Anterior Chamber Fluid Research Articles

Efficacy of Picloxidine and Staphylococcal Bacteriophage in Preoperative Eradication of Staphylococcus Epidermidis

In view of the current trend — growth of antibiotic resistance, the search for possible alternative methods of preoperative prophylaxis is relevant.The purpose: to assess the impact of different methods of preoperative eradication of Staphylococcus epidermidis (the use of specific bacteriophage and picloxidine in combination with eyelid massage) on conjunctival and aqueous moisture contamination in the course of planned phacoemulsification.Patients and Methods. 44 patients (48 eyes) were examined. Patients in group I underwent eradication with staphylococcal bacteriophage in combination with eyelid massage, in group II — with picloxidine according to the similar technique, group III was control group. Microbiological material was sampled from the conjunctival cavity before the application of the said methods and after blepharostat placement. Anterior chamber fluid (ACF) was examined at the end of the operation. Microorganisms were identified by MALDI-TOF method, sensitivity was determined by drip method.Results. The percentage of S. epidermidis contamination of conjunctiva after blepharostat placement was 25.0 %, 68.8 % and 87.5 % in groups I, II, III, respectively, in the ACF it was found in 0.0 %, 12.5 % and 37.5 % in groups I, II, III, respectively.Conclusion. Preoperative measures for S. epidermidis eradication with staphylococcal bacteriophage in combination with eyelid massage are significantly more effective than the similar technique with picloxidine and provide a significant reduction of conjunctival sac contamination by 75 %, and also absence of S. epidermidis in the ACF by the time of phacoemulsification completion.

Persistent high intraocular pressure after cataract combined with vitrectomy: a case report

Introduction and importance: When pars plana vitrectomy combined with cataract extraction, postoperative intraocular pressure (IOP) elevation is a common complication, especially in cases of incorporated eye trauma. Case presentation: A 51-year-old man was admitted to the hospital after sustaining a basketball injury to his right eye, experiencing a persistent dark shadow in his vision for 1 month. An eye examination revealed a visual acuity of 50/100, improving to 80/100 with −1.25DS correction in the right eye, and 100/100 in the left eye. IOP was measured at 25.0 mmHg in the right eye and 15.3 mmHg in the left. The cornea was clear, and the right anterior chamber appeared normal, but aqueous humor flash (++), along with an increase in anterior chamber cells (++). The right pupil was irregularly shaped with a diameter of about 5 mm and had an impaired pupillary light reflex. Lens opacity was noted as C2N2. The vitreous body contained significant blood turbidity, with numerous small dark red hemorrhages at the posterior pole. The patient underwent phacoemulsification and intraocular lens implantation, vitrectomy, gas-liquid exchange, and retinal laser photocoagulation in the right eye. Post-operatively, the patient experienced elevated IOP, which was managed through multiple anterior chamber fluid punctures to control the pressure before discharge. Clinical discussion: It is not uncommon for patients with persistent high IOP after cataract combined with vitrectomy. The patient reported in this case was unwilling to undergo further anti-glaucoma surgery. After multiple anterior chamber punctures and drainage, the IOP was finally controlled. There are not many reports in the literature on such patients. Conclusion: To investigate the causes of elevated IOP following blunt ocular trauma and vitrectomy, and to provide guidance for clinical diagnosis and treatment.

Polymerase Chain Reaction for Detection of Mycobacterium tuberculosis in Granulomatous Anterior Uveitis – An Analysis of 51 Eyes

ABSTRACT Purpose To evaluate the role of polymerase chain reaction (PCR) in detecting Mycobacterium tuberculosis (MTb) in granulomatous anterior uveitis and comparing the results with those of Mantoux test, QuantiFERON-TB Gold test, and High-Resolution Computed Tomography of Chest (HRCT-chest). Methods Data of 51 eyes of 38 patients with clinical features of granulomatous anterior uveitis undergoing anterior chamber fluid aspiration for PCR for MTb targeting IS6110 and MPB64 were studied. Results Out of 38 patients, 25 (65.8%) were positive for MTb genome on PCR. 24 patients were tested for Mantoux, out of which 12 patients (50%) were positive and 12 patients (50%) were negative. 22 out of 38 patients had undergone QuantiFERON-TB Gold (QFT) test, out of which 10 (45.5%) were positive and 12 (54.5%) were negative. 36 out of 38 patients had undergone HRCT. Eight out of 38 (21.1%) patients had significant findings in HRCT-chest, as well as PCR positivity for MTb genome while 12 (31.6%) patients did not have any significant findings on HRCT-chest, but were positive for PCR. Conclusion PCR for MTb is a valuable tool in the diagnosis of tubercular anterior uveitis. PCR can be positive even in cases of negative Mantoux test, QFT, and HRCT-chest in granulomatous anterior uveitis.

Secondary silicone-induced glaucoma after vitrectomy for regmatogenic retinal detachment

BACKGROUND: Retinal detachment is a leading cause of impaired vision and blindness, affecting 2–9% of individuals. Research has shown that local immune-inflammatory processes contribute significantly to the development of this condition. Polymethylsiloxane has long been used as a tamponade substance in the treatment of retinal detachment. It is currently utilized in various forms of retinal detachment as well as in the management of complications such as retinal edge folding and vitreous opacity. However, the use of silicone oil in the vitreous cavity can lead to the development of secondary ocular hypertension and glaucoma, with prevalence rates ranging from 2.2% to 64.2% according to studies. AIM: Conduct a comparative analysis of biochemical and morphometric indicators and justify the expediency of conducting immune therapy for patients with secondary silicone-induced glaucoma. METHODS: A prospective study included 22 patients (22 eyes) in the main group and 22 patients in the comparison group (22 eyes). The average age of the patients was 55±5.3 years (46–68 years), with 28 females and 16 males. Patients in the main group received anti-cytokine therapy (aminopropyldithioethylene-diamine sodium and anakinra). The primary endpoint of the study was the assessment of retinal nerve fiber layer thickness and perimetric indices. RESULTS: The results revealed an inverse relationship between cytokine levels and retinal nerve fiber layer thickness in patients who underwent vitrectomy with silicone tamponade. Additionally, a direct relationship was observed between the diameter of emulsified silicone in the anterior chamber and cytokine levels. The impact of mechanical fragmentation of polymethylsiloxane during nystagmus and direct toxic effects on optic nerve fibers requires further investigation. The study also highlighted the need for more accurate methods of selecting anterior chamber fluid for evaluating the effectiveness of immune therapy. Determining the appropriate dosage, duration, and administration method of anti-cytokine drugs also requires further research. Evaluation of ophthalmotonometric indicators, retinal nerve fiber layer thickness, and mean deviation revealed significantly better outcomes in patients receiving anti-cytokine therapy compared to the control group. CONCLUSION: The findings of this study support the use of anti-cytokine therapy to normalize biochemical parameters in the anterior chamber and reduce clinical manifestations of secondary silicone-induced glaucoma.

THE ROLE OF ANTI-VEGF THERAPY IN IMPROVING THE EFFICACY OF SURGICAL TREATMENT OF SECONDARY NEOVASCULAR GLAUCOMA

Neovascular glaucoma (NVG) is a refractory glaucoma secondary to retinal ischemic diseases. Aim. To investigate the fluctuation of vascular endothelial growth factor concentration after intravitreal ranibizumab injections and to evaluate the effect of anti-VEGF therapy on the outcome of surgical treatment of NVG. Materials and Methods. The study included 25 patients (25 eyes) with NVG who underwent surgery due to IOP non-compensation (more than 26 mm Hg) on maximal hypotensive therapy. In 21 cases the cause of IOP was proliferative diabetic retinopathy (PDR), in 4 cases it was central retinal vein occlusion (CRVO) or its branches. The control group consisted of 20 patients (20 eyes) with PDR, but without NVG. Patients underwent trabeculectomy (TE) according to our modification in 18 cases or implantation of the Ex-PRESS mini-shunt in 7 cases. Lucentis was injected intravitreally at a dose of 0.5 mg 5-7 days before surgery. Aqueous humour samples were taken during surgery to determine the concentration of VEGF. Results and Discussion.. All patients showed a reduction of neovascularisation 3-5 days after ranibizumab injections. Pre-treatment intraocular pressure was 30.2±5.8 mm Hg in all patients and 17.3±3.8 mm Hg after 7 days. The number of antiglaucoma medications before and after surgery decreased by 66.7%. Mean visual acuity before surgery was 0.94±0.48 LogMar and 0.88±0.56 LogMar after surgery. Before treatment, the concentration of VEGF in the anterior chamber fluid ranged from 336.61±270.33 pg/ml to 47.86±12.27 pg/ml - 5-7 days after injection. In the control group, it averaged 54.78±18.56 pg/ml on days 5-7 after injection. Conclusions. Anti-VEGF therapy and filtering surgery can reduce IOP by 47.2%, achieve IOP compensation in 96.8% of cases, reduce the number of antiglaucoma medications by 66.7% and prevent a significant decrease in visual acuity in 88.2% of cases.

Research of Bacterial Contamination of The Surgical Field During Phacoemulsification

Conditionally pathogenic conjunctival microflora is the most frequent cause of endophthalmitis after cataract phacoemulsification (“PEC”).The purpose. To evaluate the sterility of the surgical field and anterior chamber fluid (ACF) during elective (PEC).Materials and methods. 75 eyes were examined. Patients in the group I underwent standard treatment of the surgical field, in the group IA — the standard technique was supplemented with mechanical delimitation of the upper eyelid margin, in group II additional treatment of the surgical field with povidone iodine after blepharostat installation was performed. Microbiological material was collected preoperatively from three loci (conjunctival cavity, eyelid free margin, lacrimal ducts) and at different stages of surgery from the conjunctival cavity (after standard treatment, after blepharostat placement, after additional treatment). In addition, anterior chamber fluid (ACF) was examined — also during surgery. Microorganisms were identified by the MALDI­-TOF method, sensitivity was determined by the disc­diffusion method.Results. S. epidermidis prevails among all microorganisms. The percentage of the surgical field contamination by S.epidermidis after blepharostat setting was 33,33 %, 26 % and 40 % in the I, IA, II groups respectively; after additional treatment 6,6 % in the II group; in the ACF it was found in 23,33 %, 13 % and 0 % in the I, IA, II groups respectively.Conclusion. The additional treatment of the surgical field is the most effective technique to reduce the contamination of the conjunctival cavity by S.epidermidis after placing a blepharostat and the only one in the study to ensure its absence in the ACF. Standard treatments with and without mechanical delineation are less effective and do not prevent the contamination of the ACF.

Ochrobactrum anthropi infection following corneal transplantation -a case report and review of literature

BackgroundOchrobactrum anthropi is widely distributed and primarily infects patients with compromised immune functions . Historically, O. anthropi has been considered to possess low toxicity and pathogenicity; however, recent studies suggest that it may in fact cause severe purulent infections. In this case study, we examine a case of O. anthropi infection following corneal transplantation, exploring the occurrence and outcomes of such post-operative infections.Case presentationA retrospective analysis of cases involved examinations, genetic testing for diagnosis, and subsequent treatment. In patients undergoing partial penetrating keratoplasty with a fungal corneal ulcer perforation, anterior chamber exudation and purulence were observed post-surgery. Despite antifungal treatment, genetic testing of the anterior chamber fluid and purulent material confirmed O. anthropi infection. The use of antimicrobial treatment specifically targeting O. anthropi was found to be effective in treating the infection.ConclusionInflammatory reactions following corneal transplantation should be should be monitored for the presence of other infections. Genetic testing has significant implications for clinical diagnosis and treatment.

Next-Generation Sequencing of the Human Aqueous Humour Microbiome.

The microbiome of the ocular surface has been characterised, but only limited information is available on a possible silent intraocular microbial colonisation in normal eyes. Therefore, we performed next-generation sequencing (NGS) of 16S rDNA genes in the aqueous humour. The aqueous humour was sampled from three patients during cataract surgery. Air swabs, conjunctival swabs from patients as well as from healthy donors served as controls. Following DNA extraction, the V3 and V4 hypervariable regions of the 16S rDNA gene were amplified and sequenced followed by denoising. The resulting Amplicon Sequence Variants were matched to a subset of the Ribosomal Database Project 16S database. The deduced bacterial community was then statistically analysed. The DNA content in all samples was low (0-1.49 ng/µL) but sufficient for analysis. The main phyla in the samples were Acinetobacteria (48%), Proteobacteria (26%), Firmicutes (14%), Acidobacteria (8%), and Bacteroidetes (2%). Patients' conjunctival control samples and anterior chamber fluid showed similar patterns of bacterial species containing many waterborne species. Non-disinfected samples showed a different bacterial spectrum than the air swab samples. The data confirm the existence of an ocular surface microbiome. Meanwhile, a distinct intraocular microbiome was not discernible from the background, suggesting the absence of an intraocular microbiome in normal eyes.

Diagnosis of lymphoma based on magnetic resonance imaging, analysis of cerebrospinal fluid, intraocular fluid and fine‐needle aspirate of a uveal mass lesion in a dog

AbstractA 10.5‐year‐old, male, entire labrador retriever dog was presented for chronic progressive ataxia and recent onset of a left‐sided head tilt and salivation. Neurological examination findings were deemed consistent with a multifocal brain and spinal cord neuroanatomic localisation. Ophthalmological examination of the right eye revealed pupil shape abnormality (dyscoria), a pale uveal mass lesion and white cellular sediment in the anterior chamber. Magnetic resonance imaging of the brain, eyes, thoracolumbar and lumbosacral spinal cord and surrounding structures showed multiple lesions affecting the central nervous system (brain), peripheral nervous system (left trigeminal nerve) and right eye. Cerebrospinal fluid, right eye anterior chamber fluid and fine‐needle aspirate biopsy of the uveal mass lesion yielded a cytological diagnosis of lymphoma (suspected large granular lymphocytic). The dog was discharged with palliative treatment and euthanased at home 4 days later. This case report documents the cytological diagnosis of lymphoma in the cerebrospinal fluid, intraocular fluid and fine‐needle aspirate of a uveal mass in a dog.

Evaluation of eye and serum findings in different waters in rabbits by drowning and submersion modeling.

This study investigated serum, vitreous, and anterior chamber fluid electrolyte changes, corneal thickness (CT), corneal volume (CV), anterior chamber volume (ACV), and anterior chamber depth (ACD) as an auxiliary diagnostic method in the identification of drowning in fresh or salt water. The study used 35 healthy, adult, male, white New Zealand rabbits, seperated into five groups (control, saltwater drowning (SWD), saltwater immersion (SWI), freshwater drowning (FWD), freshwater immersion (FWI)). CT, CV, ACV, and ACD measurements were made with Pentacam topography at 0, 2, and 4 h in all groups. Magnesium (mg), sodium (Na), and chlorine (Cl) were measured in the blood at 0 and 2 h, and in blood, vitreous fluid, and humor aqueous at 4 h. It was determined that CT, CV, ACV, and ACD are not of great value in drowning diagnosis and are affected by the fresh or salt water rather than drowning. Vitreous Na, Cl, and Mg levels are ineffective in determining drowning after one h. Anterior chamber fluid may provide valuable information in the differentiation freshwater - saltwater drownings at the 4th h in corpses retrieved from water. Anterior chamber fluid Na and Cl levels, especially in corpses removed from salt water, can be an easily used test that can help diagnose drowning.

Herpes simplex virus dissemination with necrotizing hepatitis following Descemet membrane endothelial keratoplasty

BackgroundCorneal transplants are the most common type of transplant and increasing in frequency. Donor cornea tissues are a rare source of herpes simplex virus (HSV) transmission and not routinely tested for presence of HSV. Donor graft-to-recipient transmission typically causes graft failure and anterior uveitis, and extra-ocular HSV disease has not been previously reported. We present a case of HSV transmission from donor cornea tissue that nearly cost the corneal transplant recipient his life.Case reportAn elderly immunocompetent man developed an acute illness 10 days after having donor corneal tissue implanted in a Descemet membrane endothelial keratoplasty (DMEK). He was found to have HSV necrotizing hepatitis per liver biopsy, trilineage cytopenia, rhabdomyolysis, acute kidney failure, altered mental status, early-stage hemophagocytic lymphohistiocytosis (HLH), and donor corneal tissue implant infection resulting in graft failure and anterior uveitis. HSV DNA was detected in cerebral spinal fluid, peripheral blood, explanted donor corneal tissue, and anterior chamber fluid (220 million HSV DNA copies per mL). HSV-1 seroconversion denoted a primary HSV infection, and the patient had no other risk factor for HSV acquisition. Early recognition of HSV dissemination prompting treatment with intravenous acyclovir, as well as a short course of HLH-directed therapy, resolved the systemic illness. Vision was restored to near normal by replacement of the infected corneal graft with new donor DMEK tissue in conjunction with intravitreal foscarnet treatment.ConclusionAwareness of the potential risk of donor cornea tissue transmitting HSV and leading to life-threatening HSV disease is paramount to early diagnosis and treatment. The role of donor cornea tissue in HSV transmission and disease merits additional attention and investigation.

The Role of Oxidative Status in the Pathogenesis of Primary Open-Angle Glaucoma, Pseudoexfolyation Syndrome and Glaucoma.

To investigate the role of oxidative stress and antioxidant system in the etiopathogenesis of pseudoexfoliation and progression of pseudoexfoliation syndrome to glaucoma. A total of 20 patients with pseudoexfoliation syndrome, 20 with pseudoexfoliation glaucoma, 20 with primary open-angle glaucoma, and 20 without pseudoexfoliation and glaucoma as a control group, who underwent cataract or glaucoma surgery between December 2020 and March 2021 in the Health Sciences University Beyoğlu Eye Training and Research Hospital, 80 patients were included in the study. Best corrected visual acuity (BCVA), intraocular pressure with applanation tonometry, detailed anterior and posterior segment examinations with biomicroscopy were performed in all patients included in the study. Approximately 0.1 cc of anterior chamber fluid was taken from all patients at the beginning of surgery. Total Oxidant Status (TOS) and Total Antioxidant Status (TAS) levels were measured by keeping the samples taken in the deep freezer of the cornea bank at -80 degrees, transferring them with cold chain transport rules, and examining them with automatic measurement method in the laboratories of the Medical Biochemistry Department of the University of Health Sciences. Oxidative Stress Index (OSI) value was calculated to measure the degree of oxidative stress. TAS averages of the control and POAG groups were found to be statistically significantly higher than the PES and PEG groups (p = 0.0001, p = 0.0001). No significant difference was observed between the other groups (p > 0.05). The TOS averages of the control and POAG groups were found to be statistically significantly lower than the PES and PEG groups (p = 0.003, p = 0.0001; p = 0.01, p = 0.001), no statistically significant difference was observed between the other groups (p > 0.05). The OSI mean of the control and POAG groups was found to be statistically significantly lower than the PES and PEG groups (p = 0.001, p = 0.0001; p = 0.002, p = 0.0001), no statistically significant difference was observed between the other groups (p > 0.05). Increased TOS and OSI and decreased TAS levels in the aqueous humour of patients with PES and PEG suggest that increased oxidative stress and decreased antioxidative defense system play a role in the etiopathogenesis of the disease.

Investigation of SARS-CoV-2 in Postmortem Ocular Tissues and Evaluation of Its Effects on Corneal Donation.

The purpose of this study was to investigate the presence of viruses in postmortem nasopharyngeal swabs and ocular tissues of patients with coronavirus disease 19 (COVID-19) confirmed through an antemortem reverse transcription polymerase chain reaction (RT-PCR) test. We recorded demographic data, comorbidities, treatments, and vaccination status of the patients diagnosed with COVID-19 and monitored in the intensive care unit. Nasopharyngeal swab samples were collected from the patients within 2 hours postmortem followed by swabs from both eyes, lower and upper conjunctival sacs, corneal epithelial layer, and samples from anterior chamber fluid. The geneMAP 2019-nCoV severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) detection kit was used to detect the samples showing the presence of SARS-CoV-2. Among the 47 patients (mean age 74 years, range 39-92) included in the study, 29 were men and 18 were women. The nasopharyngeal swab samples of 21 patients were positive for the RT-PCR test for SARS-CoV-2, whereas at least one of the ocular tissue samples in 6 of those patients were positive for the RT-PCR test for SARS-CoV-2. However, all ocular swab samples were tested negative for SARS-CoV-2 in the 26 patients with negative nasopharyngeal swab samples. The mean duration from COVID-19 diagnosis to mortality was 10 days (range 2-27 days) in patients with positive postmortem nasopharyngeal swab samples for SARS-CoV-2, compared with an average of 21 days (1-80 days) in patients who tested negative. This difference was statistically significant (P = 0.01). Cadavers with negative postmortem nasopharyngeal swab samples for SARS-CoV-2 and those with the time from diagnosis to death of >3 weeks may be considered as candidates for corneal donation.

Pigmented Free-Floating Iris Cyst in the Anterior Chamber

A 45-year-old man presented with a free-floating cyst in the anterior chamber of his left eye (Fig A-B). Medical history revealed a blunt trauma by firework to the left eye 10 years prior. Anterior-segment OCT scan revealed a cyst in the anterior chamber with hyperreflective walls and clear hyporeflective lumen (Fig C-D). The optical density is comparable with the anterior chamber fluid. The cyst was examined by a pathologist, which resulted in discovery of an iris cyst derived from iris pigment epithelium (hematoxylin and eosin staining) (Fig E).

Neurofilament light chain: a new marker for neuronal decay in the anterior chamber fluid of patients with glaucoma

Background/AimsNeurofilament light chain (NfL) levels in cerebrospinal fluid and serum are reliable indicators for neuroaxonal damage in a broad spectrum of neurodegenerative diseases. Herein, we investigate NfL levels in serum...

Multi-Elemental Analysis of Human Optic Chiasm—A New Perspective to Reveal the Pathomechanism of Nerve Fibers’ Degeneration

The effect of metals on the functioning of the human eye is multifactorial and includes enzyme activity modulation, trace metal metabolic pathways changes, and cytotoxic activity. Functional dysfunctions appear mostly as a result of the accumulation of toxic xenobiotic metals or disturbances of micronutrients’ homeostasis. So far, the affinity of selected metals to eye tissues, i.e., the cornea, choroid, lens, and anterior chamber fluid, has been most studied. However, it is known that many eye symptoms are related to damage to the optic nerve. In order to fill this gap, the aim of the study is to perform a multi-element analysis of tissue collected postmortem from optic chiasm and optic nerves. A total of 178 samples from 107 subjects were tested. The concentrations of 51 elements were quantified by inductively coupled plasma mass spectrometry (ICP-MS) after the wet-mineralization step. In terms of elemental composition, the optic chiasm is dominated by two trace elements, i.e., iron (Fe) and zinc (Zn), besides macro-elements Ca, K, Na, P, and Mg. The subjects formed a homogeneous cluster (over 70% subjects) with the highest accumulation of aluminum (Al). The remaining two departing clusters were characterized by an increased content of most of the elements, including toxic elements such as bismuth (Bi), uranium (U), lead (Pb), chromium (Cr), and cadmium (Cd). Changes in elemental composition with age were analyzed statistically for the selected groups, i.e., females, males, and subjects with alcohol use disorder (AUD) and without AUD. A tendency of women to lose Se, Cu, Zn, Fe with age was observed, and a disturbed Ca/Mg, Na/K ratio in subjects with AUD. Although the observed trends were not statistically significant, they shed new light on the risks and possible pathologies associated with metal neurotoxicity in the visual tract.

Experience of the anti-inflammatory eye drops Ivinak®-SOLOpharm use in patients after cataract surgery

BACKGROUND: The prevalence of inflammatory complications that occur after phacoemulsification remains an unsolved problem.
 AIM: To analyze the results of the use of Ivinak-SOLOpharm eye drops containing 0.09% bromfenac solution in the complex of anti-inflammatory therapy in patients after cataract surgery in comparison with similar drugs from other manufacturers.
 MATERIALS AND METHODS: The study included 60 patients (60 eyes) with a diagnosis of age-related cataract, who underwent phacoemulsification. All patients were divided into 2 groups: in the first group, patients used Ivinac eye drops 3 days before surgery and 20 days after it; in the second group, patients used another similar drug containing 0.09% bromfenac solution according to an identical scheme. All patients underwent visual acuity testing and keratopachimetry before and after surgery. On Day 4 and Day 20 after surgery, the degree of inflammatory reaction of the eye was assessed by the number of cells in the anterior chamber fluid, subjective signs of inflammation in patients, using the OSDI (Ocular Surface Disease Index) questionnaire.
 RESULTS: When analyzing the obtained data, no statistically significant differences were found between the groups in terms of best corrected visual acuity, corneal thickness, number of cells in the anterior chamber fluid, and subjective symptoms of inflammation in patients.
 CONCLUSIONS: Ivinak-SOLOpharm has proven its effectiveness and safety in the perioperative prevention of inflammatory processes in phacoemulsification.

Anterior chamber infiltration of CAR T-cells

A unique image of anterior chamber infiltration in a 2-year-infant with leukemia, treated with CD19 CAR T cells. Despite significant lymphopenia and resemblance of fungal infection initially, biopsy and cytologic analysis from anterior chamber fluid confirmed that this was CAR T-cell infiltration, likely targeting microscopic leukemia, unknown to us treating physicians. This is a unique case in 2 aspects: first, to state the high quality of CAR T-cell trafficking; and second – given the wide use of these cells currently, this image may help educate clinicians regarding this potential diagnosis.

The Role of Biologically Active Aqueous Humor Molecules of the Anterior Chamber and Lacrimal Fluid in the Implementation of the Hypotensive Effect of Non-Penetrating Deep Sclerectomy

To date, the factors affecting the course of the reparative process after non-penetrating deep sclerectomy (NPDS) have not been fully determined. There is no systematic information about the regulatory role of the cytokines TGF-β, IL-6, IL-8 and MMP-9, VEGF A 121 and 165 in the formation mechanisms of the newly created pathways consistency of intraocular aqueous humor outflow.Purpose. To determine possible ways of impact of biologically active aqueous humor molecules of the anterior chamber and lacrimal fluid on the hypotensive effect of non-penetrating deep sclerectomy.Methods.A prospective study of 65 patients with open-angle glaucoma before and 12 months after NPDS and 22 patients without eye hydrodynamic disorders with the determination of the initial concentrations of biologically active molecules in the lacrimal fluid and aqueous humor of the anterior chamber. Twelve months after NPDS all patients were divided into three groups, depending on the hypotensive effect of the operation, according to the criteria.Results. Multivariate discriminant analysis showed the greatest inter-group differences, calculated by the square of the Mahalanobis distance, between group 3 with no hypotensive effect of NPDS and the control group (R2 = 8.48, p = 0.001). The most informative features that determine the differences between the 4 groups in the total population, calculated according to the Fischer F-test, were MMP-9 (F = 14.7, p = 0.001) and TGF-β (F = 7.08, p = 0.001) in the aqueous humor of the anterior chamber. In pairwise comparison of groups 1 and 2, the maximum level of significance according to the F-criterion was characteristic of the level of tear IL-6 (F = 21.25, p = 0.001), with approximately equal degree – IL-8 (F = 7.85, p = 0.001) and VEGF (F = 7.12, p = 0.001), to a lesser extent TGF of aqueous humor (F = 4.43, p = 0.001) and MMR-9 (F = 2.23, p = 0.001). Between groups 1–3, the maximum differences according to the Fisher criterion were observed in the IL-8 (F = 20.99, p = 0.001), TGF (F = 8.75, p = 0.001) and to a lesser extent – TGF (F = 5.83, p = 0.001).Conclusion. The analysis of the obtained data showed the decisive role of the imbalance of proinflammatory cytokines, signaling proteins with prolymphoangiogenic activity, and MMP-9 in the aqueous humor of the anterior chamber, as well as in the initial state of the lacrimal fluid in the postoperative healing processes after NPDS.

In vivo quantitative analysis of anterior chamber white blood cell mixture composition using spectroscopic optical coherence tomography.

Anterior uveitis is the most common form of intraocular inflammation, and one of its main signs is the presence of white blood cells (WBCs) in the anterior chamber (AC). Clinically, the true composition of cells can currently only be obtained using AC paracentesis, an invasive procedure to obtain AC fluid requiring needle insertion into the AC. We previously developed a spectroscopic optical coherence tomography (SOCT) analysis method to differentiate between populations of RBCs and subtypes of WBCs, including granulocytes, lymphocytes and monocytes, both in vitro and in ACs of excised porcine eyes. We have shown that different types of WBCs have distinct characteristic size distributions, extracted from the backscattered reflectance spectrum of individual cells using Mie theory. Here, we further develop our method to estimate the composition of blood cell mixtures, both in vitro and in vivo. To do so, we estimate the size distribution of unknown cell mixtures by fitting the distribution observed using SOCT with a weighted combination of reference size distributions of each WBC type calculated using kernel density estimation. We validate the accuracy of our estimation in an in vitro study, by comparing our results for a given WBC sample mixture with the cellular concentrations measured by a hemocytometer and SOCT images before mixing. We also conducted a small in vivo quantitative cell mixture validation pilot study which demonstrates congruence between our method and AC paracentesis in two patients with uveitis. The SOCT based method appears promising to provide quantitative diagnostic information of cellular responses in the ACs of patients with uveitis.