Cornea - ARVO

ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Cornearisks patients, and relatively low complications in high risk patients.Late HSV/VZV stromal inflammation can affect flap integrity.Commercial Relationships: Heidrun Gollogly, None; LeoMaguire, NoneSupport: Research to Prevent Blindness, Mayo FoundationProgram Number: 5420 Poster Board Number: A0119Presentation Time: 8:30 AM - 10:15 AMCharacterization of patients with ocular chronic graft-versushostdisease and evaluation of a new grading scaleChristiane Blecha 1 , Daniel Wolff 2 , David A. Maerker 1 , Horst Helbig 1 ,Tina Dietrich-Ntoukas 1 . 1 Ophthalmology, University HospitalRegensburg, Regensburg, Germany; 2 Hematology and Oncology,University Hospital Regensburg, Regensburg, Germany.Purpose: Ocular chronic graft-versus-host disease (cGVHD) is oneof the most frequent complications after allogeneic hematopoieticstem cell transplantation (alloHSCT). It often leads to reduced qualityof life due to severe ocular discomfort or even vision loss in severecases. Purpose of the study was to characterize patients with ocularcGVHD.Methods: All patients with ocular symptoms in the HSCT clinicwere examined ophthalmologically. Complete ocular examinationwas performed and subjective symptoms of keratoconjunctivitis sicca(KCS) assessed. Diagnosis of cGVHD was based on the NIHconsensus criteria for cGVHD. A new grading scale was applied,which was proposed by the Consensus Conference on ClinicalPractice in cGVHD (Dietrich-Ntoukas et al., 2011). Statisticalanalyses were performed using SPSS Version 20 (IBM SPSS,Armonk, NY, USA).Results: 35 patients (male n=25, female n=10, mean age 50 years)with ocular cGVHD were included. 95% of the patients suffered froma cGVHD of other organs, mostly of oral mucosa (62%) and the skin(62%). 94% of the patients showed blepharitis, 91% conjunctivalmanifestations. 71% suffered from corneal involvement (punctatekeratopathy (97%), filamentary keratitis (26%), corneal scarring(23%), corneal erosion (17%), corneal ulcer (12%)). The new gradingscale revealed inflammatory activity in all patients (mild (26%),moderate (43%) or severe (31%)). Results of the NIH scoring system:0% score 0 (no symptoms); 0% score 1 (mild symptoms of dry eye orasymptomatic signs of KCS); 43% score 2 (moderate dry eyesymptoms partially affecting activities of daily living, requiring drops> 3x per day or punctual plugs, without vision impairment); 57%score 3 (severe dry eye symptoms significantly affecting dailyactivities or loss of vision because of KCS). All 35 patients usedartificial tears, 29 used topical cyclosporine and 7 autologous serumeye drops.Conclusions: Patients with ocular cGVHD frequently have severeocular surface disease based on impaired function of the lacrimalgland but also of the conjunctiva and the lids, mostly associated withongoing inflammatory activity. The latter is currently not covered bythe NIH grading. Ophthalmological assessment of patients afteralloHSCT including lids, conjunctiva and inflammatory activity isnecessary to confirm the diagnosis, to optimize the therapy and toprevent irreversible complications.Commercial Relationships: Christiane Blecha, None; DanielWolff, None; David A. Maerker, None; Horst Helbig, None; TinaDietrich-Ntoukas, NoneProgram Number: 5421 Poster Board Number: A0120Presentation Time: 8:30 AM - 10:15 AMProliferative Gain of Function of Stromal Fibroblasts via SDF-1in Pathogenesis of PterygiaKyoung Woo Kim, Soo Hyun Park, Jae Chan Kim. Department ofOphthalmology, Chung-Ang University Hospital, Seoul, Republic ofKorea.Purpose: Biochemical signaling via Stromal cell-derived factor 1(SDF-1) and its receptor, Chemokine receptor type 4 (CXCR4) hadinitially attracted attention as a recruiter of progenitor cells to woundfor organ repair. Paradoxically, however, SDF-1/CXCR4 signaling isimplicated in proliferation and pheno-transdifferentiation offibroblasts in tumor. With viewing pterygia as exaggerated woundand mimicry of tumor, we investigate the involvement of SDF-1expression in pathogenesis of pterygia.Methods: In cultured stromal fibroblasts of pterygia (74 eyes) andnormal conjunctiva (24 eyes), the expression patterns of SDF-1 andCXCR4 were analyzed according to normal or pterygium, recurrencyand grade based on pterygial body morphology (T1-T3) orvascularity (V1-V3). To reveal the SDF-1-triggered possible phenotransdifferentiationof pterygial fibroblasts, the expression of α-SMA,which is the marker of myofibroblasts was co-analyzed paired withSDF-1. Then, the expression level of α-SMA was determined afterdownregulation of SDF-1 in fibroblasts by siRNA. The mRNAexpression was evaluated by RT-PCR, and the proteins were detectedby Western blot analysis, immunohisto- and immunocytochemistry.Results: Expression of SDF-1 was significantly higher in recurrent,T3 or V3 grade pterygia at both mRNA and protein levels. However,there was no significant difference in CXCR4 expression. Inimmunohistochemistry, SDF-1 was highly expressed at the stromallayer in recurrent or T3 pterygia, and at perivascular area especiallyin V3 pterygia. Expression of SDF-1 was positively correlated withthat of CXCR4 or α-SMA. Furthermore, the siRNA-SDF-1 reducedthe expression level of α-SMA.Conclusions: Proliferative gain of function of pterygial fibroblast viaSDF-1 expression is possibly associated with pathogenesis ofpterygia, especially in determination of recurrence, stromal fleshnessand vascularity. This suggests that SDF-1 can be an attractive newtherapeutic target to stabilize pterygia proliferation.Commercial Relationships: Kyoung Woo Kim, None; Soo HyunPark, None; Jae Chan Kim, NoneProgram Number: 5422 Poster Board Number: A0121Presentation Time: 8:30 AM - 10:15 AMBehaviour of Conjunctival Goblet Cells after allogenicHematopoietic Stem Cell TransplantationAlexandra B. Knoll 1 , Eva Jakob 1 , Karin Brandauer 1 , Bianca C.Dobner 1 , Ute Hegenbart 3 , Peter Dreger 3 , Gerd Auffarth 2 , FriederikeMackensen 1 . 1 Interdisciplinary Uveitis Center, University HospitalHeidelberg, Heidelberg, Germany; 2 Ophthalmology, UniversityHospital Heidelberg, Heidelberg, Germany; 3 Heamatology,University Hospital Heidelberg, Heidelberg, Germany.Purpose: The ocular Graft-versus-Host-Disease (oGvHD) is afrequent sequelae after hematopoietic stem cell transplantation(HSCT). We hypothesized that a decrease of goblet cells in theconjunctival epithelium can serve as predictive marker for anemerging oGvHD. To assess goblet cell density we compared themore invasive impression cytology (IC) with the less invasive in vivoconfocal microscopy (IVCM) (Figure A,B).Methods: Patients who were listed for HSCT were examined beforeand 100 days after the transplantation. The examination included aquestionnaire, slit lamp examination, Schirmer Test II, impressioncytology and confocal microscopy of the conjunctiva with theHeidelberg Retina Tomograph with the Rostock Cornea Modulattachment (HRT-RCM). At least three specimen/pictures of eachpatient were assessed for goblet cell density and means werecalculated. The Approval of the Ethical Review Board Heidelberg©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. 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