TOPICAL FIBRONECTIN THERAPY IN PERSISTENT CORNEAL ULCERATION

Fifteen patients with 20 episodes of persistent corneal ulceration, resistant to conventional therapy, were treated with topical autologous fibronectin Thirteen corneal ulcers (eight patients) developed following penetrating keratoplasty, three patients had mucous membrane pemphigold, two patients had herpetic keratltis and one each had Sjögren's syndrome and a trophic corneal ulcer A standard protocol for fibronectin administration was followed This therapy healed 16 of the 20 ulcers after a mean duration of treatment of 23 months Corneal ulceration associated with mucous membrane pemphigoid failed to respond to fibronectin Corneal ulcers which recurred after cessation of fibronectm responded to reintroduction of this therapy Topical fibronectin is an effective therapy for refractory corneal ulceration and is free of major side effects     

Sj?gren's syndrome beyond the eye

Sj?gren's syndrome is a common systemic disease with major clinical manifestations in the eye, mouth and musculoskeletal system. The major clinical presentations of Sj?gren's syndrome are reviewed with emphasis on diagnostic criteria, laboratory features, complications and treatment.     

下泪小点烧灼治疗重度水液缺乏型干眼的临床疗效

目的： 评价高温烧灼封闭下泪小点治疗重度水液缺乏型干眼的临床疗效。 方法： 前瞻性非随机对照 研究。选择2019年6月至2020年10月在福建医科大学附属第二医院眼科就诊的使用人工泪液和局部 抗炎保守治疗后疗效不佳的重度水液缺乏型干眼患者29 例（ 58 眼）。根据是否患有干燥综合征分为 2组：干燥综合征干眼（ SS）组17例（ 34眼）和非干燥综合征干眼（非SS）组12例（ 24眼）。采用高温热 烧灼封闭双眼下泪点,记录泪小点烧灼前2 个月、 1 d及烧灼后2 周、 2 个月时患者的眼表疾病指数 （ OSDI）、泪膜破裂时间（ TBUT）、角膜荧光素染色（ FL）和泪液分泌试验（ SⅠT）结果。数据分析采用 独立样本t检验、配对样本t检验及单因素重复测量方差分析。 结果： 2 组烧灼前各项干眼相关指标差 异无统计学意义。烧灼后2周和2个月与烧灼前1 d比较, SS组OSDI评分、 TBUT及FL评分差异均有 统计学意义（ F=69.58, P<0.001; F=49.45, P<0.001; F=34.07, P<0.001）;非SS组OSDI评分、 BUT、 FL评分及SⅠT值差异均有统计学意义（ F=57.89, P<0.001; F=72.83, P<0.001; F=47.44, P<0.001; F=28.35; P<0.001）,但SS组SⅠT值差异无统计学意义。烧灼2 个月后,非SS组OSDI评分、 TBUT、 FL评分、 SIT值均较SS组改善更明显（ t=2.22, P=0.04; t=-3.32, P<0.001; t=2.90, P=0.01; t=-4.00, P<0.001）。 SS组和非SS组均未发生明显眼部并发症,最常见的并发症为泪道再通,再通率为5.2%。 结论： 下泪小点烧灼封闭治疗重度干眼可改善重度干眼的症状和体征,是一种简单、经济且安全有 效的方法,对非干燥综合征干眼患者效果更佳。
     

Sterile corneal perforation after cataract surgery in Sj?gren's syndrome.

Painless, sterile, noninfiltrated corneal ulceration and perforation, which may occur after recent cataract surgery in patients with rheumatoid arthritis, and Sjögren's syndrome, appears to be a distinct clinical entity. The cause is probably multifactorial. Contributing factors may be the underlying systemic disease process in rheumatoid arthritis and Sjögren's syndrome, the associated keratoconjunctivitis sicca, the surgical procedure, and the postoperative use of oral and topical corticosteroids. Two cases of this clinical entity are reported here. Preoperative recognition by cataract surgeons that corneas in patients with rheumatoid arthritis and Sjögren's syndrome have an increased risk for postoperative ulceration should prompt postoperative preventive measures.     

Tear mucus ferning in patients with Sjögren's syndrome

The purpose of this study is to evaluate the possibility of using the mucus ferning phenomenon of the tears as a diagnostic test for Keratoconjunctivitis sicca in patients with Sjögren's syndrome. Using a polarising light microscope dried samples were tested for ferning phenomenon collected from (1) 36 healthy controls, (2) 21 patients with primary Sjögren's syndrome, and (3) 15 patients with secondary Sjögren's syndrome. Patients with Sjögren's had xerostomia, abnormal salivary gland biopsy and at least two positive tests for Keratoconjunctivitis sicca. Patterns of mucus crystallization were classified into 5 types according to uniformity, branch spreading and integrity (types I, II normal, types III, IV, V abnormal). Abnormal ferning was found in tear samples of 8 out of 72 normal control eyes, 38 out of 42 with primary Sjögren's syndrome and 25 out of 30 with secondary Sjögren's syndrome. The differences between both primary and secondary Sjögren's syndrome, in comparison to healthy controls, were significant (p<0.001). The sensitivity of the method was found 90% for primary Sjögren's syndrome and 80% for secondary Sjögren's syndrome. According to our data, tear mucus ferning test is a simple, sensitive and specific test to estimate Keratoconjunctivitis sicca in patients with Sjögren's syndrome.     

Corneal infection in mucosal scarring disorders and Sj?gren's syndrome

We reviewed 69 episodes of microbial keratitis occurring over an 11-year period in 56 patients with a mucosal scarring disorder or Sj?gren's syndrome. Gram-positive bacterial isolates were the most common cause of infection, and accounted for almost all cases in patients with Sj?gren's syndrome. Trichiasis (cicatricial pemphigoid), topical corticosteroids, bandage contact lenses, and corneal surgery were the main predisposing factors in the development of the corneal infection. In patients with ocular cicatricial pemphigoid, infection was much less common after chemotherapeutic control had been achieved. Recurrent infections were relatively frequent. There was a high rate of major complications, particularly in microbial keratitis complicating Sj?gren's syndrome.     

Mononuclear cell phenotypes and immunoglobulin gene rearrangements in lacrimal gland biopsies from patients with Sj?gren's syndrome

Immunocytochemical studies of lacrimal gland biopsies obtained from eight patients with Sj?gren's syndrome revealed the major component of the mononuclear cell infiltrates to be comprised of B cells and Leu-3+ T-helper cells, which were present well in excess of control glands. Three of seven cases that were tested harbored cells that stained with monoclonal antibodies against different components of Epstein-Barr virus (EBV); one of the biopsies also contained cells that bore cytomegalovirus antigens. Immunoglobulin-gene rearrangements, but not T-cell receptor rearrangements, were demonstrated in one of two Sj?gren's lacrimal gland biopsies tested. The authors conclude that the destruction of the tubuloacinar architecture of lacrimal gland tissue in Sj?gren's syndrome appears secondary to lymphoproliferation of B cells and T-helper cells, probably derived from primary lymphoid follicles. Productive infection of lacrimal gland tissue with EBV may play a role in the pathogenesis of the syndrome in selective cases.     

Alterations in corneal sensitivity and nerve morphology in patients with primary Sjögren's syndrome

The aim of the study was to assess subjective symptoms and objective clinical signs of dry eye in relation to corneal nerve morphology and sensitivity in primary Sj?gren's syndrome. Twenty eyes of 20 primary Sj?gren's syndrome patients and ten eyes of 10 healthy age- and sex-matched controls were included in the study. Ocular surface disease index (OSDI) questionnaire and visual analog scales were used to assess subjective symptoms. The mechanical sensitivity of the central cornea was measured using a modified Belmonte non-contact esthesiometer followed by an analysis of corneal nerve morphology using scanning slit confocal microscopy (ConfoScan 3). OSDI symptom scores were high in primary Sj?gren's syndrome patients, compared with controls. Accordingly, the mean corneal detection threshold was low in patients implicating corneal mechanical hypersensitivity (54.5+/-40.1ml/min vs. 85.0+/-24.6ml/min, P=0.036). However, nerve densities were similar, and no correlation was present between corneal sensitivity and nerve density. In contrast, alterations in nerve morphology were found; stromal nerves appeared thicker, and nerve growth cone-like structures were seen in 20% of patients, often associated with dendritic antigen-presenting cells. Sj?gren's syndrome patients presented with corneal mechanical hypersensitivity, although corneal nerve density did not differ from controls. However, alterations in corneal nerve morphology (nerve sprouting and thickened stromal nerves) and an increased amount of antigen-presenting cells, implicating the role of inflammation, were observed. These observations offer an explanation for the corneal mechanical hypersensitivity, or even hyperalgesia often observed in these patients. We hypothesize that patients with primary Sj?gren's syndrome dry eye suffer from neuropathic corneal mechanical hypersensitivity induced by ocular surface inflammation.     

Correlation between corneal sensitivity, subjective dry eye symptoms and corneal staining in Sjögren's syndrome

BACKGROUND: Previous studies have shown a poor correlation between dry eye symptoms and objective clinical signs in patients with Sj?gren's syndrome.We examined the hypothesis that reduced corneal sensitivity is associated with increased ocular surface disease and reduced symptoms in patients with Sj?gren's syndrome. METHODS: Eighteen subjects with a diagnosis of Sj?gren's syndrome attending a Sj?gren's clinic participated in the study. All participants completed the Ocular Surface Disease Index (OSDI) and the Symptom Severity of Discomfort (SSD) scale and answered a question regarding overall severity of dry eye symptoms.The subjects underwent measurement of best-corrected Snellen visual acuity, corneal sensitivity testing with the Cochet-Bonnet esthesiometer, fluorescein and lissamine green staining of the cornea, Schirmer's test I and determination of the tear film break-up time.The results were analysed using Pearson correlational analysis. RESULTS: Both fluorescein and lissamine green staining of the cornea correlated negatively with central corneal sensation (r = -0.3542, p = 0.034, and r = -0.3748, p = 0.029 respectively), indicating that corneal sensation was reduced with increased ocular surface disease. The overall symptom severity correlated negatively with lissamine green staining of the cornea (r = -0.4310, p = 0.011), suggesting reduced symptoms with increased corneal disease. INTERPRETATION: Reduced corneal sensation correlated with increased ocular surface disease. Ocular surface disease similarly demonstrated a reciprocal relation with patients' dry eye symptoms. Consequently, we found that patients with Sjogren's syndrome with advanced corneal staining tended to have fewer dry eye symptoms than patients with less corneal staining.     

Chronic anterior and posterior uveitis and primary Sj?gren's syndrome

We examined eight patients with primary Sj?gren's syndrome and uveitis. In all patients, the uveitis was bilateral, chronic, anterior and posterior, and not associated with active chorioretinitis. Seven of the eight patients were women. The diagnosis of primary Sj?gren's syndrome was generally based on results of a Schirmer test, minor salivary gland biopsy, and serologic studies. Frequent findings included keratic precipitates, cataract, a pars plana exudate, an increased sedimentation rate, a positive test for antinuclear antibodies in a speckled pattern, and associated systemic disease compatible with the spectrum of Sj?gren's syndrome.     

Identification of T and B lymphocytes in the human conjunctiva and lacrimal gland in ocular diseases.

The presence and localisation of T and B lymphocytes in biopsy specimens of human conjunctiva and lacrimal gland from 34 patients were studied in frozen sections. Eighteen patients had follicular conjunctivitis, 13 patients had Sjögren's syndrome, and 3 were normal. All cases of follicular conjunctivitis showed a similar picture. B cells were in higher number than T cells, but both types of lymphocytes were present in the infiltrates. In the developed follicles T cells occupied the periphery and B cells the central part of the infiltrates. In patients with Sjögren's syndrome the conjunctival biopsies showed a higher number of B lymphocytes. The number of T cells was higher in the lesions from Sjögren's syndrome than in cases of follicular conjunctivitis. The infiltrate in lacrimal gland biopsies showed T cells which were scattered while B cells were more numerous and formed clusters close to vessels. Normal conjunctiva and lacrimal gland showed no adherence of either sheep erythrocytes or human erythrocytes sensitised with antibody and complement.     

Bilateral optic neuropathy in a case of primary Gougerot Sjögren's syndrome

INTRODUCTION: Primary Sj?gren's syndrome is frequently characterized by a sicca syndrome without associated connective tissue disease. Association with an optic neuropathy is uncommon. CASE REPORT: We report a case of optic neuropathy in a 59-year-old woman known to have primary Sj?gren's syndrome confirmed clinically and histologically 2 years ago. She suddenly presented an initial bilateral visual loss. The ophthalmological exam noted a visual acuity of 1/10 in the right eye and limited to light perception in the left eye, with bilateral optic ischemic neuropathy more developed in the left eye. Fluorescein angiography showed, signs of ischemic neuropathy. The diagnosis of Horton disease was suspected, but subnormal blood velocity and a negative biopsy of the temporal artery confirmed the diagnosis of optic neuropathy associated with primary Sj?gren's syndrome. General steroid therapy improved optic neuropathy in the right eye but was ineffective in the left eye. CONCLUSION: Optic neuropathy associated with Sj?gren's syndrome is rare but must be considered the most common ophthalmological manifestation of the disease. Visual prognosis depends on the rapidity of diagnosis and therapy.     

Therapeutic contact lens-related bilateral fungal keratitis.

PURPOSE: To describe a rare case of bilateral Candida keratitis after contact lens use following bilateral penetrating keratoplasty (PK). METHODS: A 40-year-old female with a clinical diagnosis of Sj?gren's syndrome was being followed for corneal thinning in both eyes. She suffered a spontaneous bilateral perforation and underwent penetrating keratoplasty. Therapeutic contact lenses were prescribed for both eyes owing to persistent epithelial defects. Two months later, a biomicroscopic examination revealed corneal infiltrates. RESULTS: A corneal tissue sample, saline, and contact lens cultures were all positive for Candida albicans. Topical and systemic antifungal therapy successfully cleared the infection in the right eye; however, the left eye underwent another corneal graft surgery. CONCLUSIONS: Infectious fungal keratitis may be a complication of wearing therapeutic contact lenses after PK, in a patient with Sj?gren's syndrome. The pre-existing eye disease is an important associated factor in cases of yeast infection; therefore, adequate care of these patients and careful follow-up after PK are indicated as measures to prevent early infections.     

Optic neuropathy and central nervous system disease secondary to Sj?gren's syndrome in a child

The authors describe a 10-year-old girl in whom optic neuropathy and central nervous system (CNS) disease developed in association with primary Sj?gren's syndrome. There was angiographic evidence of cerebral vasculitis and multiple infarcts present on neuroimaging. Results of parotid biopsy, cerebrospinal fluid, and serologic analyses showed abnormalities that were consistent with the diagnosis of Sj?gren's syndrome. Although the patient had optic disc pallor on initial evaluation, her color vision and acuity improved with immunosuppressive therapy, as did her other neurologic symptoms. The authors believe this represents the first reported case of optic neuropathy and CNS disease associated with primary Sj?gren's syndrome in the pediatric population. The possibility of improvement in visual function with early institution of immunosuppressive therapy makes prompt diagnosis essential.     

Analysis of human tear protein profiles using high performance liquid chromatography (HPLC)

Using high performance liquid chromatography (HPLC) the tear protein profiles were measured in controls, patients with Sjögren's disease, questionable dry eye (idiopathic dry eye), idiopathic chronic conjunctivitis and the corneal melting syndrome.Qualitative comparison of the protein profiles of patients with Sjögren's disease, corneal melting and IgA deficiency shows a marked difference in the heights of various peaks as compared to the profiles of the control group. The total protein content of tears in controls and in patients with idiopathic chronic conjunctivitis is age dependent and appears to increase until the age of 40 and to decrease afterwards. The peaks containing IgA, lactoferrin and lysozyme were measured in various eye diseases. In idiopathic chronic conjunctivitis and in the corneal melting syndrome no differences were seen in comparison with controls. In patients with idiopathic dry eye and Sjögren's disease a marked decrease in the three proteins was seen. The study presented here indicates that the HPLC analysis of tears is a promising technique which may increase our knowledge of this ocular fluid.     

Tear fluid analysis in patients with primary Sjögren's syndrome using lectin probes. A comparative study of patients with primary Sjögren's syndrome, patients with other immune inflammatory connective tissue diseases and controls

PURPOSE: To study and compare the glycoprotein composition of tear fluid from patients with primary Sj?gren's syndrome, patients with other connective tissue diseases and control individuals. METHODS: SDS polyacrylamide gel electrophoresis followed by Coomassie staining or Western blotting and overlaying with ten different lectins. RESULTS: The frequency of many glycoprotein bands discovered was significantly decreased in primary Sj?gren's syndrome compared with controls and patients with other connective tissue diseases. The reduction was most pronounced in the 14-68 kDa molecular weight range. CONCLUSIONS: A decrease in the production rate and/or a change in the glycosylation pattern of the tear glycoproteins was found in patients with primary Sj?gren's syndrome. The changes discovered, however, were not specific enough to be useful as a diagnostic test.     

Diclofenac sodium, 0.1% (Voltaren Ophtha), versus sodium chloride, 5%, in the treatment of filamentary keratitis

PURPOSE: To compare the efficacy and short-term safety of diclofenac sodium, 0.1% (Voltaren Ophtha; Ciba-Vision) and of sodium chloride, 5% ophthalmic solution, in the treatment of filamentary keratitis (FK) in patients with dry-eye syndrome due to secondary Sj?gren's syndrome. METHODS: Thirty-two patients (64 eyes) with dry-eye syndrome due to secondary Sj?gren' syndrome were enrolled in a randomized study (patients and authors were aware of which medication was being used). All patients had FK. Sixteen patients were treated with sodium chloride, 5% drops, and 16 patients received diclofenac sodium, 0.1% eyedrops. Treatment regimen included instillation of 1 drop, 4 times a day for 28 days, for both groups. Clinical assessment was performed once a week during the study period. Data on the efficacy and safety of the different therapeutic regimens were collected and compared. RESULTS: Both medications achieved disappearance of filaments at the end of the study. Treatment with diclofenac sodium, 0.1%, revealed a significantly more rapid improvement of the clinical symptoms as compared with sodium chloride, 5%. No significant adverse effects were observed in both groups. CONCLUSION: Diclofenac sodium, 0.1%, may be an effective and safe topical therapy in patients with FK caused by secondary Sj?gren's disease.     

Test results in patients with Sj?gren's syndrome defined by the Japanese criteria

We examined 123 patients (mean age, 63.4 years) with Sj?gren's syndrome at Shimane Medical University Hospital from 1980 to 1988. According to the Japanese criteria for Sj?gren's syndrome, there were 106 definite and 17 probable cases. Female patients were predominant (74.8% to 25.5%). Most patients reported dry eye symptoms and had positive results on the Schirmer's, rose-bengal, and fluorescein tests. Although most patients described dry mouth symptoms, not all showed positive sialogram results, lymphocytic infiltrate on minor salivary glands, decreased salivary secretion, and salivary gland swelling. Connective tissue diseases were present in 28 patients. Most patients had positive antinuclear antibody reactions. Most of our patients who were diagnosed as having Sj?gren's syndrome by the Japanese criteria could not be classified as such by the California, Copenhagen, or Greek criteria.     

Topical treatment of severe corneal ulcers with cyclosporin A

Cyclosporin A eye drops were used on six patients to treat corneal ulcers associated with rheumatic diseases, oculomucocutaneous syndrome, and Sjögren's syndrome. Conjunctival excision was additionally carried out in two cases. All ulcers healed rapidly. The mechanism of ulcer formation involving T-lymphocytes is discussed.     

Modification of the tear function index and its use in the diagnosis of Sjögren's syndrome

BACKGROUND: The tear function index (TFI) has been shown to be of value in the diagnosis of patients suffering from Sj?gren's syndrome. It is dependent, however, on introducing into the conjunctival fornix the correct concentration of fluorescein in at least one and a half times the normal tear volume. The stimulus and effect of this added volume on the tear dynamics is likely to vary between individuals. These factors, together with the method of performing the test, limit its general applicability. AIM: To devise a method of performing the TFI with less variability and more general applicability. To present a theoretical and in vitro assessment of the dynamics of the TFI. METHOD: The study was divided into three parts. The first part was to compare the results obtained using a prepared strip containing 1.3 microl of 0.5% fluorescein with the introduction of the same amount of fluorescein as a drop. The second part was to compare the results obtained with prepared strips with the standard method of performing the TFI, both with and without topical anaesthetic. The third part was an in vitro study of the rate of flow of graded volumes on a filter paper strip. 42 subjects with a diagnosis of Sj?gren's syndrome according to the European criteria and 126 without Sj?gren's syndrome were included. RESULTS: There was no significant difference between the results obtained with a prepared strip and the introduction of 1.3 microl into the eye before performing the Schirmer's test and TFI (0.1相似文献