Comparison of corneal biomechanics in Sjögren’s syndrome and non-Sjögren’s syndrome dry eyes by Scheimpflug based device

AIM: To compare the corneal biomechanics of Sjögren’s syndrome (SS) and non-SS dry eyes with Corneal Visualization Scheimpflug Technology (CorVis ST). METHODS: Corneal biomechanics and tear film parameters, namely the Schirmer I test value, tear film break-up time (TBUT) and corneal staining score (CSS) were detected in 34 eyes of 34 dry eye patients with SS (SSDE group) and 34 dry eye subjects without SS (NSSDE group) using CorVis ST. The differences of the above parameters between the two groups were examined, and the relationship between corneal biomechanics and tear film parameters were observed. RESULTS: The differences in age, sex, intraocular pressure (IOP) and central corneal thickness (CCT) were not significant between the two groups (P>0.05). The tear film parameters had significant differences between the SSDE group and NSSDE group (all P<0.05). Patients in the SSDE group had significantly lower A1-time and HC-time, but higher DA (P=0.01, 0.02, and 0.02, respectively) compared with the NSSDE group. In the SSDE group, DA was negatively correlated with TBUT (rho=-0.38, P=0.03); HC-time was negatively correlated with CSS (rho=-0.43, P=0.02). In the NSSDE group, HC-time was again negatively correlated with CSS (rho=-0.39, P=0.02). CONCLUSION: There are differences in corneal biomechanical properties between SSDE and NSSDE. The cornea of SSDE tends to show less “stiffness”, as seen by a significantly shorter A1-time and HC-time, but larger DA, compared with the cornea of NSSDE. Biomechanical parameters can be influenced by different tear film parameters in both groups.     

A single nucleotide polymorphism in the IL1RL1 gene is associated with Behcet’s disease in a Chinese Han population

AIM: To explore the association of single nucleotide polymorphisms (SNPs) in the IL33/IL1RL1 gene region with the susceptibility to Behcet’s disease (BD) in a Chinese Han population.METHODS: A total of eight SNPs in the candidate gene region (rs11792633, rs7025417, rs10975519 and rs1048274 in IL33; rs2310220, rs12712142, rs13424006 and rs3821204 in IL1RL1) were genotyped in783 BD patients and 701 healthy controls by the Sequenom Mass Array iPLEX platform.RESULTS: A statistically significant association was observed between IL1RL1 rs12712142 and BD patients. The frequency of IL1RL1 rs12712142 variant allele A was significantly lower in BD patients than that in controls (OR=0.8, 95%CI: 0.69-0.94, Pc=0.039); the genotype distribution (Pc=0.043) and additive and dominant genetic model analyses (OR=0.8, 95%CI: 0.69-0.94, Pc=0.040 and OR=0.72, 95%CI: 0.58-0.88, Pc=0.011) also indicated a strong association between rs12712142 and BD patients.CONCLUSION: This is the first study to reveal the association between IL1RL1 rs12712142 variant allele A and the decreased risk of BD in the Chinese Han population, indicating a protective role of IL1RL1 in the pathogenesis of BD.     

Primary Sjögren’s syndrome related optic neuritis

AIM:To determine the clinical features, diagnosis and treatment of the primary Sjögren syndrome (SS) related optic neuritis.METHODS:The clinical data of 8 patients (12 eyes) with primary SS related optic neuritis were analyzed retrospectively.RESULTS: Eight of 128 consecutive patients with optic neuritis resulted from varied causes fulfilled the diagnostic criteria for the primary SS. They presented initially with the signs and symptoms of non-specific optic neuritis, and 5 patients presenting without dryness showed a chronic inflammation of submandibular gland or parotid gland, and lymphocyte infiltration was demonstrated by labial gland biopsy in 2 patients. There were serum positive titers for anti-Sjögren syndrome A (SSA) in 7 patients and anti-Sjögren syndrome B (SSB) in 8 patients. Anti-aquaporin-4 (AQP4) antibody was negative in all the 8 patients. Both glucocorticoids and immunosuppressive agent were administered, and visual acuity elevated in 8 eyes (66.7%), 3 patients (37.5%) recurred in the follow-up.CONCLUSION:Primary SS related optic neuritis is less common and easily misdiagnosed. The conventional therapies for optic neuritis could not control the recurrence.     

Primary Sj?gren’s syndrome related optic neuritis

AIM:To determine the clinical features, diagnosis and treatment of the primary Sjögren syndrome (SS) related optic neuritis.METHODS:The clinical data of 8 patients (12 eyes) with primary SS related optic neuritis were analyzed retrospectively.RESULTS: Eight of 128 consecutive patients with optic neuritis resulted from varied causes fulfilled the diagnostic criteria for the primary SS. They presented initially with the signs and symptoms of non-specific optic neuritis, and 5 patients presenting without dryness showed a chronic inflammation of submandibular gland or parotid gland, and lymphocyte infiltration was demonstrated by labial gland biopsy in 2 patients. There were serum positive titers for anti-Sjögren syndrome A (SSA) in 7 patients and anti-Sjögren syndrome B (SSB) in 8 patients. Anti-aquaporin-4 (AQP4) antibody was negative in all the 8 patients. Both glucocorticoids and immunosuppressive agent were administered, and visual acuity elevated in 8 eyes (66.7%), 3 patients (37.5%) recurred in the follow-up.CONCLUSION:Primary SS related optic neuritis is less common and easily misdiagnosed. The conventional therapies for optic neuritis could not control the recurrence.     

Comparison of the meibomian gland dysfunction in patients with chronic ocular graft-versus-host disease and Sjögren’s syndrome

AIM: To investigate the abnormalities in the meibomian gland in patients with dry eye disease (DED) associated with chronic ocular graft-versus-host disease (coGVHD) in comparison with Sjögren’s syndrome (SS), a major form of aqueous deficient DED and meibomian gland dysfunction (MGD), a common cause of evaporative DED. METHODS: A total 135 eyes of 135 subjects included in this study: patients with DED associated with coGVHD (n=30), patients with SS (n=35), patients with MGD (n=35), and normal controls (n=35). All participants completed the Ocular Surface Disease Index (OSDI) questionnaire, ocular surface examination [Schirmer test, tear film breakup time (TFBUT), and ocular surface staining], and meibomian gland assessment [meiboscore (gland dropout detected on meibography using infrared camera of the Keratograph 5M), meibum expressibility score (MES), meibum quality score (MQS), lid margin abnormality]. In addition, correlations of meibomian gland characteristics with ocular surface parameters as well as disease severity score were investigated in coGVHD group. RESULTS: The coGVHD group showed significantly higher meiboscore, MES, and MQS than the other 3 groups (all P<0.05). In the coGVHD group, parameters of meibomian gland showed a significant correlation each other and those of ocular surface. The correlation between meibomian gland parameters and severity score of coGVHD was also established (meiboscore, r=0.62; MES, r=0.47; MQS, r=0.47; lid margin abnormality score, r=0.55; all P<0.05). CONCLUSION: Patients with DED associated with coGVHD show poorer gland morphology and worse gland function than other types of DED. In addition, meibomian gland damage is not only associated with ocular surface damage but also disease severity of coGVHD.     

Evaluation of axial length/total corneal refractive power ratio as a potential marker for ocular diagnosis of Marfan’s syndrome in children

AIM: To investigate whether the axial length (AL)/total corneal refractive power (TCRP) ratio is a sensitive and simple factor that can be used for the early diagnosis of Marfan’s syndrome (MFS) in children.METHODS: The relationship between the AL/TCRP ratio and the diagnosis of MFS for 192 eyes in 97 children were evaluate. The biological characteristics, including age, sex, AL, and TCRP, were collected from medical records. Receiver operating characteristic (ROC) curve analysis was performed to investigate whether the AL/TCRP ratio effectively distinguishes MFS from other subjects. The Youden index was used to re-divide the whole population into two groups according to an AL/TCRP ratio of 0.59.RESULTS: Of 96 subjects (mean age 7.46±3.28y) evaluated, 56 (110 eyes) had a definite diagnosis of MFS in childhood based on the revised Ghent criteria, 41 (82 eyes) with diagnosis of congenital ectopia lentis (EL) were included as a control group. AL was negatively correlated with TCRP, with a linear regression coefficient of -0.36 (R2=0.08). A significant correlation was found between age and the AL/TCRP ratio (P=0.023). ROC curve analysis showed that the AL/TCRP ratio distinguished MFS from the other patients at a threshold of 0.59. MFS patients were present in 24/58 (41.38%) patients with an AL/TCRP ratio of ≤0.59 and in 34/39 (87.18%) patients with an AL/TCRP ratio of >0.59.CONCLUSION: An AL/TCRP ratio of >0.59 is significantly associated with the risk of MFS. The AL/TCRP ratio should be measured as a promising marker for the prognosis of children MFS. Changes in the AL/TCRP ratio should be monitored over time.     

Gastrointestinal microbiome and primary Sjögren’s syndrome: a review of the literature and conclusions

The recognition of the profound impact of the human gastrointestinal microbiome (GM) on human autoimmune diseases has gradually increased thanks to deeper research efforts. As a systemic autoimmune disease, primary Sjögren’s syndrome (pSS) cannot be completely cured. Human studies have revealed that GM species and diversity are altered in patients with pSS compared with healthy individuals. Animal studies have provided possible mechanisms for the association between pSS and GM. The potential role of GM in pSS is exerted through several mechanisms. GM dysbiosis leads to increased intestinal permeability, which increases the risk of GM antigen exposure and activates specific autoreactive T lymphocytes via “molecular mimicry”. In addition, GM antigen exposure and intestinal immune tolerance loss caused by GM dysbiosis together induce chronic local gut mucosal inflammation, which deteriorates to systemic chronic non-specific inflammation with the circulation of pro-inflammatory lymphocytes and cytokines. These factors eventually activate autoreactive B lymphocytes and lead to pSS. If GM plays a key role in the pathogenesis of pSS, clarifying the underlying mechanisms will be helpful for the development of new therapies targeting GM for dry eye associated with pSS. This review summarizes the latest knowledge about the relationship between GM and pSS, with the aim of contributing to future research and to the development of new clinical applications.     

Retinal capillary plexus in Parkinson’s disease using optical coherence tomography angiography

AIM: To evaluate the alterations of the retinal microvasculature and foveal avascular zone in patients with Parkinson’s disease (PD) using optical coherence tomography angiography (OCT-A). METHODS: A retrospective study of PD patients examined in the Ophthalmology Department of the General Hospital of Athens, “Georgios Gennimatas” from March 2021 to March 2022 was conducted. Totally 44 patients with PD were included and 18 healthy controls were examined, hence a total of 124 eyes were enrolled in the study. The foveal and parafoveal superficial and deep capillary plexus vascular density (fSCP-VD, fDCP-VD, pSCP-VD, pDCP-CD) and foveal avascular zone (FAZ) were quantified with OCTA. Optical coherence tomography (OCT) was used to measure macular thickness. Our statistical analysis was conducted by using a mixed effect linear regression model. RESULTS: After adjustment for age and gender, the mean parafoveal superficial capillary plexus vascular density (pSCP-VD) and mean parafoveal deep capillary plexus vascular density (pDCP-VD) were significantly decreased in individuals with PD (P<0.001 in both) by -2.35 (95%CI -3.3, -1.45) and -7.5 (95%CI -10.4, -4.6) respectively. fSCP-VD and fDCP-VD didn’t approach statistical significance. The FAZ area and perimeter were significantly decreased (P<0.001 in both) by -0.1 mm2 (95%CI -0.13, -0.07) and -0.49 mm2 (95%CI -0.66, -0.32) respectively. Circularity didn’t approach statistical significance. Central retinal thickness (CRT) was significantly decreased in individuals with PD (P<0.001) by -23.1 μm (95%CI -30.2, -16) and temporal retinal thickness (TRT) was decreased (P=0.025) by -11 μm (95%CI -22, -1.5) while nasal retinal thickness (NRT) only approached statistical significance (P=0.066). CONCLUSION: The mean pSCP-VD, pDCP-VD, CRT and TRT are significantly decreased and FAZ is altered in individuals with PD. These findings can be potentially used as biomarkers for the diagnosis and evaluation of early PD.     

Nd:YAG激光治疗囊袋收缩综合征的临床效果分析

目的观察Nd:YAG激光治疗囊袋收缩综合征的疗效。方法 15例(15只眼)经专科检查确定为囊袋收缩综合征的患者接受Nd:YAG激光囊袋切开治疗,对比观察治疗前后的视力、人工晶状体位置的变化。结果 86.7%的患者治疗取得了成功,变现为视力的提高、人工晶状体位置的改善,囊袋收缩过程结束。结论 Nd:YAG激光囊袋切开是治疗囊袋收缩综合征的有效方法。     

囊袋收缩综合征31例疗效分析

目的总结囊袋收缩综合征（CCS）的临床处理方法及其效果。方法回顾性病例研究。对31例（31眼）囊袋收缩综合征患者行Nd∶YAG激光治疗和手术治疗。行Nd∶YAG激光治疗22眼,其中行前囊三切口法17眼;先行二切口法后效果不理想即时或二期改做四切口法5眼。行手术治疗9眼。术后观察术眼视力,裂隙灯观察撕囊口透明区大小,前后囊膜情况及人工晶状体（IOL）位置等。观察术后并发症及主观症状。术后随访3～6个月。结果所有术眼术后裸眼视力及最佳矫正视力均有不同程度提高。术前主诉伴眩光或单眼复视者,术后上述主观症状消失。术眼囊袋收缩缓解,撕囊口透明区较术前扩大,IOL位置居中稳定。术后并发症主要为高眼压和轻度的虹膜炎症反应。结论Nd∶YAG激光和手术治疗CCS疗效可靠,简便安全。     

白塞氏病患者血浆中微小RNA异常表达的初步研究

目的：检测白塞氏病(BD)患者和正常人群血浆中微小核糖核酸(microRNA,miRNA)的差异表达谱,探讨miRNA在BD发病中的作用,寻找与BD相关的血浆生物标记物。

方法：收集15例活动期BD患者和15例正常人的抗凝静脉血,离心获得血浆,提取总RNA,经miRNA标记、miRNA阵列杂交、miRNA阵列扫描和分析获得BD患者异常表达的miRNA谱。通过miRTarBase(靶基因数据库)检索差异性表达的miRNA已经过验证的靶基因,并选取与免疫学相关的差异性表达的miRNA进行Real time-PCR验证。

结果：活动期BD患者血浆中hsa-miR-34c-5p、hsa-miR-144-3p、hsa-miR-483-3p较正常人表达上调,hsa-miR-301a-3p、hsa-miR-224-5p、hsa-miR-454-3p、hsa-miR-17-5p、hsa-miR-199a-5p较正常人表达下调。

结论：miRNA的差异性在BD的发生发展过程发挥重要作用,异常表达的miRNA可能通过Notch1和SMAD4信号通路促进BD发病。     

Anti-retinal auto-antibodies in Vogt-Koyanagi-Harada syndrome, Behcet's disease, and sympathetic ophthalmia

Sera of patients diagnosed as having the active Vogt-Koyanagi-Harada (VKH) syndrome, Behcet's syndrome or sympathetic ophthalmia as well as normal controls were evaluated by ELISA and by staining of normal human retinal tissue using the avidin-biotin-peroxidase complex (ABC) technique for anti-retinal antibodies. No anti-retinal S-antigen antibodies were detected by ELISA. However, autoimmune antibodies were found against the outer segments of photoreceptors and Müller cells in patients with the VKH syndrome, with lower titers in some patients with Behcet's syndrome, and in a few patients with sympathetic ophthalmia. These results suggested anti-retinal antibodies were present and that retinal autoimmunity may play a role in pathogenesis in varieties of posterior uveitis. In addition, the indirect immunoperoxidase staining technique may facilitate the diagnosis of VKH in uncertain cases.     

Capsule contraction syndrome in eight cases of hydrophobic one‐piece intraocular lens implantation

Purpose: The combination of anterior capsule opacification (ACO) with capsulorrhexis phimosis and intraocular lens (IOL) decentration characterises the capsule contraction syndrome (CCS). Eight cases of ACO complicated with capsule phimosis are described. Methods: In this study, 231 patients who underwent cataract extraction using phacoemulsification from September 2005 to May 2006 were included. An acrylic one‐piece IOL was implanted with the use of the injector supplied by the manufacturer through a 2.75 mm incision. A thorough pre‐ and post‐operative examination (visual acuity measurement, corneal curvature measurement, applanation tonometry, fundus examination) was performed for each patient. Results: In eight of 243 eyes of 231 patients, anterior capsule opacification with capsulorrhexis phimosis and IOL decentration was observed two to four months post‐operatively. In all eight cases, the haptic implanted inferiorly was observed to be mounted on the IOL optic. Conclusions: The combination of IOL memory loss in addition to ACO, capsulorrhexis phimosis and decentration can be a cause of the CCS, an observation that has not been reported previously.     

Antibodies to oral mucosa in patients with ocular Behcet's disease

A method is reported for the identification of cytoplasmic antibodies in patients with Behcet's disease and uveitis. The assay appears positive in at least 80% of patients in an American population with definite or probable Behcet's disease and 60% of patients from a Turkish population with definite Behcet's disease, with a false-positive rate of 6.5% among non-Behcet's ocular inflammatory disorders with vasculitis. When refined, this test may prove useful to the ophthalmologist in selecting out those patients with Behcet's disease from the larger group of patients with uveitis for whom no systemic etiology is identified.     

YAG激光后囊切开术治疗晚期囊袋阻滞综合征伴后发性白内障

目的：观察YAG激光后囊切开术治疗晚期囊袋阻滞综合征伴后发性白内障的疗效。

方法：对临床确诊为囊袋阻滞综合征伴后发性白内障的13例18眼患者行YAG激光后囊切开术,观察术后1,4,24h; 1,2wk的非矫正远视力、眼压、房水、玻璃体及主观症状的变化。

结果：YAG激光后囊切开术治疗囊袋阻滞综合征伴后发性白内障,可以提高患者非矫正远视力; 部分患者可出现前房内游走颗粒,但不引起炎症反应; 术后1,4,24h部分患者会引起一过性眼压升高,甚至需降眼压治疗,但术前术后眼压变化无统计学意义; 所有患者术后均出现玻璃体混浊加重,眼前漂浮影增多,但均在2wk内恢复。

结论：YAG激光后囊切开术治疗囊袋阻滞综合征伴后发性白内障,可以提高患者视力,但应严密观察患者眼压、前房内炎症反应等,及时给予处理。     

囊袋收缩综合征的手术治疗

目的:探讨白内障连续环形撕囊术后囊袋收缩综合征的手术治疗效果。方法:对15例15眼白内障连续环形撕囊术后发生囊袋收缩综合征的患者进行手术治疗,观察患者术后视力、并发症情况。结果:手术治疗后视力均有不同程度的提高。无明显的并发症发生。结论:手术治疗增殖严重的囊袋收缩综合征是一种安全有效的方法。     

Nd:YAG激光治疗晶体囊阻滞综合征的临床观察

目的：总结晶体囊袋阻滞综合征的临床特点并评价Nd:YAG激光的治疗效果。方法：对6例晶体囊袋阻滞综合征的临床特点进行回顾性分析,其中4例使用科以人7970Nd:YAG激光机行Nd:YAG激光前后囊膜切开术,平均能量4．7mJ,平均击发69次。结果：6例晶体囊袋阻滞综合征共同表现为连续环形撕囊术后人工晶体光学面被连续环行撕囊口阻塞,晶体囊袋形成密闭的液性腔,后囊膜向后膨隆。4例Nd:YAG激光前后囊膜切开成功,视力明显提高,后囊膜复位。结论：晶体囊袋阻滞综合征是白内障手术并发症之一,对术后迟发膨胀型者,Nd:YAG激光前后囊膜切开术是安全、有效的治疗方法。     

Outcome of posterior capsulotomy in late capsular block syndrome with posterior capsular opacification

BACKGROUND: To examine the results of neodymium:yttrium-aluminium-garnet (Nd:YAG) laser posterior capsulotomy in eyes with late or previously unrecognized capsular block syndrome (CBS) presenting with deterioration of vision owing to posterior capsular opacification (PCO). METHODS: Patients, who underwent uneventful phacoemulsification with intraocular implantation and were referred for Nd:YAG laser capsulotomy owing to PCO, were prospectively examined for the presence of CBS. When indicated, Nd:YAG laser posterior capsulotomy was carried out. Prospective follow-up examinations were performed for the next 6 months. The outcome measures were post-laser change in best corrected visual acuity, refraction, change in intraocular pressure, inflammation and complication rate. RESULTS: Of 655 patients referred for capsulotomy, eight had an associated CBS in that eye. These eight eyes comprised the study cases. The presence of CBS had not been recognized before the development of PCO. Best corrected visual acuity improved in all cases. In seven out of eight (87.5%) eyes refraction was unchanged throughout the follow up. Ocular hypertension, inflammation or other complications did not develop. CONCLUSION: Nd:YAG laser capsulotomy in eyes with PCO and late or previously unrecognized CBS is a safe procedure, resulting in improved visual acuity without refractive change.