Conjunctival Features Research Articles

Identifying diabetes from conjunctival images using a novel hierarchical multi-task network

Diabetes can cause microvessel impairment. However, these conjunctival pathological changes are not easily recognized, limiting their potential as independent diagnostic indicators. Therefore, we designed a deep learning model to explore the relationship between conjunctival features and diabetes, and to advance automated identification of diabetes through conjunctival images. Images were collected from patients with type 2 diabetes and healthy volunteers. A hierarchical multi-tasking network model (HMT-Net) was developed using conjunctival images, and the model was systematically evaluated and compared with other algorithms. The sensitivity, specificity, and accuracy of the HMT-Net model to identify diabetes were 78.70%, 69.08%, and 75.15%, respectively. The performance of the HMT-Net model was significantly better than that of ophthalmologists. The model allowed sensitive and rapid discrimination by assessment of conjunctival images and can be potentially useful for identifying diabetes.

Scleral and conjunctival features in patients with rhegmatogenous retinal detachment undergoing scleral buckling: an anterior segment optical coherence tomography and in vivo confocal microscopy study.

To investigate the scleral and conjunctival features in patients with rhegmatogenous retinal detachment (RRD) undergoing scleral buckling (SB), using anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM). Twenty RRD eyes were consecutively enrolled. AS-OCT was performed at RRD diagnosis (RRD-D) and day 1, week 1, month 1 and month 6 after SB to evaluate the sclera, in the affected and unaffected quadrants (AQ, UQ). IVCM was performed at RRD-D, and at month 1 and month 6, to evaluate the conjunctiva in AQ and UQ. The main outcomes were as follows: mean intra-scleral hypo-reflective spaces area (MIHSA) at AS-OCT; mean density and area of microcysts (MMD, MMA) at IVCM; and intra-ocular pressure (IOP). The relations between MIHSA, MMA, MMD and IOP were evaluated. Rhegmatogenous retinal detachment- diagnosis (RRD-D) overall-mean intra-scleral hypo-reflective spaces (MISHA), -MMD and -MMA were significantly higher in affected eye (AE) compared with UE (p<0.05) and in AQ compared with UQ (p<0.05). After SB, overall-, AQ- and UQ-MISHA further increased (p<0.05), whereas overall-MMD and -MMA did not change. At all follow-up, AQ and UQ parameters did not show significant differences between them. RRD-D IOP was 14.3±2.8 and 15.5±2.7mmHg in the AE and UE, respectively (p<0.05). After SB, week-1, month-1 and -6 IOP was significantly lower than RRD-D (p<0.05). Rhegmatogenous retinal detachment- diagnosis (RRD-D), 1- and 6-month overall and AQ-MISHA and AQ-MMD negatively correlated with IOP (p<0.05). Rhegmatogenous retinal detachment (RRD) and SB induced scleral and conjunctival changes that suggested an activation of fluid outflow through the entire unconventional aqueous humour pathway; these modifications may in part account for the relative hypotony after RRD and SB.

Trans-conjunctival aqueous humor outflow in glaucomatous patients treated with prostaglandin analogues: an in vivo confocal microscopy study.

To analyze, using in vivo laser scanning confocal microscopy (LSCM), the conjunctival features in glaucomatous patients receiving prostaglandin analogues (PGA). Eighty eyes of 80 consecutive glaucomatous patients naive for therapy were enrolled; 30 eyes of 30 healthy subjects served as a control. Patients were randomized to: preservative-free (PF) and preserved latanoprost (groups 1 and 2, respectively), PF and preserved timolol (groups 3 and 4), and controls to vehicle of latanoprost or physiological buffered saline solution (groups 5 and 6). All subjects underwent LSCM of bulbar conjunctiva at baseline and 3 months after initiating therapy. The main outcomes were: mean density (MMD: cysts/mm(2)) and mean area (MMA: cysts/mm(2)) of epithelial microcysts. The relations between MMA and MMD with intraocular pressure (IOP), age, and mean defect (MD), were analyzed. At baseline, microcysts were found in all subjects. At month three, MMD did not change in all groups (p > 0.05). MMA significantly increased only in group 1 from 2,158.81 ± 524.09 to 3,877.77 ± 867.31, and in group 2 from 2,019.71 ± 541.03 to 5,560.39 ± 1,176.14, with values significantly higher in group 2 (p < 0.001). Significant relations were not found between MMD and MMA with IOP, MD, and age (p > 0.05). PGA increased MMA in therapy-naive glaucomatous patients, indicating a possible enhancement of the trans-conjunctival aqueous humor outflow. Therefore, conjunctiva seems an additional target tissue to evaluate the hydrodynamic pathways in glaucoma and modifications induced by medical therapy.

Diagnostic and therapeutic applications of alcohol delamination (ALD) of the corneal epithelium

Abstract Purpose Application of a weak alcohol solution to delaminate the corneal epithelium was first popularised for LASEK (Laser subepithelial keratomielusis). We subsequently reported successful results using ALD for the treatment of recurrent corneal erosion syndrome. In this study we explored the uses of this technique for other therapeutic and diagnostic indications. Methods Eight patients were studied. In 3 the indication was for diagnosis only, in 3 it was for diagnosis and treatment and in 2 for treatment only. Following slitlamp evaluation, a 6mm well was placed over the site to be delaminated and 20% alcohol applied for 30‐40 seconds following which the alcohol was removed and the cornea washed before peeling off the loosened epithelial sheet, which was spread on paper and covered with fixative for light and/or electron microscopy. Results Of the 3 that had ALD for diagnosis, clinical suspicion of conjunctival intraepithelial neoplasia was confirmed in all 3 with preservation of cell morphology and orientation. 3 patients had chronic epitheliopathies manifesting as persisting epithelial defects and sick corneal epithelium. One showed epithelial cell apoptosis and the other 2 showed non specific or conjunctival features. All conditions resolved with visual improvement. Two symptomatic patients, 1 with extensive basement membrane dystrophy and the other with recurrence of granular dystrophy in the epithelium of a graft, showed improvement after ALD. Histology confirmed the diagnosis. Conclusion ALD is a simple, safe and effect intervention for removal of an intact epithelial sheet that can be histologically examined with proper tissue orientation facilitating accurate diagnosis. It also serves as a therapeutic intervention.

Ocular discomfort and conjunctival alterations in operating room workers. A single-institution pilot study.

The aim of this pilot study was to relate the eye symptoms complained of by subjects working in the operating rooms of a hospital in southern Italy, with the observations of alterations of the ocular surface. An epidemiological study was carried out by a questionnaire aimed at investigating the prevalence of ocular discomfort symptoms among 213 subjects working in operating rooms and 40 subjects working in the wards. The investigated symptoms were the following: tiredness, heaviness, burning, redness, tearing, itching, blinking, foreign body sensation, and photophobia. A randomised comparative study of the ocular surface and conjunctival cytology was also carried out, comparing two groups of age- and gender-matched subjects. Group 1 included 24 subjects randomly chosen from the operating room workers with ocular discomfort symptoms; group 2 included ten subjects randomly enrolled from hospital personnel working in the wards. Ophthalmological examination of the ocular surface was performed on each subject in the following order: slit-lamp examination, break-up time (BUT) of the pre-corneal tear film, corneal fluorescein stain, lachrymal basal secretion test, conjunctival impression cytology. A high prevalence (72.3%) of ocular discomfort symptoms was reported by operating room workers, while in ward personnel the prevalence was 55% (P = 0.04). The ocular tests showed that the conjunctival features and BUT were statistically significantly altered in subjects in group 1. Also, the conjunctival impression cytology study showed statistically significant alterations of all the investigated parameters: specimen cellularity, cell-to-cell contacts, nucleus/cytoplasm ratio, chromatin pattern, goblet cell distribution, keratinisation and the total cytological score. Our results show that self-reported eye complaints and ocular surface alterations have a high prevalence in subjects working in the operating rooms. This seems to indicate that the operating room environment could play a role in the onset of the eye disturbances.