The ocular surface最新文献

Purpose: Dry eye disease (DED) is classified based on its predominant etiology into aqueous tear-deficient (ATD), evaporative, or mixed. Sjӧgren disease keratoconjunctivitis sicca (SjD-KCS) is a very severe autoimmune form of ATD DED. The purpose of this work was to compare transcriptomic changes in the conjunctiva sampled from patients with ATD, SjD-KCS, and healthy controls (HC) to evaluate distinctions in the immune response on the ocular surface based on diagnosis.

Methods: Impression cytology of the temporal bulbar conjunctiva was collected using the EyePrim device. RNA was extracted and submitted with the Nanostring nCounter Human Immunology V2 panel for gene expression analysis. Results were uploaded to ROSALIND and Metascape to identify DEGs by comparison (all DED vs HC; SjD vs HC; ATD vs HC) and associated predicted pathways. A subset of samples (n = 4 per group) were used for immunofluorescent staining of LAMP3 and HLA-DR.

Results: 49 patients were enrolled in the study (25 HC; 12 SjD; 12 ATD). 100 DEGs were found in the comparison of all DED vs HC. 69 DEGs were found in the SjD vs HC. 11 DEGs were found in the ATD vs HC. There were no DEGs identified in the SjD vs ATD comparison. DEGs were involved in immune pathways related to viral response, adaptive immunity, and cell to cell communication. DED conjunctiva had increased expression of LAMP3 and HLA-DR compared to HC.

Conclusions: Our findings demonstrate that DED, regardless of the diagnosis, have similar immune-related DEGs and associated pathways on the ocular surface.

Introduction: Limbal stem cell deficiency (LSCD) is commonly caused by ocular surface burns. Corneal nerve damage, often due to infection, inflammation, trauma, leads to neurotrophic keratopathy (NK). This study investigates corneal sensation and nerve damage in patients with unilateral total LSCD before and after autologous cultivated limbal epithelial transplantation (Auto-CLET).

Methods: This prospective, single-centre case series included patients with unilateral total LSCD due to severe burns treated at Royal Victoria Infirmary, UK, between June 2012 and January 2018. Corneal sensation was assessed using Cochet-Bonnet aesthesiometry at baseline and 6 months post-Auto-CLET, and in vivo confocal microscopy (IVCM) was used to examine nerve regeneration.

Results: Twenty-three patients (19 males, 4 females) received Auto-CLET. Successful restoration of the ocular surface was achieved in all patients, confirmed by slit lamp examination, impression cytology, and IVCM at follow-ups up to 36 months. Baseline best corrected visual acuity was 1.67 logMAR in the affected eye compared to a mean of -0.08 in the healthy eye. Corneal aesthesiometry in LSCD eyes averaged 9.13 mm at baseline, increasing to 12.0 mm at 6 months post-Auto-CLET, though this change was not statistically significant (p = 0.26). IVCM revealed no regeneration of corneal nerves at any follow-up intervals, indicating persistent nerve damage.

Conclusions: Despite successful ocular surface restoration, corneal nerve damage persisted, leaving patients at risk of persistent NK. To address this, we strongly suggest continuous topical treatment with blood derived products, such as serum eye drops, but also newly developed therapies such as IGF and rhNGF class of drugs.

Purpose: This study investigates the association between lymphotoxin-alpha (LTA) concentration in tear fluid and dry eye disease severity, particularly in relation to the conjunctival microenvironment, and evaluates the clinical utility of measuring LTA to guide treatment with diquafosol sodium eye drops.

Methods: In this study, 75 DED patients and 35 non-DED participants were assessed at baseline and DED patients were assessed at one month after treatment with diquafosol sodium eye drops. Clinical assessments included the OSDI, LTA concentration, TBUT, CFS, CLGS, IC, Schirmer test, and MMP-9 and MUC5Ac measurement.

Results: Among 110 participants, concordance between LTA diagnostics and clinical diagnosis reached 80.90 %. There was a strong inverse correlation between tear LTA concentration and both CLGS score (R = -0.716, p < 0.001) and IC Nelson grade (R = -0.571, p < 0.001), a positive correlation with conjunctival goblet cell count (R = 0.520, p < 0.001) and TBUT (R = 0.387, p < 0.001). DED patients were subsequently divided into two groups, based on the IC Nelson grade reflecting the degree of damages in conjunctiva. ROC curve analysis identified an optimum threshold LTA concentration of 0.11 ng/mL to distinguish between mild and severe DED. Patients in the low LTA group had higher MMP-9 and lower Muc5ac concentrations compared to the high LTA group. After one month of diquafosol treatment, patients with LTA < 0.11 ng/mL showed more significant improvements compared to those with LTA ≥ 0.11 ng/mL.

Conclusion: Tear fluid LTA concentration is strongly correlated with conjunctival damage severity. Measuring LTA concentration offers a noninvasive method for evaluating the conjunctival microenvironment and guiding DED treatment.