Ocular Surface Integrity Research Articles

Biomarkers in Ocular Chronic Graft Versus Host Disease: Tear Cytokine- and Chemokine-Based Predictive Model.

To develop a tear molecule level-based predictive model based on a panel of tear cytokines and their correlation with clinical features in ocular chronic graft versus host disease (cGVHD). Twenty-two ocular cGVHD patients and 21 healthy subjects were evaluated in a controlled environmental research laboratory (CERLab). Clinical parameters were recorded, and tears were collected. Levels of 15 molecules (epidermal growth factor [EGF], IL receptor antagonist [IL-1Ra], IL-1β, IL-2, IL-6, IL-8/CXCL8, IL-10, IL-12p70, IL-17A, interferon inducible protein [IP]-10/CXCL10, IFN-γ, VEGF, TNF-α, eotaxin 1, and regulated on activation normal T cell expressed and secreted [RANTES]) were measured by multiplex-bead assay and correlated with clinical parameters. Logistic regression was used to develop a predictive model. Leave-one-out cross-validation was applied. Classification capacity was evaluated in a cohort of individuals with dry eye (DE) of other etiologies different from GVHD. Epidermal growth factor and IP-10/CXCL10 levels were significantly decreased in ocular cGVHD, positively correlating with tear production and stability and negatively correlating with symptoms, hyperemia, and vital staining. Interleukin-1Ra, IL-8/CXCL8, and IL-10 were significantly increased in ocular cGVHD, and the first two correlated positively with symptoms, hyperemia, and ocular surface integrity while negatively correlating with tear production and stability. Predictive models were generated, and the best panel was based on IL-8/CXCL8 and IP-10/CXCL10 tear levels along with age and sex, with an area under the receiving operating curve of 0.9004, sensitivity of 86.36%, and specificity of 95.24%. A predictive model based on tear levels of IL-8/CXCL8 and IP-10/CXCL10 resulted in optimal sensitivity and specificity. These results add further knowledge to the search for potential biomarkers in this devastating ocular inflammatory disease.

Cataract surgery in chronic Stevens–Johnson syndrome: aspects and outcomes

AimTo assess the outcome of cataract surgery in patients with chronic sequelae of Stevens–Johnson syndrome (SJS).MethodsSetting: Tertiary eye care centre in South India. Design: Retrospective, non-comparative, consecutive, interventional case series....

Effect of the osmolarity change in multipurpose solutions induced by an improper contact lens case cleaning procedure.

To determine whether variations in multipurpose disinfecting solution (MPDS) storage osmolarity from inappropriate contact lens (CL) case cleaning affect ocular surface integrity and wearer comfort. There were twenty contact lens cases (study CLCs) in the study group. Ten were filled with ReNu Multiplus(®) and 10 with SoloCare Aqua™ (MPDS-1 and -2, respectively) and kept closed for 8h; the cases were then emptied and kept open for air-drying for 16h. This procedure was carried out every day for two months. Storage solution osmolarity was measured on days 0, 15, 30, 45 and 60. Ten subjects were then fitted with both month-old lenses stored in the study CLCs and with new lenses stored in new cases with fresh solution for 24h (control CLCs). Symptoms, tear osmolarity and percentage of subjects whose conjunctival hyperaemia and ocular surface staining scores changed were determined after 1h of wear. Study CLC osmolarity increased in both solutions after two months (p<0.05). For MPDS-1 there were differences in stinging between study CLCs and control CLCs after 10min of CL wear (p=0.04), and in comfort after 10 (p=0.035) and 60min wear (p=0.042). Significant (p<0.05) differences between study CLC and control CLC groups were also found for MPDS-2 in limbal hyperaemia (study: 50% change; control: 0% change) and bulbar and corneal staining (study: 80% change; control: 20% change). The stored-MPDS osmolarity increase caused by air-drying the CLCs could affect the ocular surface. This increase might reduce lens wear comfort.

Long Term Follow-up of Limbal Transplantation for Unilateral Chemical Injuries: 1997-2014

Purpose: To evaluate the long term results of limbal transplantation (LT) in patients with unilateral total limbal stem cell deficiency (LSCD) after chemical injury. Methods: The study includes 22 eyes of 22 consecutive patients (20 males and 2 females) who presented with total LSCD after unilateral chemical burns and underwent Limbal transplantation (LT) in the Cornea Service of the Department of Ophthalmology at the Heraklion University Hospital in Crete during the period from 1997 to 2014. All 22 cases underwent Conjunctival Limbal autogaft (CLAU) while in 14 surgeries it was combined with amniotic membrane transplantation (AMT). A second stage penetrating keratoplasty (PKP) was performed in 11 cases for visual rehabilitation. The healing time, the changes in VA and the stability of epithelial ocular surface integrity were looked for. Results: One case failed within 3 months of surgery, while the rest 21 eyes after CLAU maintained ocular surface epithelial integrity during the follow up period (7.8 ± 3.5 years), and showed improvement partially or totally in corneal neovascularization, symblepharon and ocular motility. The mean corneal healing time was 17 days, while visual acuity either showed statistically significant improvement in 18 eyes, with CLAU alone or followed by PKP. No significant difference in the surgical outcome was observed between AMT and none AMT cases. Conclusions: Conjunctival limbal autografts for limbal deficiency after unilateral chemical burn showed long term success and stability, in 21 out of 22 eyes, whether combined or not with amniotic membrane transplantation

Influence of Climate on Clinical Diagnostic Dry Eye Tests: Pilot Study.

To analyze dry eye disease (DED) tests and their consistency in similar nonsymptomatic population samples living in two geographic locations with different climates (Continental vs. Atlantic). This is a pilot study including 14 nonsymptomatic residents from Valladolid (Continental climate, Spain) and 14 sex-matched and similarly aged residents from Braga (Atlantic climate, Portugal); they were assessed during the same season (spring) of two consecutive years. Phenol red thread test, conjunctival hyperemia, fluorescein tear breakup time, corneal and conjunctival staining, and Schirmer test were evaluated on three different consecutive visits. Reliability was assessed using the intraclass correlation coefficient and weighted kappa (κ) coefficient for quantitative and ordinal variables, respectively. Fourteen subjects were recruited in each city with a mean (± SD) age of 63.0 (± 1.7) and 59.1 (± 0.9) years (p = 0.08) in Valladolid and Braga, respectively. Intraclass correlation coefficient and κ values of the tests performed were below 0.69 and 0.61, respectively, for both samples, thus showing moderate to poor reliability. Subsequently, comparisons were made between the results corresponding to the middle and higher outdoor relative humidity (RH) visit in each location as there were no differences in mean temperature (p ≥ 0.75) despite RH values significantly differing (p ≤ 0.005). Significant (p ≤ 0.05) differences were observed between Valladolid and Braga samples on tear breakup time (middle RH visit, 2.76 ± 0.60 vs. 5.26 ± 0.64 seconds; higher RH visit, 2.61 ± 0.32 vs. 5.78 ± 0.88 seconds) and corneal (middle RH, 0.64 ± 0.17 vs. 0.14 ± 0.10; higher RH, 0.60 ± 0.22 vs. 0.0 ± 0.0) and conjunctival staining (middle RH, 0.61 ± 0.17 vs. 0.14 ± 0.08; higher RH, 0.57 ± 0.15 vs. 0.18 ± 0.09). This pilot study provides initial evidence to support that DED test outcomes assessing the ocular surface integrity and tear stability are climate dependent. Future large-sample studies should support these outcomes also in DED patients. This knowledge is fundamental for multicenter clinical trials. Lack of consistency in diagnostic clinical tests for DED was also corroborated.

Use of Prosthetic Replacement of the Ocular Surface Ecosystem Scleral Lenses in Patients with Ocular Chronic Graft-versus-Host Disease.

The purpose of this study was to evaluate the impact of prosthetic replacement of the ocular surface ecosystem (BostonSight PROSE, Boston Foundation for Sight, Needham, MA) treatment, utilizing customized scleral devices, on visual acuity, visual function, and ocular surface changes in patients with ocular chronic graft-versus-host disease (cGVHD). A retrospective analysis was performed on 79 eyes of 40 patients with cGVHD referred to the University of Southern California department of ophthalmology between November 2009 and July 2013 for PROSE treatment. This analysis included an assessment of ocular symptoms and visual function before and after treatment using the Ocular Surface Disease Index (OSDI) survey. Pre- and post-treatment visual acuity and clinical data were also compared. Twenty-eight male patients and 12 female patients were included in this study. The average age was 56.1 years (range, 27 to 74). Of the 79 eyes treated, 71 (90%) showed improved visual acuity with PROSE treatment. Fifty-seven eyes (72%) experienced a 2- or greater line visual acuity improvement and 14 eyes (18%) experienced a 1-line improvement. Average logarithm of the minimal angle of resolution improved from .49 ± .52 to .16 ± .44 (P < .0001), which correlates to a Snellen score improvement of approximately 20/60 to 20/30. Sixty-six of 79 eyes (84%) showed decreased corneal staining after treatment. All 9 eyes presenting with filamentary keratitis and 3 eyes with epithelial defects demonstrated complete healing of the epithelial surface after PROSE fitting. At post-treatment follow-up, 8 patients had died and 3 stopped wearing their devices. Of the remaining 29 patients, average OSDI scores improved from 72.6 ± 20.1 to 21.1 ± 14.9 (P < .0001). PROSE therapy, utilizing customized scleral lenses, can reduce ocular symptoms, improve visual acuity, and improve ocular surface integrity or appearance in patients with ocular cGVHD.

Sealing of the Gap between the Conjunctiva and Tenon Capsule to Improve Symblepharon Surgery

To report the surgical outcome of "sealing the gap" in treating symblepharon caused by various etiologies other than recurrent pterygium. Retrospective, interventional case series. Sixteen eyes of 14 patients with pathogenic symblepharon were consecutively operated by conjunctival recession, sealing the gap between recessed conjunctiva and Tenon capsule with a running 9-0 nylon suture, and covering of the bare sclera with amniotic membrane. For severe symblepharon where there was conjunctival shortening, oral mucosa graft was added. Outcome measures include ocular surface inflammation, fornix reformation, and restoration of ocular motility. The underlying causes of symblepharon included Stevens-Johnson syndrome (n= 6), chemical burn (n= 5), ocular cicatricial pemphigoid (n= 1), thermal burn (n= 1), following excision of conjunctival squamous cell carcinoma (n= 1), conjunctival scarring following exposed buckle (n= 1), and immune dysregulation (n= 1). Twelve eyes (75%) had an average of 1.6 ± 0.9 previous surgeries. Before surgery, ocular motility restriction was significantly correlated with the severity of symblepharon. During the follow-up period of 17.1 ± 13.6months, 13 eyes (81.3%) achieved complete success, 2 eyes (12.5%) achieved partial success, and 1 eye with immune dysregulation had failure (6.3%). There was no correlation between the success rate and the severity of symblepharon. After surgery, the ocular motility and inflammation were significantly improved. Visual acuity had improved in 2 of 15 eyes. Sealing the gap between the conjunctiva and Tenon capsule is an important step in the surgical management of pathogenic symblepharon. This method not only avoids the use of mitomycin C, but also creates a strong barrier to prevent recurrence, restore ocular surface integrity, reform a deep fornix, and regain full ocular motility.

Non-Invasive Diagnosis of Ocular Graft-versus-Host Disease

Ocular graft-vs-host disease (GvHD) is a major complication following allogenic blood stem cell transplantation (aBSCT) leading to a disturbance of the ocular surface integrity with a broad range of severity. Leading symptom is a pronounced autoinflammatory reaction in particular at the ocular surface with typical features of dry eye disease. Potential complications include visual loss, pain and damage to the ocular structures with, e. g. corneal ulcerations. Diagnosis and treatment of ocular GvHD are a challenge for attending ophthalmologists and require intensive interdisciplinary patient care in particular with haemato-oncologists. First and follow-up examinations consist of several diagnostic steps that include quantitative and qualitative analysis of tearfilm, visual acuity, ocular surface and retinal integrity, cataract development and subjective symptoms. Available tests are mostly evaluated for usage in dry eye diagnosis but are, however, mostly unspecific for diagnosing ocular GvHD reliably. Only combinations of several clinical tests together with the experience of specialised ophthalmologists may lead to the certain diagnosis and treatment decisions at state. This review illustrates the available established and innovative non-invasive diagnostic tests and evaluates their potential use for diagnosing ocular GvHD.

Use of adipose-derived mesenchymal stem cells in keratoconjunctivitis sicca in a canine model.

Keratoconjunctivitis sicca (KCS) or dry eye disease (DED) is an immune-mediated multifactorial disease, with high level of prevalence in humans and dogs. Our aim in this study was to investigate the therapeutic effects of allogeneic adipose-derived mesenchymal stromal cells (Ad-MSCs) implanted around the lacrimal glands in 12 dogs (24 eyes) with KCS, which is refractory to current available treatments. Schirmer tear test (STT) and ocular surface integrity were assessed at 0 (before treatment), 3, 6, and 9 months after treatment. Average STT values and all clinical signs showed a statistically significant change (P < 0.001) during the follow-up with reduction in all ocular parameters scored: ocular discharge, conjunctival hyperaemia, and corneal changes, and there were no signs of regression or worsening. Implanted cells were well tolerated and were effective reducing clinical signs of KCS with a sustained effect during the study period. None of the animals showed systemic or local complications during the study. To our knowledge, this is the first time in literature that implantation of allogeneic Ad-MSCs around lacrimal glands has been found as an effective therapeutic alternative to treat dogs with KCS. These results could reinforce a good effective solution to be extrapolated to future studies in human.

Conjunctiva reconstruction by induced differentiation of human amniotic epithelial cells.

In this study, we aimed to investigate the feasibility of directed differentiation of human amniotic epithelial cells into conjunctival epithelium under specific conditions as well as of constructing tissue-engineered conjunctiva for ocular surface reconstruction. Human amniotic epithelial cells were cultured with induced denuded conjunctival matrix and conjunctival homogenate. Immunohistochemistry of cytokeratin-4, cytokeratin-13, and muc5ac as well as PAS staining were performed. The concentration of muc5ac at different times was measured using ELISA. The differentiated cells with quantum dots were transferred onto a denuded amniotic membrane to establish tissue-engineered conjunctiva and transplanted into a rabbit model with a conjunctival defect. After induction of human amniotic epithelial cells, differentiated cells showed conjunctival epithelium phenotype, while trace amounts of mu5ac in the culture medium measured by ELISA increased gradually within 1 to 7 days. Successfully tissue-engineered conjunctiva had similar structure as normal conjunctiva and was transplanted into a rabbit model with conjunctiva defect. After 2 weeks post-surgery, conjunctiva grafts survived and were integrated. Immunohistochemistry showed conjunctival epithelium phenotype, positive cells were found in PAS staining. Thus, human amniotic epithelial cells could differentiate into conjunctival epithelium-like cells and goblet cells with partially physiological function, and we successfully restored ocular surface integrity in the rabbit model using tissue-engineered conjunctiva.

Amniotic membrane graft to conjunctival flap in treatment of non-viral resistant infectious keratitis: a randomised clinical study

PurposeTo evaluate and compare the results of bipedicle conjunctival flap (CF) and cryopreserved amniotic membrane graft (AMG) in the treatment of non-viral infectious keratitis resistant to medical treatment.MethodsThis prospective randomised...

Topical administration of lacritin is a novel therapy for aqueous-deficient dry eye disease.

Lacritin is a tear glycoprotein with prosecretory, prosurvival, and mitogenic properties. We examined lacritin levels in the tears of Sjögren's syndrome (SS) patients and explored the therapeutic potential of topical lacritin for the treatment of keratoconjunctivitis sicca. Tears from healthy controls (n = 14) and SS patients (n = 15) were assayed for lacritin using a C-terminal antibody. In a paired-eye study, autoimmune regulator (Aire) knockout (KO) mice (n = 7) were treated three times daily for 21 days with 10 μL of 4 μM lacritin (left eye) or vehicle (PBS) control (right eye). Tear secretion and ocular surface integrity were assessed at baseline and after treatment. Immunohistochemical staining of CD4+ T cells, cytokeratin-10 (K10), and cytokeratin-12 (K12) expression in the cornea and CD4+ T cell infiltration in the lacrimal glands were assessed. Lacritin monomer (421.8 ± 65.3 ng [SS] vs. 655.8 ± 118.9 ng [controls]; P = 0.05) and C-terminal fragment protein (125 ± 34.1 ng [SS] vs. 399.5 ± 84.3 ng [controls]; P = 0.008) per 100 μL of tear eluate were significantly lower in SS patients. In Aire KO mice treated with lacritin, tear secretion increased by 46% (13.0 ± 3.5 mm vs. 8.9 ± 2.9 mm; P = 0.01) and lissamine green staining score significantly decreased relative to baseline (-0.417 ± 0.06 vs. 0.125 ± 0.07; P = 0.02). Expression of K10 but not K12 in the cornea was significantly decreased in lacritin-treated eyes. Focal CD4+ T cell infiltration of the lacrimal glands was significantly reduced on the lacritin-treated side versus the untreated side. Lacritin is significantly reduced in the tears of SS patients. Topically administered lacritin has therapeutic potential for the treatment of aqueous-deficient dry eye disease.

Experience with straylight in the cataract clinic

AbstractWe know that there are many sources of physiologic scatters such modified cornea (after refractive surgery, haze, dystrophies, ocular surface disease) , vitreous alterations and lens changes with the aging process inducing progressive cataract and impairing light diffusion. Nowadays, thanks to the access to scatter measurement, we might be able to assess tear film quality dynamics (with an increase in ocular surface desiccation commonly observed in old patients), but moreover we could detect early cataract at the stage of no induced visual acuity decrease but quality of vision degradation. We will present the preliminary results of a multicenter French study based on the use of the Double Pass Image Analyser (OQAS) for the potential diagnosis of cataract, on a standardized questionnaire of life and taking also account the integrity of ocular surface in addition to visual performances. The key parameter provided by this platform is the OSI (Ocular Surface that increases when scatters are in elevation (superior to 4). Our preliminary pilot results show a significant correlation between quality of life and OSI changes, suggesting that the objective measurement of light scatter might be of interest for detection of early cataract and that the consideration of quality of life (based on a basic questionnaire) should be considered in the modern new definition of cataract.

Management of HSV‐1 necrotizing keratitis with amniotic membrane transplantation combined with antiviral and steroid therapy

AbstractPurpose To report promoted healing of necrotizing herpetic keratitis after amniotic membrane transplantation (AMT) in conjunction with antiviral and corticosteroid therapy.Methods Herpes necrotizing stromal keratitis was defined as a corneal ulcer with a dense, whitish inflammatory infiltration and corneal scrapping positive for HSV‐1 by polymerase chain reaction (PCR). Corneal smears and cultures were made to rule out bacterial and fungal infections. All patients received systemic antiviral treatment and topical antibiotics. When corneal ulcers were refractory to medical treatment, multilayered AMT was considered. During the post operative period, systemic antiviral treatment was continued and local corticosteroids were started. Main outcome measures were visual acuity and wound healing of corneal ulcers.Results Thirteen patients (13 eyes) with herpes necrotizing stromal keratitis were retrospectively reviewed. The mean follow up was 13.1 months (range 2‐30 months). Amniotic membrane transplantation was performed in 9 cases (twice in one patient), within a mean of 17 days (range 2‐43 days) after medical treatment initiation. Epithelial defects healed within a mean of 40 days (range 9‐97 days) after AMT. At the last visit, mean visual acuity improved from 2.2 logMAR to 1.3 LogMAR (p=0.016). No serious side effects occurred during the follow up.Conclusion Multilayer AMT combined with antiviral and corticosteroid therapy seems to be effective in treating herpes necrotizing stromal keratitis. It provides restoration of ocular surface integrity and improvement of vision.

Effects of ozone exposure on the ocular surface

Changes in the ocular surface induced by ozone have received limited research attention. Here, we investigate the effects of ozone exposure on the integrity of the ocular surface, the production of inflammatory cytokines in tears, and changes in mucin-secreting cells in a mouse model. In addition, ozone-induced nuclear factor-κB (NF-κB)-mediated inflammatory processes were evaluated in cultured human conjunctival epithelial cells. In vivo, ozone induced the breakdown of corneal epithelial integrity, decreased the number of mucin-secreting cells, and induced the production of inflammatory cytokines, without altering tear volume. In vitro, ozone exposure led to increases in NF-κB nuclear translocation, κB-dependent transcriptional activity, NF-κB inhibitor α (IκBα) proteolysis, and expression of phosphorylated IκBα (p-IκBα), but did not cause cytotoxicity or cellular apoptosis. In addition, ozone induced the expression of inflammatory cytokines, Toll-like receptors, and C–C chemokine receptors, but decreased the expression of mucins. Furthermore, inhibition of NF-κB with pyrrolidine dithiocarbamate before exposure of cultured human conjunctival epithelial cells to ozone prevented changes in IκBα and p-IκBα levels in association with a decrease in the levels of inflammatory cytokines. Therefore, we conclude that ozone exposure interferes with ocular surface integrity and induces inflammation involving NF-κB-mediated processes at the level (and/or upstream) of IκBα. Understanding the role of ozone in the initiation of inflammatory processes on the animal ocular surface and in cultured human conjunctival epithelial cells can help elucidate the pathogenesis of ocular surface damage and suggest protective strategies for preserving a healthy ocular surface against ozone exposure.

Application of umbilical cord serum eyedrops after laser epithelial keratomileusis

To investigate the efficacy of umbilical cord serum eyedrops after laser epithelial keratomileusis (LASEK). Sixty patients (120 eyes) with myopia who underwent LASEK were studied. Thirty-two patients (64 eyes) were treated with 20% umbilical cord serum eyedrops in combination with conventional treatment (group A), and 28 patients (56 eyes) received conventional treatment only (group B). Epithelial healing time was analysed. Visual acuity, refraction, haze score (0-4) and tear film and ocular surface parameters were evaluated at 1, 2, 4 and 12 weeks after LASEK. The concentration of transforming growth factor (TGF)-β1 in tears was measured with ELISA at 1 week after LASEK. No significant differences in visual acuity and refraction were found between groups. The mean time to epithelial healing was 3.53 ± 1.19 days in group A and 3.91 ± 1.41 days in group B (p = 0.18). The mean haze scores at 2 and 4 weeks were 0.59 ± 0.80 and 0.31 ± 0.54 in group A and 1.06 ± 0.91 (p = 0.02) and 0.69 ± 0.78 (p = 0.03) in group B. Four and 12 weeks after LASEK, tear film break-up time was longer and keratoepitheliopathy score was lower in group A compared with group B. The mean concentration of TGF-β1 was lower in group A compared with group B (p = 0.01). Application of 20% umbilical cord serum eyedrops in addition to conventional treatment after LASEK can reduce early postoperative corneal haze and improve tear film and ocular surface parameters.

Eye preservation tectonic graft using glycerol-preserved donor cornea

To report the surgical outcome of tectonic graft using glycerol-preserved donor corneas to treat perforated keratitis. The medical records were reviewed of all patients treated for perforated keratitis using glycerol-preserved corneas at a single institution between 1 July 2004 and 31 June 2010. The clinical features, precipitating factors, adjuvant therapies, and therapeutic outcomes were analyzed. Success was defined as re-epithelialization of the ocular surface without evisceration. Fourteen eyes from 14 patients (6 male and 8 female) were included. Age ranged from 58 to 84 years (average, 70.71 ± 8.52 years) and the follow-up time ranged from 7 to 56 months (mean, 25.35 ± 16.84 months). The culture results showed five bacterial infections, five cases of fungal keratitis, and one mixed infection; the culture results were negative for three patients. Satisfactory anatomical integrity was obtained in eight grafts (57.14%) that healed with neovascularization. Six grafts (48.85%) showed delayed re-epithelialization and were repaired with conjunctival flaps to maintain ocular surface integrity. Three patients developed secondary glaucoma and received trans-scleral cyclophotocoagulation. Thirteen patients had satisfactory anatomical integrity without evisceration or exenteration, while one patient received evisceration at 39-month follow-up because of intractable glaucoma. Glycerol-preserved donor corneas combined with anterior vitrectomy with or without conjunctival flaps may be effective substitutes for evisceration surgery in patients with perforated keratitis.

The Lid Wiper – a specialized structure at the inner eyelid margin for distribution of the tear film

AbstractPurpose The lid wiper is an epithelial structure at the inner eyelid border that distributes the thin precorneal tear film during the up‐phase of the blink. Clinically it is the first area of the ocular surface that shows epithelial alterations in dry eye disease.Methods A literature review on the posterior lid margin and lid wiper is discussed together with own data and considerations of the relevance of the lid wiper region in ocular surface physiology and pathology.Results The posterior side of the inner lid border has an epithelium of conjunctival morphology with goblet cells. It forms an elevation of about 100µm (10‐12 cell layers) thickness immediately at the crest of the inner border with a slope towards the subtarsal fold. The lid wiper hence forms a distinct epithelial lip that is the only region of the upper lid in contact with the globe as verified by functional tests. It extends along the upper and lower eyelid margins, has a width of typically about 1mm, narrower in the middle and wider to the temporal and nasal sides. The lid wiper of the upper lid appears as a suitable device to distribute the thin precorneal tear film during the blink as supported by the finding that in conditions with increased friction, such as dry eye disease and contact lens wear, the lid wiper is the first zone of the ocular surface that shows a pathological vital staining indicating epithelial destruction.Conclusion The lid wiper is of underestimated importance for tear film distribution and ocular surface integrity as well as a sensitive early indicator of dry eye disease. Integration and scoring of lid wiper epitheliopathy in dry eye diagnosis and therapy schemes could be a valuable addition to clinical practice. Support DFG KN317/11

Straylight as indication for cataract surgery

AbstractWe know that there are many sources of physiologic scatters such modified cornea (after refractive surgery, haze, dystrophies, ocular surface disease) , vitreous alterations and lens changes with the aging process inducing progressive cataract and impairing light diffusion. Nowadays, thanks to the access to scatter measurement, we might be able to assess tear film quality dynamics (with an increase in ocular surface desiccation commonly observed in old patients), but moreover we could detect early cataract at the stage of no induced visual acuity decrease but quality of vision degradation. We will present the preliminary results of a multicenter French study based on the use of the Double Pass Image Analyser (OQAS) for the potential diagnosis of cataract, on a standardized questionnaire of life and taking also account the integrity of ocular surface in addition to visual performances. The key parameter provided by this platform is the OSI (Ocular Surface that increases when scatters are in elevation (superior to 4). Our preliminary pilot results show a significant correlation between quality of life and OSI changes, suggesting that the objective measurement of light scatter might be of interest for detection of early cataract and that the consideration of quality of life (based on a basic questionnaire) should be considered in the modern new definition of cataract.

Diagnosis and Treatment of Ocular Chronic Graft-Versus-Host Disease: Report From the German–Austrian–Swiss Consensus Conference on Clinical Practice in Chronic GVHD

Ocular chronic graft-versus-host disease (cGVHD) is one of the most frequent long-term complications after hematopoietic stem cell transplantation and is often associated with significant morbidity and reduced quality of life. The German/Austrian/Swiss Consensus Conference on Clinical Practice in cGVHD aimed to summarize the currently available evidence for diagnosis and (topical) treatment and to summarize different treatment modalities of ocular cGVHD. The presented consensus was based on a review of published evidence and a survey on the current clinical practice including transplant centers from Germany, Austria, and Switzerland. Ocular cGVHD often affects the lacrimal glands, the conjunctiva, the lids (including meibomian glands), and the cornea but can also involve other parts of the eye such as the sclera. Up to now, there have been no pathognomonic diagnostic features identified. The main therapeutic aim in the management of ocular cGVHD is the treatment of inflammation and dryness to relieve patients' symptoms and to maintain ocular integrity and function. Therapy should be chosen in the context of the patient's overall condition, systemic immunosuppressive therapy, symptoms, ocular surface integrity, and inflammatory activity. The consensus conference proposed new grading criteria and diagnostic recommendations for general monitoring of patients with graft-versus-host-disease for use in clinical practice. The evidence levels for diagnosis and treatment of ocular cGVHD are low, and most of the treatment options are based on empirical knowledge. Topical immunosuppression, for example, with cyclosporine, represents a promising strategy to reduce inflammation and dryness in ocular cGVHD. Further clinical trials are necessary to elucidate risk factors for eye manifestation, complications, and visual loss and to evaluate staging criteria and diagnostic and therapeutic measures for ocular cGVHD.