Association Between Corneal Changes and Retinal Oximetry in Diabetes Mellitus

Purpose

Diabetes mellitus (DM) causes different corneal changes that are associated with the severity of diabetic retinopathy. To identify the pathophysiological reasons for this, corneal tomography and optical densitometry (COD) were combined with retinal oximetry.

Methods

Patients with DM and healthy subjects were included in this pilot study. Spatially resolved corneal thickness and COD were assessed using the Pentacam HR (Oculus). The pachymetry difference (PACDiff) was calculated as an indicator of an increase in the peripheral corneal thickness. Oxygen saturation (SO2) of the retinal vessels was measured using the Retinal Vessel Analyzer (Imedos Systems UG). Subsequently, the associations between corneal and retinal parameters were analyzed.

Results

Data from 30 patients with DM were compared with those from 30 age-matched healthy subjects. In DM, arterial (P = 0.048) and venous (P < 0.001) SO2 levels were increased, and arteriovenous SO2 difference was decreased (P < 0.001). In patients, PACDiff was higher than that in healthy subjects (P < 0.05), indicating a stronger increase in peripheral corneal thickness. The COD was reduced in DM (P = 0.004). The PACDiff of concentric rings with a diameter of 4 mm (r = -0.404; P = 0.033) to 8 mm (r = -0.522; P = 0.004) was inversely correlated with the arteriovenous SO2 difference. Furthermore, PACDiff 4 mm was negatively associated with arterial SO2 (r = -0.389; P = 0.041), and the COD of the peripheral corneal areas correlated positive with arterial SO2 (COD total 10-12 mm: r = 0.408; P = 0.025).

Conclusion

These associations might indicate a common pathogenesis of corneal and retinal changes in DM, which could be caused by reduced oxygen supply, mitochondrial dysfunction, oxidative stress, and cytokine effects.

Corneal Crosslinking With Riboflavin and UVA Light in Progressive Keratoconus: Fifteen-Year Results

PURPOSE

To analyze the 15-year results of corneal crosslinking (CXL) in progressive keratoconus.

DESIGN

Retrospective follow-up analysis of interventional study patients.

METHODS

This study included keratoconic eyes with progressive disease treated from 2001 to 2006 at the Department of Ophthalmology, Carl Gustav Carus University Hospital, TU Dresden, Germany. CXL was performed by applying riboflavin and ultraviolet A (UVA) light according to a standard protocol. The best-corrected distance visual acuity (BCVA), slitlamp examination, and corneal topography as well as corneal thickness values were recorded preoperatively and 15 years after the treatment.

RESULTS

A total of 42 eyes received a complete follow-up of 15 years. The mean age of the patients at baseline was 26.9 (95% CI: 25.0-28.8) years. The maximum keratometry was 61.6 (95% CI: 58.2 - 64.9) diopters (D) preoperatively and 55.1 (95% CI: 51.6-58.4) D postoperatively; the decrease was statistically significant (P < .001). The mean keratometry value changed from 50.3 (95% CI: 48.3-52.4) D to 47.5 (95% CI: 45.3-49.4) D (P < 0.001). Furthermore, the thinnest corneal thickness decreased statistically significantly by 40 (95% CI: 24-56) µm (P < .001). The BCVA improved statistically significantly from 0.4 to 0.2 logMAR after the treatment. Retreatment was needed in 14% of cases. Mild scarring of the superficial stromal corneal layers was observed in 36% of the eyes, and in 67% of them visual acuity was stable or even improved.

CONCLUSIONS

The CXL procedure proved to be an effective method in the treatment of keratoconic eyes in the progressive stage of the disease, and achieved long-term stabilization without the occurrence of serious complications or side effects.

Evaluation of corneal biomechanical properties using the ocular response analyzer and the dynamic Scheimpflug-Analyzer Corvis ST in high pressure and normal pressure open-angle glaucoma patients

PURPOSE

To characterize differences in corneal biomechanics in high (HPG) and normal pressure (NPG) primary open-angle glaucoma, and its association to disease severity.

METHODS

Corneal biomechanical properties were measured using the Ocular Response Analyzer (ORA) and the dynamic Scheimpflug-Analyzer Corvis ST (CST). Disease severity was functionally assessed by automated perimetry (Humphrey field analyzer) and structurally with the Heidelberg Retina Tomograph. To avoid a possible falsification by intraocular pressure, central corneal thickness and age, which strongly influence ORA and CST measurements, group matching was performed. Linear mixed models and generalized estimating equations were used to consider inter-eye correlation.

RESULTS

Following group matching, 60 eyes of 38 HPG and 103 eyes of 60 NPG patients were included. ORA measurement revealed a higher CRF in HPG than in NPG (P < 0.001). Additionally, the CST parameter integrated radius (P < 0.001) was significantly different between HPG and NPG. The parameter SSI (P < 0.001) representing corneal stiffness was higher in HPG than in NPG. Furthermore, regression analysis revealed associations between biomechanical parameters and indicators of disease severity. In HPG, SSI correlated to RNFL thickness. In NPG, dependencies between biomechanical readings and rim area, MD, and PSD were shown.

CONCLUSION

Significant differences in corneal biomechanical properties were detectable between HPG and NPG patients which might indicate different pathophysiological mechanisms underlying in both entities. Moreover, biomechanical parameters correlated to functional and structural indices of diseases severity. A reduced corneal deformation measured by dynamic methods was associated to advanced glaucomatous damage.

2-Jahres-Ergebnisse nach transskleraler MicroPulse-Lasertherapie bei Patienten mit primärem Offenwinkelglaukom

Hintergrund Untersuchung der langfristigen Effizienz und Sicherheit der transskleralen Lasertherapie (TLT) mittels MicroPulse über 24 Monate bei Patienten mit primärem Offenwinkelglaukom (POWG).

Material und Methoden In dieser prospektiven interventionellen Fallserie wurden die Daten von 44 Augen von medikamentös behandelten POWG-Patienten ausgewertet, die eine MicroPulse-TLT erhielten, um eine weitere Senkung des Augeninnendrucks (IOD) zu erreichen. Es wurden die Reduktion des 24-h-IODs, der zirkadianen IOD-Fluktuationen und der IOD-Spitzen nach 3, 12 und 24 Monaten untersucht. Zudem sollten postoperative Komplikationen, die Misserfolgsquote und Einflussfaktoren auf den Therapieerfolg analysiert werden.

Ergebnisse Der IOD ist von 16,1 ± 3,4 mmHg präoperativ auf 13,0 ± 2,9 mmHg (n = 31; p < 0,001) nach 3 Monaten, 12,3 ± 3,0 mmHg (n = 27; p < 0,001) nach 12 Monaten und 13,1 ± 2,6 mmHg (n = 23; p < 0,001) nach 24 Monaten gesunken. Nach 24 Monaten erreichten 23 Augen (52%) ihren individuellen Zieldruck. Es traten keine schwerwiegenden postoperativen Komplikationen auf. Es konnten keine Einflussfaktoren auf den Therapieerfolg identifiziert werden. Das häufigste Therapieversagen war innerhalb der ersten 3 postoperativen Monate zu beobachten und blieb danach nahezu stabil.

Schlussfolgerung Die MicroPulse-TLT zeigt eine gute IOD-Senkung bei Patienten mit primärem Offenwinkelglaukom und maximal tolerierter drucksenkender Lokaltherapie, wobei etwa 50% der Augen ihren individuellen Zieldruck erreichten.

Service evaluation: orthoptic-led teaching of soft contact lens handling for parents in the management of pediatric aphakia

To gauge parental satisfaction of an orthoptic-led specialist service for teaching soft contact lens (CL) handling in the management of children with pediatric aphakia. 20 families attending the contact lens clinic completed a satisfaction questionnaire to enquire about their experience of learning how to insert and remove their child's CL. Families were questioned on their experiences with preoperative counseling, practical teaching, additional support and the patient literature that was provided by the orthoptists in the CL clinic. Qualitative data and free comments were analyzed. 18/20 (90%) said they had received good practical insertion and removal teaching. 19/20 (95%) felt they received good emotional support. Only 6/20 (30%) families agreed with the statement that they found learning insertion and removal difficult. 15/20 (75%) families did not feel rushed, and 18/20 (90%) said they could learn at their own pace. All except one family (95%) achieved daily CL handling within a few months, with ongoing support from a multi-disciplinary team. One family surveyed was much earlier in their postoperative journey, but was on track to achieve this imminently. All families (100%) felt they were appropriately counselled preoperatively regarding the need for training and daily CL handling. 95% found the provided written information useful. 8/20 (40%) reported they found insertion harder than removal, 4/20(20%) reported they found removal harder. Teaching insertion and removal skills is an important aspect of managing paediatric aphakia and presents many challenges. Most parents eventually cope well and achieve daily CL handling within a few months, with support from a multi-disciplinary team. Families surveyed were all competent and were satisfied with their experience. The parental satisfaction survey gave our team confidence that our orthoptic-led service works well, orthoptists have the knowledge and skills to provide technical training to parents alongside vital emotional support, and contact lens handling is a rewarding extended role for orthoptists in a multi-disciplinary team.

Is the Corneal Thickness Profile Altered in Diabetes Mellitus?

Purpose: To investigate the influence of chronic hyperglycemia in diabetes mellitus (DM) on spatial corneal thickness distribution and to analyze the influence of disease-specific factors. Methods: DM patients and healthy subjects were matched according to age and intraocular pressure (IOP). In diabetics, disease duration, DM type, and HbA_1c value were assessed. Spatially resolved corneal thickness was measured by Pentacam HR. Thinnest corneal thickness (TCT) and peripheral pachymetry of concentric circles around TCT were determined. The Dynamic Scheimpflug Analyzer Corvis ST (CST) was used to measure the parameter pachy slope, which is an indicator of the change of corneal thickness from the apex to the periphery. Results: 59 DM patients and 57 healthy subjects were included. Age (P = .486) and IOP (P = .154) were not different between the groups. In DM, pachy slope was significantly higher than in healthy subjects (41.1 ± 9.87 vs. 35.18 ± 10.64 μm, P = .004). Also, the differences between TCT and the average of peripheral corneal thickness of concentric circles with a diameter of 2 mm (10.3 ± 1.7 vs. 9.3 ± 3.8 μm, P < .001) to 6 mm (82.2 ± 12.4 vs. 76.8 ± 12.6 μm, P = .011) were increased in patients. Changes in thickness profile were associated with HbA_1c value and presence of diabetic retinopathy or maculopathy. Conclusion: In DM, a stronger peripheral corneal thickness increase was detectable. This change was shown using the novel CST parameter pachy slope and confirmed by Pentacam readings. These alterations might affect IOP and biomechanical measurements, and influence refractive procedures.

Intraocular pressure measurements in diabetes mellitus

PURPOSE

To investigate the impact of diabetes mellitus-induced changes on intraocular pressure measurements using Goldmann applanation tonometry, Ocular Response Analyzer, and Corvis ST.

METHODS

Measurements were done using Goldmann applanation tonometry, Ocular Response Analyzer, and Corvis ST in 69 diabetic patients. Biomechanical-corrected intraocular pressure values by Ocular Response Analyzer (IOPcc) and Corvis ST (bIOP) were used. In addition, biometry and tomography were performed and information on diabetes mellitus specific factors was collected. Results were compared to an age-matched group of 68 healthy subjects.

RESULTS

In diabetes mellitus, Goldmann applanation tonometry intraocular pressure (P = 0.193) and central corneal thickness (P = 0.184) were slightly increased. Also, IOPcc (P = 0.075) and bIOP (P = 0.542) showed no significant group difference. In both groups, IOPcc was higher than Goldmann applanation tonometry intraocular pressure (P = 0.002, P < 0.001), while bIOP was nearly equal to Goldmann applanation tonometry intraocular pressure (P = 0.795, P = 0.323). Central corneal thickness showed a tendency to higher values in poorly controlled than in controlled diabetes mellitus (P = 0.059). Goldmann applanation tonometry intraocular pressure correlated to central corneal thickness, while IOPcc and bIOP were independent from central corneal thickness in both groups. All intraocular pressure values showed significant associations to corneal biomechanical parameters. Only in diabetes mellitus, bIOP was correlated to Pachy slope (P = 0.023).

CONCLUSION

In diabetes mellitus, Goldmann applanation tonometry intraocular pressure was slightly, but not significantly, increased, which might be caused by a higher central corneal thickness and changes in corneal biomechanical properties. However, intraocular pressure values measured by Ocular Response Analyzer and Corvis ST were not significantly different between diabetes mellitus patients and healthy subjects. The bIOP showed a higher agreement with Goldmann applanation tonometry than IOPcc and was independent from central corneal thickness.

The short-term effect of acupuncture on different ocular blood flow parameters in patients with primary open-angle glaucoma: a randomized, clinical study

Introduction

To investigate the effect of acupuncture on different ocular blood flow (OBF) parameters in patients with primary open-angle glaucoma (POAG).

Patients and methods

In a prospective, randomized study, 56 POAG patients were randomly assigned either to an eye-specific acupuncture (group I, n=28) or to an eye-unspecific acupuncture treatment (group II, n=28). Blood flow parameters were measured before and 10 minutes after treatment. Parapapillary retinal blood flow was determined by the Heidelberg retina flowmeter. Retinal vessel diameters were measured by the dynamic vessel analyzer. Pulsatile ocular blood flow, ocular pulse amplitude, and IOP were investigated by the Langham OBF system. Systemic blood pressure was obtained additionally.

Results

Pulsatile ocular blood flow increased significantly after the eye-specific acupuncture treatment from 5.6±4.3 to 6.7±4.9 µL/min (P=0.014). There was no significant change in parapapillary retinal blood flow, retinal vessel diameter, systemic blood pressure, or IOP after treatment in neither of the two groups.

Conclusion

An eye-specific acupuncture treatment may affect OBF in POAG patients.

Monitoring foveal sparing in geographic atrophy with fluorescence lifetime imaging ophthalmoscopy - a novel approach

PURPOSE

To investigate fundus autofluorescence (FAF) lifetimes in geographic atrophy (GA) with a focus on macular pigment (MP) and foveal sparing.

METHODS

The study included 35 eyes from 28 patients (mean age 79.2 ± 8.0 years) with GA. A 30° retinal field, centred at the macula, was investigated using fluorescence lifetime imaging ophthalmoscopy (FLIO). The FLIO technology is based on a Heidelberg Engineering Spectralis system. Decays of FAF were detected in a short (498-560 nm, SSC) and long (560-720 nm, LSC) spectral channel. The mean fluorescence lifetime, τ_m , was calculated from a three-exponential approximation of the FAF decays. Macular optical coherence tomography (OCT) scans as well as fundus photography were recorded.

RESULTS

Review of FLIO data reveals specific patterns of significantly prolonged τ_m in regions of GA (SSC 616 ± 343 ps, LSC 615 ± 154 ps) as compared to non-atrophic regions. Large τ_m differences between the fovea and atrophic areas correlate with better visual acuity (VA). Shorter τ_m at the fovea than within other non-atrophic regions indicates sparing, which was identified in 16 eyes. Seventy per cent of patients treated with lutein supplementation showed foveal sparing, whereas the rate among non-supplemented patients was 22%.

CONCLUSION

Using FLIO, we present a novel way to detect foveal sparing, investigate MP, and analyse variability of τ_m in different foveal regions (including the prognostic valuable border region) in GA. These findings support the potential utility of FLIO in monitoring disease progression. The findings also highlight the possibly protective effect of lutein supplementation, with implication in recording the presence and distributional pattern of MP.

Monitoring foveal sparing in geographic atrophy with fluorescence lifetime imaging ophthalmoscopy - a novel approach

PURPOSE

To investigate fundus autofluorescence (FAF) lifetimes in geographic atrophy (GA) with a focus on macular pigment (MP) and foveal sparing.

METHODS

The study included 35 eyes from 28 patients (mean age 79.2 ± 8.0 years) with GA. A 30° retinal field, centred at the macula, was investigated using fluorescence lifetime imaging ophthalmoscopy (FLIO). The FLIO technology is based on a Heidelberg Engineering Spectralis system. Decays of FAF were detected in a short (498-560 nm, SSC) and long (560-720 nm, LSC) spectral channel. The mean fluorescence lifetime, τ_m , was calculated from a three-exponential approximation of the FAF decays. Macular optical coherence tomography (OCT) scans as well as fundus photography were recorded.

RESULTS

Review of FLIO data reveals specific patterns of significantly prolonged τ_m in regions of GA (SSC 616 ± 343 ps, LSC 615 ± 154 ps) as compared to non-atrophic regions. Large τ_m differences between the fovea and atrophic areas correlate with better visual acuity (VA). Shorter τ_m at the fovea than within other non-atrophic regions indicates sparing, which was identified in 16 eyes. Seventy per cent of patients treated with lutein supplementation showed foveal sparing, whereas the rate among non-supplemented patients was 22%.

CONCLUSION

Using FLIO, we present a novel way to detect foveal sparing, investigate MP, and analyse variability of τ_m in different foveal regions (including the prognostic valuable border region) in GA. These findings support the potential utility of FLIO in monitoring disease progression. The findings also highlight the possibly protective effect of lutein supplementation, with implication in recording the presence and distributional pattern of MP.

Measurement of Orbital Biomechanical Properties in Patients with Thyroid Orbitopathy Using the Dynamic Scheimpflug Analyzer (Corvis ST)

PURPOSE

To investigate orbital biomechanical properties in patients with thyroid orbitopathy and in age- and gender-matched healthy subjects using the Corvis-ST (CST, Oculus Wetzlar, Germany).

METHODS

The CST allows a non-contact tonometry with an ultra-high-speed Scheimpflug device to record the deformation of the cornea during an air pulse. Biomechanical response parameters (intraocular pressure (IOP), whole eye movement length (WEMl) and time (WEMt), deflection amplitude 2 mm ratio max, deflection amplitude max, stiffness parameter, and biomechanically corrected IOP were measured in 39 patients with thyroid orbitopathy (= group I) and in 33 age- and gender-matched healthy subjects (= group II) using the CST.

RESULTS

Mean age in group I was 54.3 ± 11.6 years and in group II 54.2 ± 12.3 years with no statistical significant difference between the groups (P = 0.98). The gender distribution between the groups was not statistically significantly different (P = 0.51). Mean central corneal thickness was 571 ± 30 µm in group I and 563 ± 36 µm in group II (P = 0.306). There were statistically significant differences (P < 0.001) between groups I and II in mean IOP (19.3 ± 4.5 vs. 14.8 ± 2.3 mmHg, mean biomechanically corrected IOP (17.1 ± 3.4 vs. 13.4 ± 2.1 mmHg), mean WEMl (207 ± 57 vs. 322 ± 50 µm), mean WEMt (20.5 ± 1.0 vs. 21.9 ± 0.7 ms), mean IOP-adjusted WEMl (213 ± 56 vs. 314 ± 62 µm), and in mean stiffness parameter (132.5 ± 29.6 vs. 107.8 ± 23.3 mmHg/mm), respectively.

CONCLUSION

Biomechanical parameters as measured by the CST were significantly reduced in patients with thyroid orbitopathy compared to age- and gender-matched healthy subjects, indicating a reduction in orbital compliance in thyroid orbitopathy. The parameters WEMl and WEMt might be a useful diagnostic tool to evaluate the condition of the eyeball within the orbit.

Monitoring macular pigment changes in macular holes using fluorescence lifetime imaging ophthalmoscopy

PURPOSE

To investigate the impact of macular pigment (MP) on fundus autofluorescence (FAF) lifetimes in vivo by characterizing full-thickness idiopathic macular holes (MH) and macular pseudo-holes (MPH).

METHODS

A total of 37 patients with MH and 52 with MPH were included. Using the fluorescence lifetime imaging ophthalmoscope (FLIO), based on a Heidelberg Engineering Spectralis system, a 30° retinal field was investigated. FAF decays were detected in a short (498-560 nm; ch1) and long (560-720 nm; ch2) wavelength channel. τ_m , the mean fluorescence lifetime, was calculated from a three-exponential approximation of the FAF decays. Macular coherence tomography scans were recorded, and macular pigment's optical density (MPOD) was measured (one-wavelength reflectometry). Two MH subgroups were analysed according to the presence or absence of an operculum above the MH. A total of 17 healthy fellow eyes were included. A longitudinal FAF decay examination was conducted in nine patients, which were followed up after surgery and showed a closed MH.

RESULTS

In MH without opercula, significant τ_m differences (p < 0.001) were found between the hole area (MHa) and surrounding areas (MHb) (ch1: MHa 238 ± 64 ps, MHb 181 ± 78 ps; ch2: MHa 275 ± 49 ps, MHb 223 ± 48 ps), as well as between MHa and healthy eyes or closed MH. Shorter τ_m , adjacent to the hole, can be assigned to areas with equivalently higher MPOD. Opercula containing MP also show short τ_m . In MPH, the intactness of the Hele fibre layer is associated with shortest τ_m .

CONCLUSIONS

Shortest τ_m originates from MP-containing retinal layers, especially from the Henle fibre layer. Fluorescence lifetime imaging ophthalmoscope (FLIO) provides information on the MP distribution, the pathogenesis and topology of MH. Macular pigment (MP) fluorescence may provide a biomarker for monitoring pathological changes in retinal diseases.

Monitoring macular pigment changes in macular holes using fluorescence lifetime imaging ophthalmoscopy

PURPOSE

To investigate the impact of macular pigment (MP) on fundus autofluorescence (FAF) lifetimes in vivo by characterizing full-thickness idiopathic macular holes (MH) and macular pseudo-holes (MPH).

METHODS

A total of 37 patients with MH and 52 with MPH were included. Using the fluorescence lifetime imaging ophthalmoscope (FLIO), based on a Heidelberg Engineering Spectralis system, a 30° retinal field was investigated. FAF decays were detected in a short (498-560 nm; ch1) and long (560-720 nm; ch2) wavelength channel. τ_m , the mean fluorescence lifetime, was calculated from a three-exponential approximation of the FAF decays. Macular coherence tomography scans were recorded, and macular pigment's optical density (MPOD) was measured (one-wavelength reflectometry). Two MH subgroups were analysed according to the presence or absence of an operculum above the MH. A total of 17 healthy fellow eyes were included. A longitudinal FAF decay examination was conducted in nine patients, which were followed up after surgery and showed a closed MH.

RESULTS

In MH without opercula, significant τ_m differences (p < 0.001) were found between the hole area (MHa) and surrounding areas (MHb) (ch1: MHa 238 ± 64 ps, MHb 181 ± 78 ps; ch2: MHa 275 ± 49 ps, MHb 223 ± 48 ps), as well as between MHa and healthy eyes or closed MH. Shorter τ_m , adjacent to the hole, can be assigned to areas with equivalently higher MPOD. Opercula containing MP also show short τ_m . In MPH, the intactness of the Hele fibre layer is associated with shortest τ_m .

CONCLUSIONS

Shortest τ_m originates from MP-containing retinal layers, especially from the Henle fibre layer. Fluorescence lifetime imaging ophthalmoscope (FLIO) provides information on the MP distribution, the pathogenesis and topology of MH. Macular pigment (MP) fluorescence may provide a biomarker for monitoring pathological changes in retinal diseases.

Dependence of diameters and oxygen saturation of retinal vessels on visual field damage and age in primary open-angle glaucoma

PURPOSE

To investigate the interrelationship between the oxygen supply of the retina and its regulation with the severity of primary open-angle glaucoma (POAG).

METHODS

Central retinal artery (CRAE) and vein (CRVE) diameters and oxygen saturation of peripapillary retinal vessels in 41 patients suffering from POAG (64.1 ± 12.9 years) and 40 healthy volunteers (63.6 ± 14.1 years) were measured using the retinal vessel analyzer. All measures were taken before and during flicker light stimulation. The mean retinal nerve fiber layer thickness (RNFLT) was determined by OCT and the visual field mean defect (MD) was identified using perimetry.

RESULTS

In glaucoma patients, CRAE (r = -0.48 p = 0.002) and CRVE (r = -0.394 p = 0.014) at baseline were inversely related to MD, while arterial and venous oxygen saturation showed no significant dependence on the severity of the damage. However, the flicker light-induced change in arterio-venous difference in oxygen saturation was correlated with the MD (r = 0.358 p = 0.027). The diameters of arteries and veins at baseline decreased with reduction of the mean RNFLT (arteries: r = 0.718 p < 0.001; veins: r = 0.685 p < 0.001).

CONCLUSION

Vessel diameters showed a strong correlation with RNFLT and MD. This, as well as the reduction of stimulation-induced change in arterio-venous oxygen saturation difference with visual field loss, may be explained by a reduction of the retinal metabolic demand with progressive loss of neuronal tissue in glaucoma.

Single-cell analysis by RT-PCR reveals differential expression of multiple type 1 and 2 cytokine genes among cells within polarized CD4+ T cell populations

RT-PCR was used to examine the expression of IFN-gamma, IL-2, IL-4, IL-5, IL-6 and IL-10 mRNAs by single murine CD4+ T cells activated either in a strongly type 1-polarized mixed lymphocyte reaction (MLR) or in the type 2-polarized response to immunization with keyhole limpet hemocyanin (KLH) in alum. The frequencies of expression of each cytokine differed markedly between the two responses, consistent with their polarization at the population level. However, most cells expressed only none to three of the six cytokines assayed, few displayed the canonical type 1 profile and none in either response expressed a full type 2 or type 0 profile. A significant fraction of cells co-expressed IFN-gamma with IL-4 and/or other type 2 cytokines at frequencies that suggested that most of these genes were independently regulated. Collectively, these single-cell expression patterns indicate that polarization at the population level can mask substantial intercellular heterogeneity, and show directly that multiple type 1 and 2 cytokines can be expressed simultaneously in an individual T cell.

The CD4+ T-cell response to protein immunization is independent of accompanying IFN-gamma-producing CD8+ T cells

By virtue of their strong bias towards production of interferon-gamma (IFN-gamma), CD8+ T cells have the potential to promote the development of type 1 immune responses. We have previously shown that the CD4+ T-cell response to immunization with the protein antigen keyhole limpet haemocyanin (KLH) has a mixed interleukin-4 (IL-4)/IFN-gamma production profile. Here we show that this immunization regimen also stimulates accumulation in the draining lymph nodes of CD8+ T cells, which preferentially contain IFN-gamma mRNA ex vivo and secrete IFN-gamma protein in vitro. This provides a model to test whether CD8+ cell-derived IFN-gamma participates in the normal control of the immune response to a non-viable exogenous antigen. To investigate regulation of the anti-KLH response by the CD8+ population or IFN-gamma produced by this or other cell types, mice were administered depleting antibodies. Depletion of CD8+ cells had no effect on the frequency of clonogenic KLH-specific CD4+ T cells, the IL-4/IFN-gamma profiles of their progeny, or the isotype profiles of the serum antibody response to KLH. In contrast, IFN-gamma neutralization diminished cell accumulation in the lymph nodes and reduced both the frequency of KLH-specific CD4+ T cells that gave rise to IFN-gamma-producing clones and serum titres of KLH-specific IgG2a and IgG3. Therefore, despite the potential for cross-regulation, the CD4+ T-cell response to this immunogen is independent of the IFN-gamma-skewed CD8+ response.

Expression of tumour markers CA125, CASA and OSA in minimal/mild endometriosis

Ovarian cancer associated antigens CA125, CASA and OSA were measured in serum from 23 patients with mild endometriosis before, during and after medical therapy. Pretreatment CA125 levels were elevated above 35 mu/ml in 4(17%), and above 25 mu/ml in 7 (30%) patients. Mean CA125 levels decreased during treatment, but in only 10 patients did levels reflect disease response. There was no correlation between CA125 levels and disease severity as measured by modified American Fertility Society Scoring. Neither CASA nor OSA were detected in these women.

Clomipramine and exposure for chronic obsessive-compulsive rituals: III. Two year follow-up and further findings

Forty chronic ritualizers were given clomipramine or placebo from weeks 0 to 36; also all had exposure in vivo, half from weeks 4 to 10 (30 hours) and half from weeks 7 to 10 (15 hours). In the 37 patients available at week 114 there were substantial and maintained improvements in rituals, mood and social adjustment compared to week 0. Reduction of rituals was even greater in those who had 30 hours of exposure. There was no drug effect on rituals at two year follow-up. Greater initial anxiety or depression predicted the superiority of clomipramine over placebo from weeks 10 to 36 and more prescription of tricyclics in follow-up. However, two years outcome was not predicted by initial anxiety or depression, nor by sex, age, age of onset nor duration of rituals.

Guided mourning for morbid grief: a controlled study

During 2 weeks on a waiting list 12 patients with morbid grief did not improve significantly. They were then randomly allocated either to guided mourning treatment, in which they were encouraged to face cues concerning their bereavement, or to control treatment in which they were asked to avoid such cues. Each treatment comprised six 1 1/2 hour sessions over 2 weeks. At week 4 guided mourning patients had improved significantly more than had controls on 3 measures, with a supportive trend on 4 measures. Improvement, though modest, was maintained to 10-28 weeks follow-up. Control patients did not improve significantly or show any trend to do so.