 days with PBLs, activated or not with phorbol 12-myristate 13-acetate (PMA). Morphologic analyses of cell interactions were performed using membrane stainings (green PKH67 for WKD cells and red PKH26 for PBL), F-actin immunostaining, and scanning electron microscopy. Sub-G(1) peak, CD95/Fas, and HLA-DR expression were assessed by flow cytometry (FCM). Specific interactions through the E-cadherin-CD103 complex were studied with FCM and standard immunofluorescence. Five different concentrations of BAC were tested in microplate cytofluorometry assays, to evaluate cytotoxic effects on cell viability and apoptosis.

RESULTS

WKD/PBL coculture allowed obvious cell interactions, as shown through plasma membrane exchanges. Direct-contact coculture potentiated the BAC cytotoxic effects and increased HLA-DR and CD95/Fas expression on WKD cells. Trichostatin A-pretreated WKD/PBL coculture induced a slight increase in CD103 expression on PBLs. Moreover, the presence of PBLs during the recovery period after WKD cell BAC stimulation reduced WKD cell apoptosis.

CONCLUSIONS

These results suggest that the in vitro interaction of PBLs with WKD cells participates in BAC-induced epithelial toxicity regulation, probably through cell membrane contacts.

[Corneal sensitivity in patients treated medically for glaucoma or ocular hypertension]

PURPOSE

To evaluate the corneal sensitivity in patients treated with intraocular pressure (IOP)-lowering medications.

INTRODUCTION

Chronic administration of anti-glaucoma drops is associated with numerous tissue changes on the ocular surface. The purpose of this study was to investigate the effect of these medications and their preservative, benzalkonium chloride (BAK), on corneal sensitivity.

PATIENTS AND METHODS

Thirty-nine patients treated for glaucoma or ocular hypertension (OHT) and nine untreated patients were included in this study. Treated patients were divided into three groups according to the daily number of preserved eyedrops (0, 1 and ≥2). Corneal sensitivity was assessed using the Cochet-Bonnet esthesiometer. All patients underwent a complete examination of the ocular surface including Schirmer testing, tear film breakup time (BUT) and corneal and conjunctival fluorescein staining. The Ocular Surface Disease Index (OSDI) questionnaire was used to evaluate symptoms.

RESULTS

Corneal sensitivity was 58.8±2.8mm, 56.2±5.2mm, 50.3±12.5mm and 44.3±13.6mm in untreated patients, in patients treated with none, one and two or more instillations of preserved eyedrops, respectively. Corneal sensitivity in patients treated with preserved eyedrops was significantly lower as compared to untreated patients (P<0.001) and patients treated with preservative-free eyedrops (P=0.012). Corneal sensitivity of patients treated with intraocular pressure-lowering medications was negatively correlated to the number of instillations of preserved eyedrops (r=-0.390 ; P<0.001) as well as to the duration of treatment (R=-0.357 ; P=0.001). BUT and fluorescein staining were significantly altered in treated patients compared to the untreated control group ; however, no significant difference was observed between the treated groups. There was no significant difference for OSDI or Schirmer testing between the various groups.

CONCLUSION

Chronic administration of BAK-containing anti-glaucoma eyedrops appears to alter corneal sensitivity. These results could explain the absence of correlation between clinical signs and symptoms sometimes observed in patients treated for glaucoma or OHT.

[The influence of ocular surface diseases in the management of glaucoma]

INTRODUCTION

The medical treatment of glaucoma is frequently used as a first-line treatment. Often effective, this treatment is administered over the long term. Chronic administration of eye drops is implicated in ocular surface disease. The objective of this study was to determine the prevalence of ocular surface diseases (OSDs) in patients treated for glaucoma or ocular hypertension (OHT) as well as their influence on therapeutic management.

PATIENTS AND METHODS

Eighty-eight patients followed at the Quinze-Vingts National Ophthalmology Hospital for glaucoma or OHT were evaluated. All patients had a complete ocular examination including an evaluation of the ocular surface. A questionnaire derived from the Ocular Surface Disease Index (OSDI) was used to assess ocular surface symptoms and the related impairment of quality of life. According to the clinical evaluation of the ocular surface, patients were classified into three groups (A, no OSD; B, moderate OSD; C, severe OSD. The patients for whom ocular surface disease had modified the therapeutic management of glaucoma were identified.

RESULTS

In this study, 72 patients (82 %) showed significant symptoms of OSDs (OSDI score>22). A moderate or severe OSD was observed in 67 patients (76 %). For 33 patients (38 %), the OSD influenced the choice of glaucoma or OHT treatment. Among these patients, six had glaucoma surgery, one had laser trabeculoplasty, and 26 required one or several changes in eyedrops.

CONCLUSION

This study confirmed the high prevalence of OSDs in patients treated for glaucoma or OHT. For numerous patients, these pathologies influenced not only their quality of life but also their therapeutic management.

Multiple endpoint analysis of BAC-preserved and unpreserved antiallergic eye drops on a 3D-reconstituted corneal epithelial model

PURPOSE

To compare the effects of benzalkonium chloride (BAC)-preserved and unpreserved antiallergic eye drops on the human 3D-reconstituted corneal epithelial model (3D-HCE).

METHODS

3D-HCE were treated for 24 h followed or not by a 24 h post-incubation recovery period (24 h+24 h) with phosphate-buffered saline (PBS), 0.01% BAC, unpreserved formulations of ketotifen, N Acetyl-Aspartyl Glutamic Acid (NAAGA), cromoglycate, or BAC-preserved commercial formulations of ketotifen, olopatadine, epinastine, and levocabastine. The 3D-HCE viability was evaluated using the 3-(4,5-Dimethylthiazol-2-yl) -2,5-Diphenyltetrazolium Bromide (MTT) test at 24 h and 24 h+24 h. At 24 h, the numbers of Cluster of Differentiation 54 (CD54)- and Ki67-immunopositive cells as well as the number of apoptotic deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL)-positive cells were evaluated on 3D-HCE frozen sections. The expression of the tight junction-associated protein occludin was also assessed using fluorescence confocal microscopy on flat-mounted 3D-HCE epithelia.

RESULTS

The MTT and the TUNEL tests revealed a significant decrease of cell viability and an increased apoptosis in the superficial layers of the 3D-HCE only when treated with BAC-containing formulations and in a BAC concentration-dependent manner. The expression of CD54 and Ki67 in the basal layers was also increased in this group. A concentration-dependent disorganization of occludin distribution in the epithelium treated with BAC-containing solutions was also observed. The unpreserved formulations induced effects comparable to the control.

CONCLUSIONS

BAC-preserved solutions decreased cell viability and induced apoptosis in a concentration-dependent manner. Moreover, they induced CD54 expression, proliferation in the basal layers, and changes in the distribution of occludin, which is consistent with a disorganization of the tight-junctions and suggests the loss of the epithelial barrier function. On the contrary, the unpreserved solutions did not impair cell structures and viability, suggesting a better tolerance for the ocular surface. As allergic patients often exhibit impaired and inflammatory ocular surface, BAC-free compounds should be the first choice when treating allergic conjunctivitis.

Comparative study on the cytotoxic effects of benzalkonium chloride on the Wong-Kilbourne derivative of Chang conjunctival and IOBA-NHC cell lines

PURPOSE

The Wong-Kilbourne derivative of Chang conjunctiva-derived cell line has been widely used for toxicological and functional in vitro studies on the ocular surface. The common reserve to this cell line is the reported contamination with HeLa cells. Thus, the IOBA-NHC spontaneously immortalized conjunctival epithelial cell line has been recently developed and did not show other cell type contamination. Our purpose was to determine whether both cell lines would be equally suitable for in vitro toxicological studies. Therefore, we compared in these two cell types the toxic effects of the preservative, benzalkonium chloride (BAC); its toxicity has been often reported on conjunctival in vivo and in vitro models.

METHODS

The necrotic, apoptotic, and oxidative effects of BAC were evaluated on Chang and IOBA-NHC cell lines using microplate cytofluorometry tests (neutral red, 2,7- dichlorofluorescein diacetate dye [H(2)DCF-DA], hydroethidine, and Yopro-1), flow cytometry (Annexin V/7-AAD and DNA content tests), and standard immunofluorescence stainings. Cells were exposed to five concentrations of BAC (10(-2)%, 5.10(-3)%, 10(-3)%, 10(-4)%, and 10(-5)%) for two incubation times: 15 min of treatment and 15 min of treatment followed by 24 h of cell recovery in complete medium.

RESULTS

All parameters of toxicity increased in a BAC dose-dependent manner on both cell lines.

CONCLUSIONS

The comparison of BAC toxicity on both cell lines supported the use of IOBA-NHC and Chang cells for toxicological in vitro studies. Drawbacks of both cell lines have to be known and considered in studies performed on these cell lines.

In vivo confocal microscopy in fungal keratitis

BACKGROUND

Fungal keratitis is a major blinding eye disease found throughout the world, particularly in developing countries. Given the recent increase in Fusarium keratitis infections in contact lens wearers owing to contact lens solutions, a warning was recently issued by the Food and Drug Administration, making it a public health concern in developed countries.

OBJECTIVE

To show the advantages of in vivo confocal microscopy imaging using the Heidelberg Retina Tomograph II-Rostock Cornea Module (HRTII-RCM) in the early diagnosis of fungal keratitis.

METHODS

HRTII-RCM confocal microscopy was performed on five patients presenting with fungal keratitis and on three donor corneas contaminated with Fusarium solani, Aspergillus fumigatus and Candida albicans.

RESULTS

Direct microscopic evaluation of corneal smears and culture revealed the presence of F solani in four cases and C albicans in one case. HRTII-RCM examination of the infected patients and contaminated donor corneas revealed numerous high-contrast elements resembling Fusarium, Aspergillus hyphae or Candida pseudofilaments in the anterior stroma.

CONCLUSION

HRTII-RCM in vivo confocal microscopy is a new, non-invasive and rapid technique for the early diagnosis of fungal keratitis, showing high-resolution images resembling fungal structures in the early phase of the disease.

Efficacy of interferon-alpha for the treatment of Kaposi's sarcoma herpesvirus-associated uveitis

PURPOSE

To report cases of uveitis that are associated with human herpesvirus-8 (HHV-8) and the impact of interferon-alpha therapy on their visual outcome.

DESIGN

Interventional case reports.

METHODS

Extensive examination was performed in patients with chronic and severe uveitis to exclude a viral cause that requires specific therapy. After histopathologic, molecular, and/or serologic confirmation of HHV-8 uveitis, interferon-alpha2a therapy (3 millions IU/d, 3 days per week, subcutaneously) was initiated.

RESULTS

Two patients of Mediterranean origin were included. HHV-8 serologic result was positive in both cases. Histopathologic examination of conjunctival biopsy specimens confirmed Kaposi's sarcoma in the second case, and quantitative polymerase chain reaction identified HHV-8 DNA in the biopsy specimen. Disease was controlled by interferon-alpha2a in both cases, but maintenance therapy was mandatory to prevent relapses.

CONCLUSION

HHV-8-associated uveitis is a rare condition in immunocompetent hosts. Severe and chronic conditions may require antiviral and immunomodulatory therapies. Interferon alpha seems to be a good candidate and may be proposed in these cases.