TFOS Lifestyle: Impact of nutrition on the ocular surface

Nutrients, required by human bodies to perform life-sustaining functions, are obtained from the diet. They are broadly classified into macronutrients (carbohydrates, lipids, and proteins), micronutrients (vitamins and minerals) and water. All nutrients serve as a source of energy, provide structural support to the body and/or regulate the chemical processes of the body. Food and drinks also consist of non-nutrients that may be beneficial (e.g., antioxidants) or harmful (e.g., dyes or preservatives added to processed foods) to the body and the ocular surface. There is also a complex interplay between systemic disorders and an individual's nutritional status. Changes in the gut microbiome may lead to alterations at the ocular surface. Poor nutrition may exacerbate select systemic conditions. Similarly, certain systemic conditions may affect the uptake, processing and distribution of nutrients by the body. These disorders may lead to deficiencies in micro- and macro-nutrients that are important in maintaining ocular surface health. Medications used to treat these conditions may also cause ocular surface changes. The prevalence of nutrition-related chronic diseases is climbing worldwide. This report sought to review the evidence supporting the impact of nutrition on the ocular surface, either directly or as a consequence of the chronic diseases that result. To address a key question, a systematic review investigated the effects of intentional food restriction on ocular surface health; of the 25 included studies, most investigated Ramadan fasting (56%), followed by bariatric surgery (16%), anorexia nervosa (16%), but none were judged to be of high quality, with no randomized-controlled trials.

Differential methylation of microRNA encoding genes may contribute to high myopia

Introduction: High myopia (HM), an eye disorder with a refractive error ≤-6.0 diopters, has multifactorial etiology with environmental and genetic factors involved. Recent studies confirm the impact of alterations in DNA methylation and microRNAs (miRNAs) on myopia. Here, we studied the combined aspects evaluating to the role of methylation of miRNA encoding genes in HM. Materials and Methods: From the genome-wide DNA methylation data of 18 Polish children with HM and 18 matched controls, we retrieved differentially methylated CG dinucleotides localized in miRNA encoding genes. Putative target genes of the highest-ranked miRNAs were obtained from the miRDB and included in overrepresentation analyses in the ConsensusPathDB. Expression of target genes was assessed using the RNA sequencing data of retinal ARPE-19 cell line. Results: We identified differential methylation of CG dinucleotides in promoter regions of MIR3621, MIR34C, MIR423 (increased methylation level), and MIR1178, MIRLET7A2, MIR885, MIR548I3, MIR6854, MIR675, MIRLET7C, MIR99A (decreased methylation level) genes. Several targets of these miRNAs, e.g. GNAS, TRAM1, CTNNB1, EIF4B, TENM3 and RUNX were previously associated with myopia/HM/refractive error in Europeans in genome-wide association studies. Overrepresentation analyses of miRNAs' targets revealed enrichment in pathways/processes related to eye structure/function, such as axon guidance, transcription, focal adhesion, and signaling pathways of TGF-β, insulin, MAPK and EGF-EGFR. Conclusion: Differential methylation of indicated miRNA encoding genes might influence their expression and contribute to HM pathogenesis via disrupted regulation of transcription of miRNAs' target genes. Methylation of genes encoding miRNAs may be a new direction in research on both the mechanisms determining HM and non-invasive indicators in diagnostics.

Decreased Levels of DNA Methylation in the PCDHA Gene Cluster as a Risk Factor for Early-Onset High Myopia in Young Children

Purpose

High myopia (HM), an eye disorder with at least –6.0 diopters refractive error, has a complex etiology with environmental, genetic, and likely epigenetic factors involved. To complement the DNA methylation assessment in children with HM, we analyzed genes that had significantly lower DNA methylation levels.

Methods

The DNA methylation pattern was studied based on the genome-wide methylation data of 18 Polish children with HM paired with 18 controls. Genes overlapping CG dinucleotides with decreased methylation level in HM cases were assessed by enrichment analyses. From those, genes with CG dinucleotides in promoter regions were further evaluated based on exome sequencing (ES) data of 16 patients with HM from unrelated Polish families, Sanger sequencing data of the studied children, and the RNA sequencing data of human retinal ARPE-19 cells.

Results

The CG dinucleotide with the most decreased methylation level in cases was identified in a promoter region of PCDHA10 that overlaps intronic regions of PCDHA1–9 of the PCDHA gene cluster in myopia 5q31 locus. Also, two single nucleotide variants, rs200661444, detected in our ES, and rs246073, previously found as associated with a refractive error in a genome-wide association study, were revealed within this gene cluster. Additionally, genes previously linked to ocular phenotypes, myopia-related traits, or loci, including ADAM20, ZFAND6, ETS1, ABHD13, SBSPON, SORBS2, LMOD3, ATXN1, and FARP2, were found to have decreased methylation.

Conclusions

Alterations in the methylation pattern of specific CG dinucleotides may be associated with early-onset HM, so this could be used to develop noninvasive biomarkers of HM in children and adolescents.

Retinal Vascular Endothelial Cell Dysfunction and Neuroretinal Degeneration in Diabetic Patients

Diabetes mellitus (DM) has become a vital societal problem as epidemiological studies demonstrate the increasing incidence of type 1 and type 2 diabetes. Lesions observed in the retina in the course of diabetes, referred to as diabetic retinopathy (DR), are caused by vascular abnormalities and are ischemic in nature. Vascular lesions in diabetes pertain to small vessels (microangiopathy) and involve precapillary arterioles, capillaries and small veins. Pericyte loss, thickening of the basement membrane, and damage and proliferation of endothelial cells are observed. Endothelial cells (monolayer squamous epithelium) form the smooth internal vascular lining indispensable for normal blood flow. Breaking its continuity initiates blood coagulation at that site. The endothelium controls the process of exchange of chemical substances (nutritional, regulatory, waste products) between blood and the retina, and blood cell passing through the vascular wall. Endothelial cells produce biologically active substances involved in blood coagulation, regulating vascular wall tension and stimulating neoangiogenesis. On the other hand, recent studies have demonstrated that diabetic retinopathy may be not only a microvascular disease, but is a result of neuroretinal degeneration. Neuroretinal degeneration appears structurally, as neural apoptosis of amacrine and Muller cells, reactive gliosis, ganglion cell layer/inner plexiform (GCL) thickness, retinal thickness, and retinal nerve fiber layer thickness, and a reduction of the neuroretinal rim in minimum rim width (MRW) and functionally as an abnormal electroretinogram (ERG), dark adaptation, contrast sensitivity, color vision, and microperimetric test. The findings in early stages of diabetic retinopathy may precede microvascular changes of this disease. Furthermore, the article's objective is to characterize the factors and mechanisms conducive to microvascular changes and neuroretinal apoptosis in diabetic retinopathy. Only when all the measures preventing vascular dysfunction are determined will the risk of complications in the course of diabetes be minimized.

Comparison of the Diagnostic Power of Serum IL-6, IL-8 and TNF-α for the Idiopathic Anterior Uveitis in Children

BACKGROUND

Uveitis is the inflammation of the uvea that often occurs in children. There are many causes of disease, but some of them do not have any reasons and are then called idiopathic uveitis. Cytokines play an important role in the regulation of the immune response. Determination of cytokine profiles could contribute to the explanation of the etiology of uveitis and could serve to evaluate the inflammation intensity as well as be helpful in the early diagnosis this disease. The purpose of this study was to determine the serum level of selected inflammatory cytokines, such as interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor α (TNF-α) and to compare their diagnostic power as a markers of idiopathic anterior uveitis in children.

METHODS

The study was carried out on 28 children diagnosed with idiopathic anterior uveitis. The reference group comprised 30 healthy children. Serum IL-6, IL-8, and TNF-α concentrations were measured with specific enzyme-linked immunoassay (ELISA) methods.

RESULTS

The mean values of IL-6, IL-8, and TNF-α in the children with idiopathic anterior uveitis were significantly higher than those found in the reference group. The highest sensitivity, specificity, accuracy, positive and negative predictive value, and likelihood ratio of a positive test result were achieved for IL-8. There was a significant difference between the area under the curve for IL-6 and IL-8.

CONCLUSIONS

Increased serum concentrations of interleukin IL-6, IL-8, and TNF-α may suggest that these cytokines induce inflammatory changes in the ocular surface. Analysis of cytokine levels showed that IL-8 has the highest diagnostic power and is the best marker for diagnosis of idiopathic anterior uveitis in children.

Evidence against ZNF469 being causative for keratoconus in Polish patients

PURPOSE

Keratoconus (KTCN) is a degenerative disorder characterized by stromal thinning and protrusion of the cornea, resulting in severe impairment of visual function. A recent study proposed that rare heterozygous mutations in ZNF469 determine KTCN aetiology.

METHODS

To investigate the contribution of ZNF469 to KTCN, we Sanger sequenced ZNF469 in 42 unrelated Polish patients with KTCN and 49 Polish individuals with high myopia (HM) and compared the results with whole-exome sequencing (WES) data performed in 268 Polish individuals without ocular abnormalities.

RESULTS

The average number of ZNF469 non-synonymous variants was 16.31 and 16.0 for individuals with KTCN and HM, respectively (p = 0.3724). All identified variants were previously reported. Alternative allele frequency (AAF) was determined based on the WES results. Among missense variants, only one (rs528085780) has AAF ≤ 0.001 and was identified in one patient with sporadic KTCN. However, the resulting Arg1864Lys substitution was not predicted to be deleterious.

CONCLUSION

In summary, we have not found a significant enrichment of sequence variants in ZNF469 in Polish patients with KTCN. High prevalence of ZNF469 variants identified in our KTCN group is typical for a common genetic variation observed in general population. Our findings indicate that variation in ZNF469 is not responsible for KTCN and other genetic variants are involved in the development and progression of this disease in Polish patients.

Elevated percentage of HLA-DR⁺ and ICAM-1⁺ conjunctival epithelial cells in active Graves' orbitopathy

Background

To evaluate if conjunctival epithelial cells’ expression of HLA-DR and ICAM-1 could be helpful as early topical markers of inflammation in Graves’ orbitopathy (GO).

Methods

The ocular examination evaluated a clinical activity score (CAS) by assessment of clinical features, (e.g., eyelid or conjunctival inflammation, lid width, lid closure, proptosis, ocular motility). Conjunctival epithelial cell specimens for flow-cytometric evaluations of ICAM-I and HLADR expression were collected by impression cytology from ten eyes with active GO (CAS ≥ 4 and duration ≤ 12 months), from 15 eyes with Graves’ disease (GD) without active GO (CAS 0–2) and from 15 normal specimens without any ocular disorders.

Results

The percentage of HLA-DR + conjunctival epithelial cells was significantly elevated in patients with active GO comparing to GD without active GO and healthy controls, 10.7 % (8.5–17.7) and 7.78 % (3.92–10.1) (p < 0.05) vs. control 4.89 % (3.5–5.5) (p < 0.005), respectively. The expression of ICAM − 1+ conjunctival epithelial cells was greater only in patients with GO vs. controls, 5.5 % (4.8–7.03) and 1.46 % (0.69–2.51) (p < 0.005), respectively.

Conclusion

The percentage of HLA-DR⁺ and ICAM-1⁺ conjunctival epithelial cells in patients with the active GO may serve as a topical inflammation marker in Graves’ orbitopathy.

IGF-1 gene polymorphisms in Polish families with high-grade myopia

PURPOSE

Recent work has suggested that insulin-like growth factor 1 (IGF-1) gene polymorphisms are genetically linked with high-grade myopia (HM), which is a complex-trait eye disorder in which numerous candidate loci and genes are thought to play a role. We investigated whether the IGF-1 single nucleotide polymorphisms (SNPs) rs6214, rs10860860, and rs2946834 are associated with HM (≤-6.0 diopters [D]) and any myopia (≤-0.5 D) phenotype in Polish families.

METHODS

Forty-two multiplex HM Polish families, of whom 127 had HM, participated in the study. All of the family members (n=306) underwent a detailed ophthalmic examination, including axial length measurements. The IGF-1 SNPs rs6214, rs10860860, and rs2946834 were evaluated by PCR-RFLP and direct sequencing methods. Both Family-Based Association Test (FBAT) and family-based Pedigree Disequilibrium Test (PDT) were used to examine the potential association of the IGF-1 SNPs rs6214, rs10860860, and rs2946834 with HM or any myopia. To determine the distribution of the HM-associated SNPs rs6214 and rs10860860, 543 unrelated individuals from the general Polish population were also analyzed.

RESULTS

We found no significant association between the IGF-1 SNPs rs6214, rs10860860, and rs2946834 and HM or any myopia phenotype in Polish HM families. In the general Polish population, the minor allele frequencies of the SNPs rs6214 and rs10860860 did not deviate significantly from the distribution reported for European populations (p=0.629). In the FBAT analysis under the dominant model, the haplotype consisted of T allele of rs10860860, with C allele of rs2946834 of IGF-1 was found less frequently transmitted to HM individuals (p=0.0065), pointing to a nonassociated or protective haplotype.

CONCLUSIONS

Our results do not support recent studies reporting an association of the SNPs rs6214, rs10860860, and rs2946834 in the IGF-1 gene with HM and any myopia phenotypes. Further replication studies involving other populations are needed to investigate the possible role of IGF-1 as a potential myopia candidate gene.

Identification of novel suggestive loci for high-grade myopia in Polish families

PURPOSE

Myopia is the most common human eye disorder with complex genetic and environmental causes. To date, several myopia loci have been identified in families of different geographic origin. However, no causative gene(s) have yet been identified. The aim of this study was the characterization of Polish families with high-grade myopia, including genetic analysis.

METHODS

Forty-two multiplex Polish families with non-syndromic high-grade myopia participated in the study. All family members underwent detailed ophthalmic examination and high-grade myopia was defined as ≤-6.0 diopters (D) based on the spherical refractive error. A genome-wide single nucleotide polymorphism (SNP)-based high-density linkage scan was performed using Affymetrix Human SNP Array 6.0 on a selected family (HM-32) with multiple affected individuals.

RESULTS

Nonparametric linkage analysis identified three novel loci in family HM-32 at chromosome 7p22.1-7p21.1 ([NPL] 8.26; p=0.006), chromosome 7p12.3-7p11.2 ([NPL] 8.23; p=0.006), and chromosome 12p12.3-12p12.1 ([NPL] 8.02; p=0.006), respectively. The effect of linkage disequilibrium on linkage due to dense SNP map was addressed by systematically pruning SNPs from the linkage panel.

CONCLUSIONS

Haplotype analysis with informative crossovers in affected individuals defined a 12.2; 10.9; and 9.5 Mb genomic regions for high-grade myopia spanned between SNP markers rs11977885/rs10950639, rs11770622/rs9719399, and rs4763417/rs10842388 on chromosomes 7p22.1-7p21.1, 7p12.3-7p11.2, and 12p12.3-12p12.1, respectively.

CCL4/MIP-1beta levels in tear fluid and serum of patients with cystic fibrosis

Cystic fibrosis (CF) is an autosomal recessive genetic disorder. The disease affects all secretory epithelia including the eye and belongs to the group of ocular surface epithelial diseases, termed keratoconjunctivitis sicca that develop in dry eye. In the pathogenesis of dry eye, inflammation plays a crucial role. The aim of this study was to assess the potential role of MIP-1beta in the pathogenesis of dry eye syndrome in patients with CF. We assayed MIP-1beta levels in tear fluid and serum of 28 patients with CF and 27 controls by ELISA. The ophthalmic examinations including the tests for dry eye were used to study the ocular surface. The tear levels of MIP-1beta in the CF patients were significantly higher than those in the controls. Dry eye syndrome was observed in 10 (36%) CF patients. The tear fluid levels of MIP-1beta were significantly raised in CF patients with dry eye syndrome compared with CF patients without dry eye symptoms. Our results suggest a crucial role of CCL4/MIP-1beta in the development of dry eye syndrome in CF patients and immunopathogenesis of ocular surface changes in this disease. Clarification of the role of CCL4/MIP-1beta in the pathogenesis of ocular findings in CF patients will be useful in establishing immunotherapeutic strategies for this disease.

Fas expression in conjunctival epithelial cells of patients with cystic fibrosis

Cystic fibrosis (CF) is a genetic disease caused by mutations in the cystic fibrosis transmembrane regulator (CFTR) gene resulting in absent or deficient expression and function of CFTR protein. It has recently been reported that CFTR may also be involved in the apoptotic process of epithelial cells. In this study we examined the expression of Fas on conjunctival epithelial cells and the serum and tear fluid concentrations of soluble Fas (sFas) in patients with cystic fibrosis. This article studied 25 patients with CF and 25 normal subjects. Conjunctival epithelial cells were obtained by impression cytology, and processed and analyzed for flow cytometry. The amount of sFas in serum and tear fluid was measured by enzyme-linked immunosorbent assay (ELISA). The analysis of Fas expression showed significant increases in the CF patients compared with the control group (P = 0.000012). There was no difference in the concentration of serum and tear fluid sFas between CF patients and controls (P = 0.0515 and P < 0.05, respectively). Fas expression in cystic fibrosis conjunctival epithelium could play an important role in controlling local inflammatory cell apoptosis and may confirm the role of Fas in maintaining ocular immune privilege.

IL-8 and IFN-gamma in tear fluid of patients with cystic fibrosis

Cystic fibrosis (CF) is inherited as an autosomal recessive disorder. It is caused by mutations in the protein-coding gene of chromosome 7, resulting in chronic pulmonary disease and pancreatic insufficiency. The disease affects all secretory epithelia, including the eye. The pathogenesis of ocular changes in CF is still unknown, but the involvement of immunologic processes in patients with CF has been studied in recent years. We measured interleukin-8 (IL-8) and interferon-gamma (IFN-gamma) levels in tears in a group of patients and a group of normal controls to determine if the levels of these cytokines are elevated in CF. The levels of these cytokines in tears and the clinical severity of CF and eye disease were compared. Tear samples were collected from 24 patients with CF at the department of pediatric diseases, Medical University of Bialystok, Poland. Cytokine levels were determined by ELISA. Ophthalmic examinations, including tests for keratoconjunctivitis sicca (dry eye), were used to study the ocular surface. The tear levels of IL-8 and IFN-gamma in the CF patients were significantly higher than those in controls. The clinical severity of CF correlated significantly with the IL-8 and IFN-gamma levels. We found positive correlation between the tear levels of IFN-gamma and dry eye findings in CF patients. Our results suggest that the inflammatory cytokines IL-8 and IFN-gamma may play key roles in the regulation of ocular surface inflammation and the immunologic reaction in patients with CF. The tear levels of IL-8 and IFN-gamma may be candidate markers for evaluation of the clinical status of CF and eye disease. These findings help to provide a new insight into the pathogenesis of dry eye in patients with CF and provide potential targets for therapy.

Elevated tear fluid levels of MIP-1alpha in patients with cystic fibrosis

Cystic fibrosis (CF) is the commonest multisystem genetic disease of white races, caused by mutations in the cystic fibrosis transmembrane regulator (CFTR), encoded on the long arm of chromosome 7. Mutations in the CFTR gene result in defective sodium, chloride, and water transport in the epithelial cells of the respiratory, hepatobiliary, gastrointestinal, and reproductive tracts, the pancreas, and the eye. The pathogenesis of ocular changes in CF is still unknown, but CF belongs to the large pathologic group of ocular surface epithelial diseases, termed keratoconjunctivitis sicca (KCS), that develop in dry eye syndrome. The aim of this study was to evaluate the levels of macrophage inflammatory protein-1alpha (MIP-1alpha) in the tear fluid of CF patients. We also investigated the correlation between the tear levels of this chemokine and clinical severity of CF and ocular surface disease. We studied 25 patients with CF with a mean age of 14 years. Chemokine levels were determined by ELISA. Complete ophthalmic examination, including dry eye tests, were used to study the ocular surface. The tear levels of MIP-1alpha in the CF patients were significantly higher when compared with healthy controls. We found a negative correlation between the tear levels of MIP-1alpha and clinical severity in CF patients and a positive correlation between the tear levels of MIP-1alpha and the presence of dry eye findings in CF patients. This current study indicates that chemokines play an important role in the ongoing inflammatory response. Our findings may help to explain one of the key factors contributing to the pathogenesis of ocular surface changes in CF patients.

Impression cytology of the conjunctival epithelial cells in patients with cystic fibrosis

PURPOSE

Cystic fibrosis (CF) is the most frequent lethal autosomal recessive hereditary disorder. The disease affects all secretory epithelia, including the eye, and belongs to the group of ocular surface epithelial diseases, termed keratoconjunctivitis sicca or dry eye syndrome. The aim of this study was to evaluate goblet cell population and conjunctival epithelial morphology in patients with CF.

METHODS

A total of 20 CF patients and 20 controls underwent conjunctival impression cytology.

RESULTS

Impression cytology showed conjunctival squamous metaplasia and goblet cell loss in patients with CF.

CONCLUSION

Reduced goblet cell numbers and squamous metaplasia may be indicative of a higher degree of epithelial damage of conjunctival epithelial cells in CF patients, and the presence of neutrophils is a strong sign for an inflammatory background of this disease.In view of the simple, noninvasive nature of impression cytology, this technique may prove to be an important tool for the diagnosis and monitoring of dry eye changes in CF patients.

ICAM-1 expression on conjunctival epithelial cells in patients with cystic fibrosis

BACKGROUND

Cystic fibrosis is one of the most common lethal genetic conditions. The defect is due to mutations in a gene on chromosome 7, named the cystic fibrosis transmembrane regulator (CFTR), which functions as a chloride channel in epithelial membranes It is presumed that the disease affects all secretory epithelia including the eye. The objective of this study is to investigate the expression of intercellular adhesion molecule-1 (ICAM-1) by conjunctival epithelial cells of patients with cystic fibrosis and the correlation between of the expression of ICAM-1 and the grade of cystic fibrosis severity.

METHODS

Impression cytology specimens were collected in 24 patients with cystic fibrosis. Cells were processed for flow cytometry, by using monoclonal antibodies to ICAM-1.

RESULTS

A significant increase of ICAM-1 expression on epithelial cells was found in patients with cystic fibrosis when compared with normal eyes. A positive correlation between the ICAM-1 expression and severe clinical status of CF patients was also observed.

CONCLUSIONS

Our findings suggest that the inflammation appears to have a role in the pathogenesis of the ocular surface changes in patients with cystic fibrosis. ICAM-1 expression on conjunctival epithelial cells may be a marker of the inflammatory status in cystic fibrosis patients. The method described here reveal good repeatability and reliability for the analysis of the inflammatory markers on conjunctival epithelial cells and can be a useful tool in evaluating of the ocular findings and treatment interventions in patients with cystic fibrosis.

Flow cytometric analysis of HLA-DR antigen in conjunctival epithelial cells of patients with cystic fibrosis

PURPOSE

Cystic fibrosis (CF) is an autosomal-recessive genetic disorder. The disease affects all secretory epithelia including the eye and belongs to the group of ocular surface epithelial diseases, termed keratoconjunctivitis sicca that develop in dry eye. In the pathogenesis of dry eye, inflammation plays a crucial role. The aim of this study was to investigate the expression of HLA-DR on conjunctival epithelial cells from patients with CF.

MATERIALS AND METHODS

Twenty-five patients with CF and 25 normal subjects underwent ocular examination. Tear film break-up time (TBUT), Schirmer test, lissamine green staining, and conjunctival impression cytology were carried out. Cells were processed for flow cytometry, by using monoclonal antibodies to HLA-DR.

RESULTS

The Schirmer test and TBUT scores were significantly lower in CF patients compared with controls. A significant increase of HLA-DR expression on epithelial cells was found in patients with CF compared with normal eyes. The Schirmer and TBUT test were positively correlated with HLA-DR expression for the percentage of cells.

CONCLUSION

These results suggest that conjunctival epithelial cells play an important proinflammatory role in ocular changes in CF patients. Our findings confirm the presence of an inflammatory background and the immune nature of this disease. HLA-DR measurement might be a useful method for monitoring of inflammatory processes in the conjunctiva and could be helpful in the use of anti-inflammatory drugs in the treatment of ocular findings in CF patients.

Macular pigmentary changes as a sequelae of retinal hemorrhages in premature infants with retinopathy of prematurity

PURPOSE

We assess the incidence of macular changes in ROP patients with retinal hemorrhages.

PATIENTS AND METHODS

The premature group consisted of 360 children born 32 weeks gestation and/or with weight below 1,500 g. We used the RetCam-120 Digital Retinal Camera to document retinal changes.

RESULTS

Of the 360 premature infants 241 (67%) had no ROP, and 119 (33%) had ROP. Of the preterm infants with ROP retinal hemorrhages were found in 46 (38%) children. Of the newborns with ROP and with retinal hemorrhages, macular pigmentary changes were found in 3 (6%) patients. Of these 3 patients, the first had pre-threshold ROP, the second threshold ROP and had underwent diode laser photocoagulation, and the third patient had stage 2 ROP. In the patients with pre-threshold and threshold ROP retinal hemorrhages appeared 6 weeks after birth and macular pigmentary changes were found 6 months after birth. In the patient with stage 2 ROP hemorrhages appeared 7-8 weeks after birth and macular pigmentary changes were detected 12 months after birth.

CONCLUSIONS

Although macular hemorrhages almost always resorb without complications, our study allows the assumption that retinal hemorrhages may cause macular pigmentary changes in the macula, and thus may lead to deprivation amblyopia. Our results may suggest that the presence of the macular pigmentary changes may be related to the hemorrhage and not to the specific therapy or to the disease.

Retinol binding protein status in relation to ocular surface changes in patients with cystic fibrosis treated with daily vitamin A supplements

Cystic fibrosis (CF) is an autosomal recessive disease characterised by increased viscosity of mucus secretions and high chloride concentration in exocrine secretions. Clinically, the patients suffer from chronic pulmonary changes, chronic pancreatic deficiency, and an obstruction of the gastrointestinal tract. The disease affects all secretory epithelia including the eye. The influence of nutritional status on long-term survival and quality of life of CF patients is well documented. Steatorrhea, a consequence of decreased fat digestion and absorption may be associated with vitamin deficiences, including vitamin A. The aim of this study was to document plasma retinol binding protein (RBP) status, a specific plasma transport protein for vitamin A, and ocular surface changes in children and adolescents with CF. The patients were recruited at the 3rd Department of Paediatric Diseases, Medical University of Bialystok, Poland. All patients were regularly seen by a CF specialist dietitian. A group of 15 patients had the following investigations: plasma RBP, visual acuity, physical examination, tear film break-up time, fluorescein staining and Schirmer tear test. A group of 15 age- and sex-matched controls without CF or ocular pathology were also recruited. Plasma RBP concentrations were significantly lower in patients with CF than in the control group. CF patients showed a statistically significant increase in the incidence of clinical blepharitis. Five of the CF patients had clinical evidence of dry eyes.

CONCLUSION

Low plasma retinol binding protein levels frequently occur in clinically stable and retinol supplemented cystic fibrosis patients, of whom five had dry eyes. We recommend monitoring of plasma retinol binding protein levels and evaluation of ocular surface changes, especially those with dry eye symptoms in all cystic fibrosis patients.

Optical Coherence Tomography Measurement of the Retinal Nerve Fiber Layer in Normal and Juvenile Glaucomatous Eyes

The aim of this study was to quantitatively assess and compare the thickness of the retinal nerve fiber layer (RNFL) in normal and glaucomatous eyes of children using the optical coherence tomograph. The mean RNFL thickness of normal eyes (n=26) was compared with that of glaucomatous eyes (n=26). The eyes were classified into diagnostic groups based on conventional ophthalmological physical examination, Humphrey 30-2 visual fields, stereoscopic optic nerve head photography, and optical coherence tomography. The mean RNFL was significantly thinner in glaucomatous eyes than in normal eyes: 95+/-26.3 and 132+/-24.5 microm, respectively. More specifically, the RNFL was significantly thinner in glaucomatous eyes than in normal eyes in the inferior quadrant: 87+/-23.5 and 122+/-24.2 microm, respectively. The mean and inferior quadrant RFNL thicknesses as measured by the optical coherence tomograph showed a statistically significant correlation with glaucoma. Optical coherence tomography may contribute to tracking of juvenile glaucoma progression.

Pediatric ophthalmologic findings of Cohen syndrome in twins

We present the clinical findings and follow-up data of male twins with Cohen syndrome. The most characteristic ophthalmologic findings were down-slanting eyelids, lens opacities, chorioretinal dystrophy, pigmentary retinal deposits, pale disk, and bull's eye maculae.

Use of optical coherence tomography in myopia

PURPOSE

To measure retinal thickness and retinal nerve fiber layer thickness using optical coherence tomography in patients with myopia.

PATIENTS AND METHODS

Thirty patients (13 girls and 17 boys) 14 to 18 years old were included in the study. The control group consisted of 15 patients. Each patient was subjected to routine ophthalmic investigations, which included the assessment of visual acuity for near and distant objects, autorefractometry, measurement of intraocular pressure, biometry, and assessment of the static visual field. The foveal retinal thickness and the peripapillary nerve fiber layer thickness were measured using optical coherence tomography.

RESULTS

The mean foveal retinal thickness was 231.0 microm in eyes with low myopia, 218.0 microm in eyes with medium myopia, and 178.0 microm in eyes with high myopia. The mean thickness of the retinal nerve fiber layer was 150.0 microm, 140.0 microm, and 152.0 microm, respectively. Statistically significant differences were revealed between patients with high myopia and the control group.

CONCLUSION

Optical coherence tomography can be employed to assess the retinal thickness and thus facilitate the detection of the evolution of alterations in myopia.

[Selected markers of T cell activation in children with idiopathic uveitis]

The aim of our investigation was to assess T cell activation markers (CD69, HLA-DR, CD25, CD49a) in idiopathic uveitis. T cells from children aged 9-17 with idiopathic uveitis were studied. Monoclonal antibodies against chosen markers of T cell activation were used. Expression of the CD69, HLA-DR, CD25, CD49a were determined by flow-cytometry. HLA-DR and CD49a--marker of the late activation--were significantly increased.

[Sub-retinal fluid interleukin-10 (Il-10) and interleukin-13 (Il-13) concentration in patients with retinal detachment]

PURPOSE

To evaluate the presence of IL-10 and IL-13 in subretinal fluid of patients with rhegmatogenous retinal detachment.

MATERIAL AND METHOD

The studies comprised 14 patients on with retinal detachment operated. The presence of cytokines was evaluated using immunoenzymatic assay.

RESULTS

IL-10 and IL-13 were found in all subretinal fluid samples. Our results suggest that the presence of IL-10 and IL-13 has the influence on suppression of inflammatory agent release and activity during retinal detachment.

[Morning glory syndrome: a case report]

The case of morning glory syndrome in two years old patient is presented.

[The results of surgery on squint with pathological muscle attachment]

The aim of our study was to evaluate the results of the operation on squint with pathological attachment of lateral rectus revealed during surgery.

MATERIAL AND METHODS

The study involved 22 children (12 girls and 10 boys) out of 320 children operated on for squint in the years 1993-1996, who had pathological attachment of lateral rectus. Alternating convergent squint was found in 12 children, unilateral in 10. Muscle exposure showed dislocation of lateral rectus attachment--upwards by c. 1.5 mm in 11 children, downwards and obliquely by c. 2 mm in 10 children, in 1 child the upper part of the attachment was shifted forward by 1 mm. During the surgery, in addition to the reduction of squint angle, physiological attachment of the rectus was reconstructed.

RESULTS

The operation restored parallel position of the eyes in 22 children, very good vision was obtained in 12 (54%) with alternating convergent squint, significant improvement in 5 (22%) with unilateral convergent squint, and only slight improvement in the remaining 5 (22.7%) with high initial amblyopia and squint angle from +15 degrees to +30 degrees.

[Biological activity of subretinal fluid in selected in vitro tests]

PURPOSE

The aim of this study was to evaluate the ability of SRF to activate autologous leucocytes derived from the peripheral blood.

MATERIAL AND METHOD

We studied 49 patients with idiopathic retinal detachment. Leucocyte migration inhibition, proliferation of T-lymphocytes after PHA stimulation, nonspecific suppressor activity induced by Con A, T-lymphocytes IL-2 production and basophils histamine release were assessed.

RESULTS

Lymphocytes obtained from patients with retinal detachment lasting 3-4 weeks exhibited in vitro in the presence of SRF: increased ability to produce IL-2, increased proliferation after PHA stimulation and increased nonspecific T-suppressor activity induced by Con A. SRF enhanced also leucocyte migration inhibition and release of histamine from basophils.

[Rubinstein-Taybi syndrome--case report]

The authors described symptoms of Rubinstein-Taybi syndrome and presented a treatment of this disease. It concerned a 1-year-old baby with obstruction of left lacrimal ducts, psychomotor retardation and facial abnormalities.

[Evaluation of posterior capsule opacification after extracapsular cataract extraction with and without implantation of intraocular lens]

PURPOSE

The aim of the study was evaluation of the rate of posterior capsule opacification after extracapsular cataract extraction with and without implantation of intraocular lens.

MATERIAL AND METHOD

The clinical material comprised 77 patients operated on in the years 1990-1994. Only the cases in which visual acuity exceeded 5/10 were included into the study. 107 eyes were examined, among them 75 after implantation of posterior chamber intraocular lens.

RESULTS

Opacification of the posterior capsule occurred in 37 eyes, but only in 25 of 75 eyes in the patients with implantation of the artificial lens. We found that following extracapsular cataract extraction without implantation of intraocular lens, opacification of the posterior capsule occurs more frequently, especially during 1-2 years after the surgery.

CONCLUSION

Cortical-nuclear cataract and not much advanced age are factors predisposing for greater rate of opacification of the posterior capsule after extracapsular cataract extraction.

[Concentration of selected cytokines in subretinal fluid in patients with retinal detachment (IL-8, TNF-alpha, IFN-gamma)]

PURPOSE

The aim of this study was to evaluate the presence of IL-8, TNF-alpha, IFN-gamma in subretinal fluid of patients with rhegmatogenous retinal detachment.

MATERIAL AND METHODS

We studied 15 patients operated on retinal detachment. The presence of cytokines was evaluated using immunoenzymatic assay.

RESULTS

IL-8, TNF-alpha and IFN-gamma were found in all subretinal fluid samples. The concentration of cytokines in patients with retinal detachment lasting to 2 months was higher than in cases of retinal detachment over 2 months.